An Examination of Practice and Laterality Effects on the Purdue Pegboard and Moving Beans with Tweezers

The acute effects of motor imagery and cervical transcutaneous electrical stimulation on manual dexterity and neural excitability

Transcutaneous electrical stimulation (TCES) of the spinal cord induces changes in spinal excitability. Motor imagery (MI) elicits plasticity in the motor cortex. It has been suggested that plasticity occurring in both cortical and spinal circuits might underlie the improvements in performance observed when training is combined with stimulation. We investigated the acute effects of cervical TCES and MI delivered in isolation or combined on corticospinal excitability, spinal excitability and manual performance. Participants (N = 17) completed three sessions during which they engaged in 20 min of: 1) MI, listening to an audio recording instructing to complete the purdue pegboard test (PPT) of manual performance; 2) TCES at the spinal level of C5-C6; 3) MI + TCES, listening to the MI script while receiving TCES. Before and after each condition, we measured corticospinal excitability via transcranial magnetic stimulation (TMS) at 100% and 120% motor threshold (MT), spinal excitability via single-pulse TCES and manual performance with the PPT. Manual performance was not improved by MI, TCES or MI + TCES. Corticospinal excitability assessed at 100% MT intensity increased in hand and forearm muscles after MI and MI + TCES, but not after just TCES. Conversely, corticospinal excitability assessed at 120% MT intensity was not affected by any of the conditions. The effects on spinal excitability depended on the recorded muscle: it increased after all conditions in biceps brachii (BB) and flexor carpi radialis (FCR); did not change after any conditions in the abductor pollicis brevis (APB); increased after TCES and MI + TCES, but not after just MI in the extensor carpi radialis (ECR). These findings suggest that MI and TCES increase the excitability of the central nervous system through different but complementary mechanisms, inducing changes in the excitability of spinal and cortical circuits. MI and TCES can be used in combination to modulate spinal/cortical excitability, an approach particularly relevant for people with limited residual dexterity who cannot engage in motor practice.

Dual-site TMS as a tool to probe effective interactions within the motor network: a review

Dual-site transcranial magnetic stimulation (ds-TMS) is well suited to investigate the causal effect of distant brain regions on the primary motor cortex, both at rest and during motor performance and learning. However, given the broad set of stimulation parameters, clarity about which parameters are most effective for identifying particular interactions is lacking. Here, evidence describing inter- and intra-hemispheric interactions during rest and in the context of motor tasks is reviewed. Our aims are threefold: (1) provide a detailed overview of ds-TMS literature regarding inter- and intra-hemispheric connectivity; (2) describe the applicability and contributions of these interactions to motor control, and; (3) discuss the practical implications and future directions. Of the 3659 studies screened, 109 were included and discussed. Overall, there is remarkable variability in the experimental context for assessing ds-TMS interactions, as well as in the use and reporting of stimulation parameters, hindering a quantitative comparison of results across studies. Further studies examining ds-TMS interactions in a systematic manner, and in which all critical parameters are carefully reported, are needed.

Severity of Unconstrained Simultaneous Bilateral Slips: The Impact of Frontal Plane Feet Velocities Relative to the Center of Mass to Classify Slip-Related Falls and Recoveries

Targeted interventions to prevent slip-related falls may be informed by specific kinematic factors measured during the reactive response that accurately discriminate recoveries from falls. But reactive responses to diverse slipping conditions during unconstrained simultaneous bilateral slips, which are closely related to real-world slips, are currently unknown. It is challenging to identify these critical kinematic factors due to the wide variety of upper and lower body postural deviations that occur following the slip, which affect stability in both the sagittal and frontal planes. To explore the utility of kinematic measurements from each vertical plane to discriminate slip-related falls from recoveries, we compared the accuracy of four Linear Discriminant Analysis models informed by predetermined sagittal or frontal plane measurements from the lower body (feet velocities relative to the center of mass) or upper body (angular momentum of trunk and arms) during reactive responses after slip initiation. Unconstrained bilateral slips during over-ground walking were repeatedly administered using a wearable device to 10 younger (24.7 ± 3.2 years) and 10 older (72.4 ± 3.9 years) adults while whole-body kinematics were measured using motion capture. Falls (n = 20) and recoveries (n = 40) were classified by thresholding the dynamic tension forces measured in an overhead harness support system and verified through video observation. Frontal plane measurements of the peak feet velocities relative to the center of mass provided the best classification (classification accuracy = 73.3%), followed by sagittal plane measurements (classification accuracy = 68.3%). Measurements from the lower body resulted in higher accuracy models than those from the upper body, but the accuracy of all models was generally low compared to the null accuracy of 66.7% (i.e., predicting all trials as recoveries). Future work should investigate novel models that include potential interactions between kinematic factors. The performance of lower limb kinematics in the frontal plane in classifying slip-related falls demonstrates the importance of administering unconstrained slips and measuring kinematics outside the sagittal plane.

Active versus resting neuro-navigated robotic transcranial magnetic stimulation motor mapping

Transcranial magnetic stimulation (TMS) motor mapping is a safe, non-invasive method that can be used to study corticomotor organization. Motor maps are typically acquired at rest, and comparisons to maps obtained during muscle activation have been both limited and contradictory. Understanding the relationship between functional activation of the corticomotor system as recorded by motor mapping is crucial for their use clinically and in research. The present study utilized robotic TMS paired with personalized neuro-navigation to examine the relationship between resting and active motor map measures and their relationship with motor performance. Twenty healthy right-handed participants underwent resting and active robotic TMS motor mapping of the first dorsal interosseous to 10% maximum voluntary contraction. Motor map parameters including map area, volume, and measures of map centrality were compared between techniques using paired sample tests of difference and Bland-Altman plots and analysis. Map area, volume, and hotspot magnitude were larger in the active motor maps, while map center of gravity and hotspot locations remained consistent between both maps. No associations were observed between motor maps and motor performance as measured by the Purdue Pegboard Test. Our findings support previous suggestions that maps scale with muscle contraction. Differences in mapping outcomes suggest rest and active motor maps may reflect functionally different corticomotor representations. Advanced analysis methods may better characterize the underlying neurophysiology of both types of motor mapping.

Handgrip Strength Asymmetry and Weakness Together Are Associated With Functional Disability in Aging Americans

Background

Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans.

Methods

The analytic sample included 18,468 Americans aged ≥50 years from the 2006–2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS >10% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS >10% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS >10% stronger on their nondominant hand were classified as having nondominant HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses.

Results

Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95% confidence interval [CI]: 1.02–1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16–1.74) for weakness alone, and 1.81 (CI: 1.52–2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13–1.50) for nondominant HGS asymmetry alone, 1.42 (CI: 1.16–1.74) for weakness alone, 1.72 (CI: 1.29–2.29) for both weakness and nondominant HGS asymmetry, and 1.86 (CI: 1.52–2.28) for both weakness and dominant HGS asymmetry.

Conclusions

HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers.

Effects of a hot ambient operating theatre on manual dexterity, psychological and physiological parameters in staff during a simulated burn surgery

OBJECTIVES

Hot environmental conditions can result in a high core-temperature and dehydration which can impair physical and cognitive performance. This study aimed to assess the effects of a hot operating theatre on various performance, physiological and psychological parameters in staff during a simulated burn surgery.

METHODS

Due to varying activity levels, surgery staff were allocated to either an Active (n = 9) or Less-Active (n = 8) subgroup, with both subgroups performing two simulated burn surgery trials (CONTROL: ambient conditions; 23±0.2°C, 35.8±1.2% RH and HOT: 34±0°C, 28.3±1.9% RH; 150 min duration for each trial), using a crossover design with four weeks between trials. Manual dexterity, core-temperature, heart-rate, sweat-loss, thermal sensation and alertness were assessed at various time points during surgery.

RESULTS

Pre-trials, 13/17 participants were mildly-significantly dehydrated (HOT) while 12/17 participants were mildly-significantly dehydrated (CONTROL). There were no significant differences in manual dexterity scores between trials, however there was a tendency for scores to be lower/impaired during HOT (both subgroups) compared to CONTROL, at various time-points (Cohen's d = -0.74 to -0.50). Furthermore, alertness scores tended to be higher/better in HOT (Active subgroup only) for most time-points (p = 0.06) compared to CONTROL, while core-temperature and heart-rate were higher in HOT either overall (Active; p<0.05) or at numerous time points (Less-Active; p<0.05). Finally, sweat-loss and thermal sensation were greater/higher in HOT for both subgroups (p<0.05).

CONCLUSIONS

A hot operating theatre resulted in significantly higher core-temperature, heart-rate, thermal sensation and sweat-loss in staff. There was also a tendency for slight impairment in manual dexterity, while alertness improved. A longer, real-life surgery is likely to further increase physiological variables assessed here and in turn affect optimal performance/outcomes.

Handedness Matters for Motor Control But Not for Prediction

Skilled motor behavior relies on the ability to control the body and to predict the sensory consequences of this control. Although there is ample evidence that manual dexterity depends on handedness, it remains unclear whether control and prediction are similarly impacted. To address this issue, right-handed human participants performed two tasks with either the right or the left hand. In the first task, participants had to move a cursor with their hand so as to track a target that followed a quasi-random trajectory. This hand-tracking task allowed testing the ability to control the hand along an imposed trajectory. In the second task, participants had to track with their eyes a target that was self-moved through voluntary hand motion. This eye-tracking task allowed testing the ability to predict the visual consequences of hand movements. As expected, results showed that hand tracking was more accurate with the right hand than with the left hand. In contrast, eye tracking was similar in terms of spatial and temporal gaze attributes whether the target was moved by the right or the left hand. Although these results extend previous evidence for different levels of control by the two hands, they show that the ability to predict the visual consequences of self-generated actions does not depend on handedness. We propose that the greater dexterity exhibited by the dominant hand in many motor tasks stems from advantages in control, not in prediction. Finally, these findings support the notion that prediction and control are distinct processes.

When Non-Dominant Is Better than Dominant: Kinesiotape Modulates Asymmetries in Timed Performance during a Synchronization-Continuation Task

There is a growing consensus regarding the specialization of the non-dominant limb (NDL)/hemisphere system to employ proprioceptive feedback when executing motor actions. In a wide variety of rhythmic tasks the dominant limb (DL) has advantages in speed and timing consistency over the NDL. Recently, we demonstrated that the application of Kinesio^® Tex (KT) tape, an elastic therapeutic device used for treating athletic injuries, improves significantly the timing consistency of isochronous wrist’s flexion-extensions (IWFEs) of the DL. We argued that the augmented precision of IWFEs is determined by a more efficient motor control during movements due to the extra-proprioceptive effect provided by KT. In this study, we tested the effect of KT on timing precision of IWFEs performed with the DL and the NDL, and we evaluated the efficacy of KT to counteract possible timing precision difference between limbs. Young healthy subjects performed with and without KT (NKT) a synchronization-continuation task in which they first entrained IWFEs to paced auditory stimuli (synchronization phase), and subsequently continued to produce motor responses with the same temporal interval in the absence of the auditory stimulus (continuation phase). Two inter-onset intervals (IOIs) of 550-ms and 800-ms, one within and the other beyond the boundaries of the spontaneous motor tempo, were tested. Kinematics was recorded and temporal parameters were extracted and analyzed. Our results show that limb advantages in performing proficiently rhythmic movements are not side-locked but depend also on speed of movement. The application of KT significantly reduces the timing variability of IWFEs performed at 550-ms IOI. KT not only cancels the disadvantages of the NDL but also makes it even more precise than the DL without KT. The superior sensitivity of the NDL to use the extra-sensory information provided by KT is attributed to a greater competence of the NDL/hemisphere system to rely on sensory input. The findings in this study add a new piece of information to the context of motor timing literature. The performance asymmetries here demonstrated as preferred temporal environments could reflect limb differences in the choice of sensorimotor control strategies for the production of human movement.

Handedness and index finger movements performed on a small touchscreen

Many studies of right/left differences in motor performance related to handedness have employed tasks that use arm movements or combined arm and hand movements rather than movements of the fingers per se, the well-known exception being rhythmic finger tapping. We therefore explored four simple tasks performed on a small touchscreen with relatively isolated movements of the index finger. Each task revealed a different right/left performance asymmetry. In a step-tracking Target Task, left-handed subjects showed greater accuracy with the index finger of the dominant left hand than with the nondominant right hand. In a Center-Out Task, right-handed subjects produced trajectories with the nondominant left hand that had greater curvature than those produced with the dominant right hand. In a continuous Circle Tracking Task, slips of the nondominant left index finger showed higher jerk than slips of the dominant right index finger. And in a continuous Complex Tracking Task, the nondominant left index finger showed shorter time lags in tracking the relatively unpredictable target than the dominant right index finger. Our findings are broadly consistent with previous studies indicating left hemisphere specialization for dynamic control and predictable situations vs. right hemisphere specialization for impedance control and unpredictable situations, the specialized contributions of the two hemispheres being combined to different degrees in the right vs. left hands of right-handed vs. left-handed individuals.

Differential effects of facilitatory and inhibitory theta burst stimulation of the primary motor cortex on motor learning

OBJECTIVE

To evaluate the differential effects on motor learning of two types of theta burst stimulation (TBS), the excitatory intermittent TBS (iTBS) and inhibitory continuous TBS (cTBS), if TBS is applied in an early stage of learning process.

METHODS

Thirty right handed healthy people were randomly allocated into one of the three groups according to the intervention applied, iTBS, cTBS or placebo. The interventions and measurements targeted the non-dominant side. The reaction time task (RTT) and Purdue pegboard task (PPT) were used. Measurements and motor tasks were carried out at baseline (T0), immediately after the intervention (T1), and 30 min later (T2).

RESULTS

Compared to placebo, following cTBS M1 excitability went down and PPT learning was slowed. Following iTBS M1 excitability increased temporarily and PPT learning pattern changed, but learning was not improved. The MEP and PPT changes induced during the T0-T1 time interval correlated significantly.

CONCLUSIONS

The early consolidation of the learned material was much more influenced by the TBS induced promotion/suppression of the M1 functional plasticity reserves than by the absolute level of the M1 activation.

SIGNIFICANCE

The results may help to better define the use of TBS in promotion of motor learning in neurorehabilitation and cognitive enhancement.

Transcranial magnetic stimulation has no placebo effect on motor learning

OBJECTIVE

Motor learning is the core cognitive function in neurorehabilitation and in various other skill-training activities (e.g. sport, music). Therefore, there is an increasing interest in the use of transcranial magnetic stimulation (TMS) methods for its enhancement. However, although usually assumed, a potential placebo effect of TMS methods on motor learning has never been systematically investigated.

METHODS

Improvement of performance on the Purdue Pegboard Task over three test-blocks (T0, T1, and T2), separated by >20 min, was used to evaluate motor learning. In Experiment-1, two groups of 10 participants each were compared: one group immediately before T1 received a sham intermittent theta burst stimulation procedure (P-iTBS group), while another did not have any intervention at all (control - CON group). In Experiment-2, a third group of participants (six subjects) who received sham high-frequency repetitive TMS procedure before T1 (P-rTMS group) was compared with P-iTBS group.

RESULTS

All three groups showed significant learning over time, but without any difference between them, either in Experiment-1 between P-iTBS and CON, or in Experiment-2 between P-rTMS and P-iTBS.

CONCLUSION

The results suggest lack of any placebo effect of TMS on motor learning.

SIGNIFICANCE

The results may help in designing further TMS-motor learning studies and in interpreting their results.

Laterality and age-level differences between young women and elderly women in controlled force exertion (CFE)

This study aimed to examine laterality and age-level differences in maximal handgrip strength and CFE using women as subjects. The subjects were 50 young women (mean age 20.9±1.9 years) and 50 elderly women (mean age 72.9±6.6 years). The maximal handgrip strength was measured twice with a 1-min interval, and the larger value was used in this study. In the CFE test, the subjects matched their submaximal grip strengths to the demand values changing at a constant frequency (range=5-25% of the maximal grip strength). The CFE test was performed twice after one practice trial (one trial was 40s). The sum of the percent of differences between the demand value and the grip exertion value was used as an estimate of CFE. CFE was estimated using a mean from two trials, excluding the first 15s of each trial. The elderly were significantly inferior in maximal handgrip strength of the dominant and non-dominant hands to young adults (about 70%), and the non-dominant hand was significantly inferior to the dominant hand. The elderly were significantly inferior in CFE of both hands to young adults (about 50%), and the non-dominant hand was significantly inferior. In conclusion, the age-level differences in maximal handgrip strength and CFE are found in the dominant and non-dominant hands, and laterality is also found in both young adults and the elderly. The CFE relating closely to nerve function may have a larger age-level difference than maximal handgrip strength.

Specific factors that influence deciding the takeoff leg during jumping movements

The definition of the dominant leg (lateral dominance) is not clear, and there has been little reporting related to lateral dominance in the legs. To uncover the practical factors influencing which leg to use as the takeoff leg in 1-legged jumping movements, this study aimed to investigate the subjective dominance side of fundamental movements and to examine the lateral dominance of motor functions between the takeoff leg and non-takeoff leg. The subjects consisted of 27 young men who exercised regularly. They had not trained particularly on unilateral jumping. Fifteen men are the athlete group (left-legged jumpers group [LG]) using a left leg and 12 men are the athlete group (right-legged jumpers group [RG]) using a right leg as determined by a preliminary survey related to takeoff leg during high jump. The fundamental motions of the subjective dominant leg were investigated and the differences between the motor functions of takeoff and lead legs, such as sole shapes, single-leg vertical jump, 20-m hopping, ladder hopping, single-leg balance, and isokinetic strength were examined. It was found that many RG subjects (83%) tended to select the right leg for hopping, and many LG subjects (87%) tended to select the left leg for 1-legged balance. It was suggested that skilled movements show right-leg dominance in both takeoff leg groups. In the LG subjects, the left leg showed a higher value than the right leg in sole shape. The RG subjects showed a higher value in the right leg than in the left leg in a single-leg vertical jump. However, marked dominance was not found in the takeoff leg. The lower limbs may not show marked lateral dominance such as in the upper limbs.

Effects of prior use of chopsticks on two different types of dexterity tests: Moving Beans Test and Purdue Pegboard

The Purdue Pegboard and Moving Beans with Tweezers test have been used in the rehabilitation of persons with nervous system disorders; however, these two tests differ in their methodology. In the latter test, the testee picks up items with chopsticks or tweezers, but in the former test, the testee grasps items directly with the fingers of one hand. Use experience of a tool may strongly influence performance. The present study examined the use of chopsticks in daily life on performance of the two tests of finger dexterity by two groups of 20 youths who habitually used chopsticks to eat and 20 who did not. Three 30-sec. trials with the dominant and nondominant hands were given. Analysis of variance gave a main effect for number of beans moved between the two groups, hand (nondominant vs dominant), and trials. Significantly more beans were moved by the group with prior chopsticks use than the nonusers by the dominant hand than the nondominant hand, and on Trials 2 and 3 than Trial 1. For the Purdue Pegboard, the only significant difference for trials showed fewer pegs moved on Trial 1 than Trial 3. In conclusion, the groups who habitually used chopsticks performed better on the Moving Beans with Tweezers test than the group without such experience. Also, the marked laterality and practice effects for chopstick users was not observed on the Purdue Pegboard.