Damage to the parietal lobe impairs bimanual coordination

A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study

The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20-30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP.

Neurological and Functional Outcomes after Pediatric Stroke

Pediatric stroke results in life-long morbidity for many patients, but the outcomes can vary depending on factors such as age of injury, or mechanism, size, and location of stroke. In this review, we summarize the current understanding of outcomes in different neurological domains (eg, motor, cognitive, language) for children with stroke of different mechanisms (ie, arterial ischemic stroke, cerebral sinus venous thrombosis, and hemorrhagic stroke), but with a focus on World Health Organization International Classification for Functioning, Disability, and Health (ICF-CY) framework for measuring health and disability for children and youth. We describe outcomes for the population as a whole and certain factors that may further refine prognostication.

Non-human primate epidural ECoG analysis using explainable deep learning technology

Objective.With the development in the field of neural networks,explainable AI(XAI), is being studied to ensure that artificial intelligence models can be explained. There are some attempts to apply neural networks to neuroscientific studies to explain neurophysiological information with high machine learning performances. However, most of those studies have simply visualized features extracted from XAI and seem to lack an active neuroscientific interpretation of those features. In this study, we have tried to actively explain the high-dimensional learning features contained in the neurophysiological information extracted from XAI, compared with the previously reported neuroscientific results.Approach. We designed a deep neural network classifier using 3D information (3D DNN) and a 3D class activation map (3D CAM) to visualize high-dimensional classification features. We used those tools to classify monkey electrocorticogram (ECoG) data obtained from the unimanual and bimanual movement experiment.Main results. The 3D DNN showed better classification accuracy than other machine learning techniques, such as 2D DNN. Unexpectedly, the activation weight in the 3D CAM analysis was high in the ipsilateral motor and somatosensory cortex regions, whereas the gamma-band power was activated in the contralateral areas during unimanual movement, which suggests that the brain signal acquired from the motor cortex contains information about both contralateral movement and ipsilateral movement. Moreover, the hand-movement classification system used critical temporal information at movement onset and offset when classifying bimanual movements.Significance.As far as we know, this is the first study to use high-dimensional neurophysiological information (spatial, spectral, and temporal) with the deep learning method, reconstruct those features, and explain how the neural network works. We expect that our methods can be widely applied and used in neuroscience and electrophysiology research from the point of view of the explainability of XAI as well as its performance.

Single Units in the Posterior Parietal Cortex Encode Patterns of Bimanual Coordination

Bimanual coordination is critical for a broad array of behaviors. Drummers, for example, must carefully coordinate movements of their 2 arms, sometimes beating on the same drum and sometimes on different ones. While coordinated behavior is well-studied, the early stages of planning are not well understood. In the parietal reach region (PRR) of the posterior parietal cortex (PPC), the presence of neurons that modulate when either arm moves by itself has been taken as evidence for a role in bimanual coordination. To test this notion, we recorded neurons during both unilateral and bimanual movements. We find that the activity that precedes an ipsilateral arm movement is primarily a sensory response to a target in the neuron's visual receptive field and not a plan to move the ipsilateral arm. In contrast, the activity that precedes a contralateral arm movement is the sum of a movement plan plus a sensory response. Despite not coding ipsilateral arm movements, about half of neurons discriminate between different patterns of bimanual movements. These results provide direct evidence that PRR neurons represent bimanual reach plans, and suggest that bimanual coordination originates in the sensory-to-motor processing stream prior to the motor cortex, within the PPC.

Spatial eye-hand coordination during bimanual reaching is not systematically coded in either LIP or PRR

When we reach for something, we also look at it. If we reach for two objects at once, one with each hand, we look first at one and then the other. It is not known which brain areas underlie this coordination. We studied two parietal areas known to be involved in eye and arm movements. Neither area was sensitive to the order in which the targets were looked at. This implies that coordinated saccades are driven by downstream areas and not by the parietal cortex as is commonly assumed.

We often orient to where we are about to reach. Spatial and temporal correlations in eye and arm movements may depend on the posterior parietal cortex (PPC). Spatial representations of saccade and reach goals preferentially activate cells in the lateral intraparietal area (LIP) and the parietal reach region (PRR), respectively. With unimanual reaches, eye and arm movement patterns are highly stereotyped. This makes it difficult to study the neural circuits involved in coordination. Here, we employ bimanual reaching to two different targets. Animals naturally make a saccade first to one target and then the other, resulting in different patterns of limb–gaze coordination on different trials. Remarkably, neither LIP nor PRR cells code which target the eyes will move to first. These results suggest that the parietal cortex plays at best only a permissive role in some aspects of eye–hand coordination and makes the role of LIP in saccade generation unclear.

Motor extinction: a deficit of attention or intention?

Motor extinction refers to a deficit of motor production on the side opposite a brain lesion that either only becomes apparent or disproportionately worsens during bilateral motor activity. It may arise due either to a contralesional deficit in setting the motor activation level (an intentional deficit) or a deficit in contralesional awareness of the sensory consequences of movement (an attentional deficit). In this study, we investigate the nature of motor extinction in a patient (LR) with a right fronto-temporal lesion through the kinematic analysis of unimanual and bimanual circle-drawing movements. While the ipsi- and contralesional limbs performed comparably for unimanual movements, the contralesional limb demonstrated marked bradykinesia and hypometria during bimanual movements. Furthermore, these deficits were not overcome when visual feedback of the contralesional limb was provided (Experiment 1). However, when performing bimanual movements in the presence of a visual template (Experiment 2), LR was able to overcome the contralesional hypometria but not the bradykinesia which proved intractable across both experiments. Both the bradykinesia and hypometria could result from an intentional deficit of motor production. However, in Experiment 2, LR also demonstrated an abnormal level of positional drift in the contralesional limb for bimanual movements indicative of an additional attentional deficit. We conclude that LR’s presentation of motor extinction is the result of a primary intentional deficit and a secondary attentional deficit.

Matching accuracy in hemiparetic cerebral palsy during unimanual and bimanual movements with (mirror) visual feedback

In the present study participants with Spastic Hemiparetic Cerebral Palsy (SHCP) were asked to match the position of a target either with the impaired arm only (unimanual condition) or with both arms at the same time (bimanual condition). The target was placed at 4 different locations scaled to the individual maximum reaching distance. To test the effect of mirror visual feedback of the less-impaired arm on the matching accuracy, an opaque screen or a mirror was placed in between the arms which masked vision of the impaired arm. Absolute endpoint error was smaller in the bimanual condition compared to the unimanual condition, but there was no effect of mirror visual feedback. Inspection of the individual data, however, showed that 13 out of 23 participants did experience a positive effect of mirror visual feedback. A positive correlation between the baseline error (screen) and the improvement in accuracy with mirror visual feedback seems to suggest that individuals with lower proprioceptive accuracy in the baseline condition may benefit more from mirror visual feedback. Together these findings indicate that bimanual therapy and therapy with mirror visual feedback might be valuable approaches for rehabilitation for a subset of the individuals with SHCP.

Shared neural resources between left and right interlimb coordination skills: the neural substrate of abstract motor representations

Functional magnetic resonance imaging was used to reveal the shared neural resources between movements performed with effectors of the left versus right body side. Prior to scanning, subjects extensively practiced a complex coordination pattern involving cyclical motions of the ipsilateral hand and foot according to a 90 degrees out-of-phase coordination mode. Brain activity associated with this (nonpreferred) coordination pattern was contrasted with pre-existing isodirectional (preferred) coordination to extract the learning-related brain networks. To identify the principal candidates for effector-independent movement encoding, the conjunction of training-related activity for left and right limb coordination was determined. A dominantly left-lateralized parietal-to-(pre)motor activation network was identified, with activation in inferior and superior parietal cortex extending into intraparietal sulcus and activation in the premotor areas, including inferior frontal gyrus (pars opercularis). Similar areas were previously identified during observation of complex coordination skills by expert performers. These parietal-premotor areas are principal candidates for abstract (effector-independent) movement encoding, promoting motor equivalence, and they form the highest level in the action representation hierarchy.

The relationship between visual orienting and interlimb synchrony in a patient with a superior parietal infarction: a case study

Much work indicates that parietal cortex mediates the transformation of visual information into the motor commands necessary for successful performance of many unimanual tasks. Accumulating evidence suggests that parietal cortex also mediates the coordination of bimanual movements, during which the natural tendency is to couple the limbs temporally. However, the extent to which parietal oculomotor and/or visual processes contribute to temporal coupling of the limbs during bimanual task performance is unknown. In the current study, we monitored the eye movements of a patient with a left parietal infarction as she performed a series of bimanual visuomotor tasks. We demonstrate the impact of an ipsilesional (leftward) orientation bias on her ability to synchronize the onset of bimanual limb movements; the movements were performed in serial fashion, i.e., left limb before right, when the patient was permitted to freely shift saccades and the visual target cuing the left (ipsilesional) limb movement was presented at greater (leftward) eccentricities. Disruption of interlimb synchrony as such was not, however, evident when the patient was required to fixate or when visual targets were presented at lesser ipsilesional eccentricities. Additionally, despite the disruptive influence of oculomotor and visual factors on interlimb synchrony, the patient appeared capable of using visual feedback to straighten the right (contralesional) limb trajectory, thus improving the spatial component of task performance. Results suggest that parietal cortex plays an important role in the coordination of limb movements during performance of bimanual visuomotor tasks. This role appears to involve orienting gaze or attention to the goals of each limb so that the nervous system can synchronize the activity of both limbs and thereby ensure successful task completion.

Network activation during bimanual movements in humans

The coordination of movement between the upper limbs is a function highly distributed across the animal kingdom. How the central nervous system generates such bilateral, synchronous movements, and how this differs from the generation of unilateral movements, remain uncertain. Electrophysiologic and functional imaging studies support that the activity of many brain regions during bimanual and unimanual movement is quite similar. Thus, the same brain regions (and indeed the same neurons) respond similarly during unimanual and bimanual movements as measured by electrophysiological responses. How then are different motor behaviors generated? To address this question, we studied unimanual and bimanual movements using fMRI and constructed networks of activation using Structural Equation Modeling (SEM). Our results suggest that (1) the dominant hemisphere appears to initiate activity responsible for bimanual movement; (2) activation during bimanual movement does not reflect the sum of right and left unimanual activation; (3) production of unimanual movement involves a network that is distinct from, and not a mirror of, the network for contralateral unimanual movement; and (4) using SEM, it is possible to obtain robust group networks representative of a population and to identify individual networks which can be used to detect subtle differences both between subjects as well as within a single subject over time. In summary, these results highlight a differential role for the dominant and non-dominant hemispheres during bimanual movements, further elaborating the concept of handedness and dominance. This knowledge increases our understanding of cortical motor physiology in health and after neurological damage.

Bimanual passive movement: functional activation and inter-regional coupling

The aim of this study was to investigate intra-regional activation and inter-regional connectivity during passive movement. During fMRI, a mechanic device was used to move the subject's index and middle fingers. We assessed four movement conditions (unimanual left/right, bimanual symmetric/asymmetric), plus Rest. A conventional intra-regional analysis identified the passive stimulation network, including motor cortex, primary and secondary somatosensory cortex, plus the cerebellum. The posterior (sensory) part of the sensory-motor activation around the central sulcus showed a significant modulation according to the symmetry of the bimanual movement, with greater activation for asymmetric compared to symmetric movements. A second set of fMRI analyses assessed condition-dependent changes of coupling between sensory-motor regions around the superior central sulcus and the rest of the brain. These analyses showed a high inter-regional covariation within the entire network activated by passive movement. However, the specific experimental conditions modulated these patterns of connectivity. Highest coupling was observed during the Rest condition, and the coupling between homologous sensory-motor regions around the left and right central sulcus was higher in bimanual than unimanual conditions. These findings demonstrate that passive movement can affect the connectivity within the sensory-motor network. We conclude that implicit detection of asymmetry during bimanual movement relies on associative somatosensory region in post-central areas, and that passive stimulation reduces the functional connectivity within the passive movement network. Our findings open the possibility to combine passive movement and inter-regional connectivity as a tool to investigate the functionality of the sensory-motor system in patients with very poor mobility.

Disruption of reciprocal coordination by a medial frontal stroke sparing the corpus callosum

Aleksandr Luria described several tests of higher motor function, including the "reciprocal coordination" test of bimanual coordination. Although these tests are commonly used to assess frontal lobe function, their specific neuroanatomic underpinnings are not completely understood. We describe a man with a medial frontal stroke sparing the corpus callosum with a defect in Luria's reciprocal coordination test but otherwise intact motor abilities, including other tests of higher motor function.

Brain activity associated with dual-task management differs depending on the combinations of response modalities

Several functional imaging studies have demonstrated the importance of fronto-parietal network in dual-task management. However, neural correlates underlying the difference in intensity of dual-task interference between the same and different response modalities remain unknown. Therefore, we investigated the relationship between brain activity associated with dual-task management and the combinations of response modalities. We used the dual-task requiring bilateral finger responses (DT-same condition) and that requiring finger and oral responses (DT-different condition) to visual and auditory stimuli. The right premotor cortex, precuneus and right posterior parietal cortex were significantly activated in the DT-same condition. The neural activities in the right premotor cortex significantly correlated to the delayed responses in the DT-same condition relative to the single-task conditions, indicating that the right premotor cortex is partly associated with dual-task management (i.e., the regulation of information flow). In addition, neural activity in this brain region was significantly higher in the DT-same condition than in the DT-different condition, suggesting that the difference in intensity between the same and different response modalities is partly associated with difference in the load on the premotor cortex between the DT-same and DT-different conditions. The significant activation of the parietal cortex also differed between the DT-same and DT-different conditions. These results demonstrate that brain activity associated with dual-task management differs depending on the combination of response modalities and that such a difference in brain activity, particularly in the right premotor cortex, might be partly associated with the difference in intensity of dual-task interference between the DT-same and DT-different conditions.

The missing link between action and cognition

The study of the neural correlates of motor behaviour at the systems level has received increasing consideration in recent years. One emerging observation from this research is that neural regions typically associated with cognitive operations may also be recruited during the performance of motor tasks. This apparent convergence between action and cognition - domains that have most often been studied in isolation - becomes especially apparent when examining new complex motor skills such as those involving sequencing or coordination, and when taking into account external (environment-related) factors such as feedback availability and internal (performer-related) factors such as pathology. Neurally, overlap between action and cognition is prominent in frontal lobe areas linked to response selection and monitoring. Complex motor tasks are particularly suited to reveal the crucial link between action and cognition and the generic brain areas at the interface between these domains.

Zones of bimanual and unimanual preference within human primary sensorimotor cortex during object manipulation

We asked which brain areas are engaged in the coordination of our hands in dexterous object manipulations where they cooperate for achieving a common goal. Well-trained right-handers steered a cursor on a screen to hit successively displayed targets by applying isometric forces and torques to a rigid tool. In two bimanual conditions, the object was held freely in the air and the hands thus generated coupled opposing forces. Yet, depending on the mapping rule linking hand forces and cursor movements, all subjects selected either the left or the right hand as prime actor. In two unimanual conditions, the subjects performed the same task with either the left or the right hand operating on a fixed tool. Functional magnetic resonance imaging revealed common activation across all four conditions in a dorsal fronto-parietal network biased to the left hemisphere and in bilateral occipitotemporal cortex. Contrary to the notion that medial wall premotor areas are especially active in complex bimanual actions, their activation depended on acting hand (left, right) rather than on grip type (bimanual, unimanual). We observed effects of grip type only in the primary sensorimotor cortex (SMC). In particular, with either hand as prime actor, bimanual actions preferentially activated subregions of the SMC contralateral to the acting hand. A sizeable subregion with preference for unimanual activity was found only in the left SMC in our right-handed subjects. Collectively, these results indicate a hemispheric asymmetry for the SMC and that partially different neural populations support the control of bimanual versus unimanual object manipulations.

Cortical areas functionally linked with the cerebellar second homunculus during out-of-phase bimanual movements

We used functional magnetic resonance imagery (fMRI) to study cortical activation during index finger-thumb opposition of both hands using in-phase and out-of-phase modes. In-phase movements activated the sensorimotor cortex. During out-of-phase movements, activations were also observed in the supplementary motor area (SMA), in the cingulate motor area (CMA) and, less frequently, in the anterior cingulate cortex (ACC). As we have previously shown and confirmed in the present study, the same out-of-phase bimanual movements specifically activate the cerebellar second homunculus, leading us to postulate that the cerebellar second homunculus and medial wall motor areas participate in a circuit specifically involved in timing complex movements.

Transtorno do déficit de atenção e hiperatividade (TDAH): aspectos relacionados à comorbidade com distúrbios da atividade motora

A presente revisão aborda aspectos fisiopatológicos e clínicos referentes ao Transtorno do Déficit de Atenção com Hiperatividade (TDAH), em especial aqueles que concernem à associação desse transtorno com o Distúrbio do Desenvolvimento da Coordenação (DDC). Utilizou-se a base de dados Medline para levantamento de artigos indexados a partir de 1965 até 2004. Aos artigos selecionados dessa forma, outros foram obtidos pela relevância atribuída a eles nas fontes iniciais. A pré-disposição hereditária desse transtorno é indiscutível, bem como a presença da disfunção nora-drenégica e dopaminérgica no córtex pré-frontal e suas conexões. Apesar desse conhecimento, o diagnóstico da condição se baseia em dados clínicos. As associações mórbidas ocorrem em cerca de metade dos indivíduos, sendo as principais comorbidades de natureza psiquiátrica. A presença de uma comorbidade pode modificar a terapêutica e o prognóstico. O Distúrbio do Desenvolvimento da Coordenação, condição também de diagnostico clínico, confere pior prognóstico às crianças que partilham ambos os quadros. Recomenda-se que uma busca ativa de condições associadas seja realizada em cada criança diagnosticada como portadora de TDAH.

Neural correlates of the spontaneous phase transition during bimanual coordination

Repetitive bimanual finger-tapping movements tend toward mirror symmetry: There is a spontaneous transition from less stable asymmetrical movement patterns to more stable symmetrical ones under frequency stress but not vice versa. During this phase transition, the interaction between the signals controlling each hand (cross talk) is expected to be prominent. To depict the regions of the brain in which cortical cross talk occurs during bimanual coordination, we conducted event-related functional magnetic resonance imaging using a bimanual repetitive-tapping task. Transition-related activity was found in the following areas: the bilateral ventral premotor cortex, inferior frontal gyrus, middle frontal gyrus, inferior parietal lobule, insula, and thalamus; the right rostral portion of the dorsal premotor cortex and midbrain; the left cerebellum; and the presupplementary motor area, rostral cingulate zone, and corpus callosum. These regions were discrete from those activated by bimanual movement execution. The phase-transition-related activation was right lateralized in the prefrontal, premotor, and parietal regions. These findings suggest that the cortical neural cross talk occurs in the distributed networks upstream of the primary motor cortex through asymmetric interhemispheric interaction.

Anarchic hand syndrome: Bimanual coordination and sensitivity to irrelevant information in unimanual reaches

Anarchic hand syndrome is characterised by unintended but purposeful and autonomous movements of the upper limb and intermanual conflict. Based on predictions of internal models of movement generation, we examined the role of visual cues in unimanual and bimanual movements in a patient with anarchic hand syndrome and in a matched control. In Experiment 1, participants made unimanual movements in a sequential button-pressing task. The cue for the next target in a sequence appeared either prior to (exogenous) or after (endogenous) the initiation of movement. For the patient, performance of the anarchic left hand was selectively impaired in the endogenous condition. In Experiment 2, participants made unimanual movements on a digitising tablet to a target, which appeared either alone or with a distractor. While the presence of a distractor was associated with increased Initiation time in general, the patient's anarchic left hand was particularly vulnerable to disruption by the distractor. The findings of Experiments 1 and 2 indicate excessive reliance on salient environmental stimuli for movement production in anarchic hand syndrome. We conclude that in AHS goal-directed actions of the affected limb are particularly vulnerable to disruption by non-relevant information. Finally, in Experiment 3, participants performed unimanual and mirror-image bimanual movements on a digitising tablet to targets in the left or right hemispace. Coupling of the parameters of the two hands was evident such that, compared with a unimanual baseline, Initiation time of the intact right hand deteriorated while it improved for the anarchic left hand.

Don’t think twice, it's all right—contralesional dependency for bimanual prehension movements

In bimanual coordination when moving the hands to two separate objects, subjects tend to initiate and terminate the movements together, even when the targets are at different distances or are of a different size. Additionally, each hand tends to scale its grasp independently to the object to be grasped. Here, we report the performance of a patient, who had previously shown signs of motor neglect, on two experiments investigating coupling and independence in bimanual coordination. The patient showed relatively normal bimanual behaviour for the transport phase of prehension when objects were placed at different distances (Experiment 1), but abnormal behaviour for the grasp component when objects were of different sizes (Experiment 2). Moreover, the contralesional limb demonstrated a dependency of grasp that was related to the object grasped by the ipsilesional limb. We discuss the possible underlying mechanisms of this dependency in relation to competitive motor programming and attentional bias. The results also reinforce the view that the transport and grasp components of prehension are distinct processes.

Parieto-premotor Areas Mediate Directional Interference During Bimanual Movements

In bimanual movements, interference emerges when limbs are moved simultaneously along incompatible directions. The neural substrate and mechanisms underlying this phenomenon are largely unknown. We used functional magnetic resonance imaging to compare brain activation during directional incompatible versus compatible bimanual movements. Our main results were that directional interference emerges primarily within superior parietal, intraparietal and dorsal premotor areas of the right hemisphere. The same areas were also activated when the unimanual subtasks were executed in isolation. In light of previous findings in monkeys and humans, we conclude that directional interference activates a parieto-premotor circuit that is involved in the control of goal-directed movements under somatosensory guidance. Moreover, our data suggest that the parietal cortex might represent an important locus for integrating spatial aspects of the limbs' movements into a common action. It is hypothesized to be the candidate structure from where interference arises when directionally incompatible movements are performed. We discuss the possibility that interference emerges when computational resources in these parietal areas are insufficient to code two incompatible movement directions independently from each other.

Cerebellar and premotor function in bimanual coordination: parametric neural responses to spatiotemporal complexity and cycling frequency

In the present functional magnetic resonance imaging (fMRI) study, we assessed the neural network governing bimanual coordination during manipulations of spatiotemporal complexity and cycling frequency. A parametric analysis was applied to determine the effects of each of both factors as well as their interaction. Subjects performed four different cyclical movement tasks of increasing spatiotemporal complexity (i.e., unimanual left-right hand movements, bimanual in-phase movements, bimanual anti-phase movements, and bimanual 90 degrees out-of-phase movements) across four frequency levels (0.9, 1.2, 1.5, and 1.8 Hz). Results showed that, within the network involved in bimanual coordination, functional subcircuits could be distinguished: Activation in the supplementary motor area, superior parietal cortex (SPS), and thalamic VPL Nc was mainly correlated with increasing spatiotemporal complexity of the limb movements, suggesting that these areas are involved in higher-order movement control. By contrast, activation within the primary motor cortex, cingulate motor cortex (CMC), globus pallidus, and thalamic VLo Nc correlated mainly with movement frequency, indicating that these areas play an important role during movement execution. Interestingly, the cerebellum and the dorsal premotor cortex were identified as the principal regions responding to manipulation of both parameters and exhibiting clear interaction effects. Therefore, it is concluded that both areas represent critical sites for the control of bimanual coordination.

Bimanual coordination and interhemispheric interaction

Bimanual coordination of skilled finger movements requires intense functional coupling of the motor areas of both cerebral hemispheres. This coupling can be measured non-invasively in humans with task-related coherence analysis of multi-channel surface electroencephalography. Since bimanual coordination is a high-level capability that virtually always requires training, this review is focused on changes of interhemispheric coupling associated with different stages of bimanual learning. Evidence is provided that the interaction between hemispheres is of particular importance in the early phase of command integration during acquisition of a novel bimanual task. It is proposed that the dynamic changes in interhemispheric interaction reflect the establishment of efficient bimanual 'motor routines'. The effects of callosal damage on bimanual coordination and learning are reviewed as well as functional imaging studies related to bimanual movement. There is evidence for an extended cortical network involved in bimanual motor activities which comprises the bilateral primary sensorimotor cortex (SM1), supplementary motor area, cingulate motor area, dorsal premotor cortex and posterior parietal cortex. Current concepts about the functions of these structures in bimanual motor behavior are reviewed.

Intermanual coordination: from behavioural principles to neural-network interactions

Locomotion in vertebrates and invertebrates has a long history in research as the most prominent example of interlimb coordination. However, the evolution towards upright stance and gait has paved the way for a bewildering variety of functions in which the upper limbs interact with each other in a context-specific manner. The neural basis of these bimanual interactions has been investigated in recent years on different scales, ranging from the single-cell level to the analysis of neuronal assemblies. Although the prevailing viewpoint has been to assign bimanual coordination to a single brain locus, more recent evidence points to a distributed network that governs the processes of neural synchronization and desynchronization that underlie the rich variety of coordinated functions. The distributed nature of this network accounts for disruptions of interlimb coordination across various movement disorders.

Callosotomy patients exhibit temporal uncoupling during continuous bimanual movements

Rhythmic bimanual movements are highly constrained in the temporal domain, with the gestures of the two hands tightly synchronized. Previous studies have implicated a subcortical locus for temporal coupling based on the observation that these constraints persist in callosotomy patients. We now report that such coupling is restricted to movements entailing a discrete event (such as a movement onset). Three callosotomy patients exhibited a striking lack of temporal coupling during continuous movements, with the two hands oscillating at non-identical frequencies. We propose a subcortical locus of temporal coupling for movements involving discrete events. In contrast, synchronization between the hands during continuous movements depends on interhemispheric transmission across the corpus callosum.

Role of the corpus callosum in bimanual coordination: a comparison of patients with congenital and acquired callosal damage

The objective of the study was to investigate temporal control in patients with congenital as compared to acquired pathology of the corpus callosum during two different bimanual paradigms: (i) a drawer-opening task during which one hand opened a drawer while the other hand reached and grasped a small object, and (ii) rhythmical circling movements that were executed according to the in-phase or antiphase mode. Synchronization values revealed that patients with acquired callosal dysfunction generally showed optimal behaviour during the goal-directed and familiar drawer-opening task but demonstrated strong tendencies towards desynchronization during circling movements, which became most apparent for antiphase coordination. Whereas one patient with callosal agenesis showed a similar performance, the other acallosal patients performed both activities successfully. These observations indicate that patients with congenital absence of the corpus callosum can make use of compensatory mechanisms for allowing temporal synchronization during bimanual movements whereas patients with acquired callosal dysfunction are severely hampered when the task places significant demands on the control processes. The data also underline that the ability of callosal patients to precisely time events in coordinated actions depend on the task constraints.