Bimanual Skills Research Articles

Fast and Fun: A Pilot Feasibility Study Using Dual Joystick-Operated Ride-on Toys for Upper Extremity Rehabilitation in Children with Hemiplegia

Aim Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP). Methods We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children’s facial expressions and affective states, indicative of their level of engagement during intervention sessions. Results We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE. Conclusions Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP.

Bimanual coordinated motor skill learning in patients with a chronic cerebellar stroke.

Cerebellar strokes induce coordination disorders that can affect activities of daily living. Evidence-based neurorehabilitation programs are founded on motor learning principles. The cerebellum is a key neural structure in motor learning. It is unknown whether and how well chronic cerebellar stroke individuals (CCSIs) can learn to coordinate their upper limbs through bimanual motor skill learning. The aim was to determine whether CCSIs could achieve bimanual skill learning through a serious game with the REAplan® robot and to compare CCSIs with healthy individuals (HIs). Over three consecutive days, sixteen CCSIs and eighteen HIs were trained on an asymmetric bimanual coordination task ("CIRCUIT" game) with the REAplan® robot, allowing quantification of speed, accuracy and coordination. The primary outcomes were the bimanual speed/accuracy trade-off (BiSAT) and bimanual coordination factor (BiCo). They were also evaluated on a bimanual REACHING task on Days 1 and 3. Correlation analyses between the robotic outcomes and clinical scale scores were computed. Throughout the sessions, BiSAT and BiCo improved during the CIRCUIT task in both HIs and CCSIs. On Day 3, HIs and CCSIs showed generalization of BiSAT, BiCo and transferred to the REACHING task. There was no significant between-group difference in progression. Four CCSIs and two HIs were categorized as "poor learners" according to BiSAT and/or BiCo. Increasing age correlated with reduced BiSAT but not BiCo progression. Over three days of training, HIs and CCSIs improved, retained, generalized and transferred a coordinated bimanual skill. There was no between-group difference, suggesting plastic compensation in CCSIs. Clinical trial NCT04642599 approved the 24th of November 2020.

Evaluating physical therapy interventions for pediatric developmental disorders: Enhancing motor skill

Objective: To evaluate the efficacy of specific physical therapy interventions, including Metaverse Physical Therapy, Nintendo Wii-integrated therapy, Whole-Body Vibration training, Segmental trunk and head control training, Ride-on car training, swimming programs, structured bimanual skill training, and running interventions in enhancing motor skills in children with pediatric developmental disorders. Methodology: A systematic review of randomized controlled trials (RCTs) and longitudinal studies published from 2013 to 2023 was conducted. Studies that compared the effects of innovative physical therapy interventions such as metaverse physical therapy, virtual reality-enhanced treatments, and Nintendo Wii-integrated therapy, and traditional physical therapies on children with developmental disorders were included. Primary outcomes assessed included improvements in motor skills, cognitive functions, and social interactions. Results: The review identified significant improvements in motor function across various interventions. Innovations like metaverse physical therapy and virtual reality-enhanced treatments showed additional benefits in engagement and motivation. While all interventions generally improved motor skills, those incorporating advanced technologies and integrative approaches also positively impacted cognitive and social development, although to varying degrees. Conclusion: Physical therapy, particularly when integrating new technologies and holistic approaches, is crucial for improving overall development in children with developmental disorders. The review highlights the need for personalized, multifaceted therapy plans that address not only physical but also cognitive and social needs to optimize outcomes.

Effect of Feedback Modality on Simulated Surgical Skills Learning Using Automated Educational Systems– A Four-Arm Randomized Control Trial

To explore optimal feedback methodologies to enhance trainee skill acquisition in simulated surgical bimanual skills learning during brain tumor resections. (1) Providing feedback results in better learning outcomes in teaching surgical technical skill when compared to practice alone with no tailored performance feedback. (2) Providing more visual and visuospatial feedback results in better learning outcomes when compared to providing numerical feedback. A prospective 4-parallel-arm randomized controlled trial. Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Canada. Medical students (n = 120) from 4 Quebec medical schools. Participants completed a virtually simulated tumor resection task 5 times while receiving 1 of 4 feedback based on their group allocation: (1) practice-alone without feedback, (2) numerical feedback, (3) visual feedback, and (4) visuospatial feedback. Outcome measures were participants' scores on 14-performance metrics and the number of expert benchmarks achieved during each task. There were no significant differences in the first task which determined baseline performance. A statistically significant interaction between feedback allocation and task repetition was found on the number of benchmarks achieved, F (10.558, 408.257)=3.220, p < 0.001. Participants in all feedback groups significantly improved their performance compared to baseline. The visual feedback group achieved significantly higher number of benchmarks than the practice-alone group by the third repetition of the task, p = 0.005, 95%CI [0.42 3.25]. Visual feedback and visuospatial feedback improved performance significantly by the second repetition of the task, p = 0.016, 95%CI [0.19 2.71] and p = 0.003, 95%CI [0.4 2.57], respectively. Simulations with autonomous visual computer assistance may be effective pedagogical tools in teaching bimanual operative skills via visual and visuospatial feedback information delivery.

Remote ischaemic conditioning combined with bimanual task training to enhance bimanual skill learning and corticospinal excitability in children with unilateral cerebral palsy: a study protocol of a single centre, phase II randomised controlled trial

IntroductionChildren with unilateral cerebral palsy (UCP) have difficulty in bimanual coordination that restricts the child’s independence in daily activities. Although several efficacious interventions to improve bimanual coordination exist, these interventions...

Task integration in complex, bimanual sequence learning tasks.

Sequence learning and multitasking studies have largely focused on simple motor skills, which cannot be directly transferred to the plethora of complex skills found outside of laboratory conditions. Established theories e.g. for bimanual tasks and task integration thus have to be reassessed in the context of complex motor skills. We hypothesize that under more complex conditions, task integration facilitates motor learning, impedes or suppresses effector-specific learning and can still be observed despite partial secondary task interference. We used the Ξ-apparatus to assess the learning success of six groups in a bimanual dual-task, in which we manipulated the degree of possible integration between the right-hand and the left-hand sequences. We could show that task integration positively influences the learning of these complex, bimanual skills. However, the integration impedes but not fully suppresses effector-specific learning, as we could measure reduced hand-specific learning. Task integration improves learning despite the disruptive effect of partial secondary task interference, but its mitigating effect is only effective to some extent. Overall, the results suggest that previous insights on sequential motor learning and task integration can largely also be applied to complex motor skills.

Prior Movement of One Arm Facilitates Motor Adaptation in the Other.

Many movements in daily life are embedded in motion sequences that involve more than one limb, demanding the motor system to monitor and control different body parts in quick succession. During such movements, systematic changes in the environment or the body might require motor adaptation of specific segments. However, previous motor adaptation research has focused primarily on motion sequences produced by a single limb, or on simultaneous movements of several limbs. For example, adaptation to opposing force fields is possible in unimanual reaching tasks when the direction of a prior or subsequent movement is predictive of force field direction. It is unclear, however, whether multilimb sequences can support motor adaptation processes in a similar way. In the present study (38 females, 38 males), we investigated whether reaches can be adapted to different force fields in a bimanual motor sequence when the information about the perturbation is associated with the prior movement direction of the other arm. In addition, we examined whether prior perceptual (visual or proprioceptive) feedback of the opposite arm contributes to force field-specific motor adaptation. Our key finding is that only active participation in the bimanual sequential task supports pronounced adaptation. This result suggests that active segments in bimanual motion sequences are linked across limbs. If there is a consistent association between movement kinematics of the linked and goal movement, the learning process of the goal movement can be facilitated. More generally, if motion sequences are repeated often, prior segments can evoke specific adjustments of subsequent movements.SIGNIFICANCE STATEMENT Movements in a limb's motion sequence can be adjusted based on linked movements. A prerequisite is that kinematics of the linked movements correctly predict which adjustments are needed. We show that use of kinematic information to improve performance is even possible when a prior linked movement is performed with a different limb. For example, a skilled juggler might have learned how to correctly adjust his catching movement of the left hand when the right hand performed a throwing action in a specific way. Linkage is possibly a key mechanism of the human motor system for learning complex bimanual skills. Our study emphasizes that learning of specific movements should not be studied in isolation but within their motor sequence context.

P.140 Development and predictive validation of an intelligent surgical bimanual skills continuous assessment system

Background: Surgeons’ bimanual dexterity may correlate with the surgical outcome. Continuous assessment of psychomotor performance enables action-oriented feedback and error avoidance guidance. We outline an artificial intelligence (AI) application to continuously assess surgical bimanual skills and its predictive validation on surgical trainee performance throughout a neurosurgery residency program. Methods: Participants (n=50, 14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 novices/medical students) performed two simulated subpial tumour resections a total of 300 times. A deep neural network was developed using expert/neurosurgeon and novice/medical student data to score bimanual performance at 0.2-second intervals between a score of 1.00 and -1.00. An average score was calculated for each task. Results: The average performance score differentiated among four expertise levels, p&lt;.001. Neurosurgeons scored significantly higher than senior residents (p=.045) and junior residents scored significantly higher than medical students (p=.04). The intelligent system also differentiated between senior and junior trainee levels (p=.004). The performance score linearly correlated with resident year of neurosurgical training (adjusted R2=27.7%). Conclusions: The AI-powered intelligent system outlined is the first expert surgeon-data-based technical skills continuous assessment system, with predictive validity throughout a neurosurgical residency program. Intelligent systems may aid in the competency-based approach in surgery by accurately assessing trainee skills.

Passive Bimanual Skills Learning From Demonstration With Motion Graph Attention Networks

Enabling household robots to passively learn task-level skills from human demonstration could substantially boost their application in daily life. In this letter, we propose a Learning from Demonstration (LfD) scheme capturing human uni/bimanual demonstrations with motion capture suit and virtual reality (VR) trackers, wherein the demonstrated skills are transferred to a humanoid with a learnable graph attention network (GAT) based model. The model trained with human hand trajectories and target object poses yield the movement policy as a trajectory generator, which outputs the Cartesian trajectories for robot end-effectors to execute the task given their poses and optionally the object’s initial pose as input. Test on synthetic data and three real robot experiments indicated that the policy could learn unimanual and coordinated bimanual, interactive and non-interactive manipulation skills with a unified scheme.

Atypical connectivity in the cortico-striatal network in NF1 children and its relationship with procedural perceptual-motor learning and motor skills

IntroductionNeurofibromatosis type 1 (NF1) is considered a model of neurodevelopmental disorder because of the high frequency of learning deficits, especially developmental coordination disorder. In neurodevelopmental disorder, Nicolson and Fawcett formulated the hypothesis of an impaired procedural learning system that has its origins in cortico-subcortical circuits. Our aim was to investigate the relationship between cortico-striatal connectivity and procedural perceptual-motor learning performance and motor skills in NF1 children.MethodsSeventeen NF1 and 18 typically developing children aged between 8 and 12 years old participated in the study. All were right-handed and did not present intellectual or attention deficits. In all children, procedural perceptual-motor learning was assessed using a bimanual visuo-spatial serial reaction time task (SRTT) and motor skills using the Movement Assessment Battery for Children (M-ABC). All participants underwent a resting-state functional MRI session. We used a seed-based approach to explore cortico-striatal connectivity in somatomotor and frontoparietal networks. A comparison between the groups’ striato-cortical connectivity and correlations between connectivity and learning (SRTT) and motor skills (M-ABC) were performed.ResultsAt the behavioral level, SRTT scores are not significantly different in NF1 children compared to controls. However, M-ABC scores are significantly impaired within 9 patients (scores below the 15th percentile). At the cerebral level, NF1 children present a higher connectivity in the cortico-striatal regions mapping onto the right angular gyrus compared to controls. We found that the higher the connectivity values between these regions, differentiating NF1 and controls, the lower the M-ABC scores in the whole sample. No correlation was found for the SRTT scores.ConclusionNF1 children present atypical hyperconnectivity in cortico-striatal connections. The relationship with motor skills could suggest a sensorimotor dysfunction already found in children with developmental coordination disorder. These abnormalities are not linked to procedural perceptual-motor learning assessed by SRTT.

O51: ARTIFICIAL INTELLIGENCE UTILIZING RECURRENT NEURAL NETWORKS TO CONTINUOUSLY MONITOR COMPOSITES OF SURGICAL EXPERTISE

Abstract Introduction Many surgical adverse events occur secondary to technical errors related to poor bimanual skills, fatigue and lack of the required expertise. We developed AI algorithms to continuously assess surgical bimanual technical performance during virtual reality simulated surgical tasks. To our knowledge, this is the first attempt in surgery to train AI algorithms to continuously monitor and evaluate bimanual skills comprehensively. Method Fifty individuals from four expertise levels (14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 medical students) performed two virtual reality simulated surgical tasks with haptic feedback: a subpial tumor resection 5 times and a complex, realistically simulated brain tumor operation once. Each task required complete tumor removal while minimizing bleeding and damage to surrounding tissues using a simulated ultrasonic aspirator and a bipolar. A recurrent neural network continually tracked individual bimanual performance utilizing 16 performance metrics generated every 0.2 seconds. Result The recurrent neural network algorithm was successfully trained using neurosurgeons and medical students' data, learning the composites of expertise comparing high and lower skill levels. The trained algorithm outlined and monitored technical skills every 0.2 second continuously organizing performance of each surgical task into three levels: ‘excellent’, ‘average’ and ‘poor’. The percentage time spent on each level was calculated and significant differences found between all four groups for ‘excellent’ and ‘poor’ levels. Conclusion AI-powered surgical simulators provide an advanced assessment and training tool. AI's ability to continuous assess bimanual technical skills during surgery may further define the composites necessary to train surgical expertise. Abbrev AI: artificial intelligence Take-home message By advanced artificial intelligence algorithms surgeon's bi-manual technical skills can be assessed continuously, time periods of poor performance which increase the possibility of errors in performance can be identified.

Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial.

Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied "as-needed." This study was approved by the local ethical committee (Comité d'éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019.

Hand Function in 8- to 12-Year-Old Children with Bilateral Cerebral Palsy and Interpretability of the Both Hands Assessment

Aim To describe bimanual performance in a sample of Australian children with bilateral cerebral palsy (CP) and, examine the qualitative meaning (or interpretability) of scores on the Both Hands Assessment (BoHA). Methods Children with bilateral CP aged 8–12 years (n = 54) classified Manual Ability Classification System (MACS) level I = 20, II = 18, III = 16 were examined using the BoHA. Results Bimanual performance was significantly different across MACS levels I-III (p < 0.001). Mean (95%CI) BoHA-unit for each MACS level were I = 85 (81–89), II = 72 (68–76) and III = 53 (49–56). Children with asymmetrical hand use (≥ 20% difference between upper limbs, n = 10) were classified MACS levels II and III and had a mean (95%CI) BoHA-unit of 56 (51–62). Children with symmetrical hand use were classified in MACS level I-III and had a mean (95%CI) BoHA-unit of 74 (70–79). Conclusions The BoHA quantified observations of bimanual performance for children with bilateral CP, differentiated between MACS levels I-III and provided clinically meaningful information. The BoHA may facilitate tailoring of upper limb intervention. Future research is recommended to examine inter-rater and intra-rater reliability and responsiveness of the BoHA, as well as longitudinal studies of bimanual hand skill development in children with bilateral CP.

Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats

Disuse of the paretic hand after stroke is encouraged by compensatory reliance on the nonparetic hand, to exacerbate impairment and potentially constrain motor rehabilitation efficacy. Rodent stroke model findings support that learning new unimanual skills with the nonparetic forelimb diminishes functional improvements that can be driven by rehabilitative training of the paretic forelimb. The influence of learning new ways of skillfully using the two hands together on paretic side function is much less clear. To begin to explore this, we developed a new cooperative bimanual skilled reaching task for rats, the Popcorn Retrieval Task. After motor cortical infarcts impaired an established unimanual reaching skill in the paretic forelimb, rats underwent a 7 week period of de novo bimanual training (BiT) or no-training control procedures (Cont). Probes of paretic forelimb unimanual performance revealed significant improvements during and after the training period in BiT vs. Cont. We additionally observed a striking change in the bimanual task strategy over training days: a switch from the paretic to the nonparetic forelimb for initiating reach-to-grasp sequences. This motivated another study to test whether rats that established the bimanual skill prior to the infarcts would similarly switch handedness, which they did not, though paretic paw use for manipulative movements diminished. These results indicate that unimanual function of the paretic side can be improved by novel bimanual skill practice, even when it involves compensatory reliance on the nonparetic hand. They further support the suitability of the Popcorn Retrieval Task for studying bimanual skill learning effects in rats.

Bimanual skills and symmetry of upper limb movement in a group of drummers

Introduction: Hand-eye coordination is essential to carry out daily activities or take part in sports. Developing strong visual-motor coordination is especially important for athletes or musicians who rely on it for their careers. Goal: This study aimed to evaluate visual-motor coordination in drummers’ upper limbs. Materials and methods: The study group consisted of 60 men, aged 20 to 30 years (average 24.62 ±2.48). The respondents were divided into two groups, group P consisted of 30 experienced drummers and group N of 30 non-drummers. Standardized tests were employed: Relative Hand Skill test (RHS test) and a plate tapping test. Results: The RHS test conducted on an original sample demonstrated no significant difference between the P and N group for the dominant limb (p=0.7272) or the non-dominant limb (p=0.3274). A significant difference was observed between the P and N group in the plate tapping test. The difference in the plate tapping test results between the dominant and non-dominant hands was significantly smaller in the P group than in the N group (p&lt; 0.0001).

Functional and Structural Plasticity Co-express in a Left Premotor Region During Early Bimanual Skill Learning.

Introduction: Motor skill learning already triggers the functional reorganization of regional brain activity after short periods of training. Recent studies suggest that microstructural change may emerge at similar timescales, but the spatiotemporal profiles of functional and structural plasticity have rarely been traced in parallel. Recently, we demonstrated that 5 days of endoscopic skill training induces changes in task-related brain activity in the ventral premotor cortex (PMv) and other areas of the frontoparietal grasping network. Here, we analyzed microstructural data, collected during the same experiment to investigate if microstructural plasticity overlaps temporally and spatially with the training-induced changes in task-related brain activity.Materials and Methods: Thirty-nine students were divided into a full-routine group (n = 20), that underwent three endoscopy training sessions in the MR-scanner as well as a 5-day virtual reality (VR)-endoscopy training and a brief-routine group (n = 19), that only performed the in-scanner endoscopy training sessions. Diffusion Tensor Imaging (DTI)-derived fractional anisotropy (FA) and resting-state functional magnetic resonance imaging (rs-fMRI) were collected at baseline, after the first and after the last VR-training session.Results: The full-routine group showed significant FA changes in a left-hemispheric subcortical cluster underlying the PMv region, for which we previously demonstrated functional plasticity during endoscopy training in the same sample. Functional (task-related fMRI) and structural (FA) changes showed the largest change from the first to the second scan, suggesting similar temporal dynamics. In the full-routine group, the FA change in the subcortical cluster underlying the left PMv scaled positively with the individual improvement in endoscopic surgery.Conclusion: Microstructural white-matter plasticity mirrors the spatiotemporal profile of task-dependent plasticity during a 5-day course of endoscopy skill training. The observed similarities motivate future research on the interplay between functional and structural plasticity during early skill acquisition.

Functional Brain Imaging Reliably Predicts Bimanual Motor Skill Performance in a Standardized Surgical Task.

Currently, there is a dearth of objective metrics for assessing bi-manual motor skills, which are critical for high-stakes professions such as surgery. Recently, functional near-infrared spectroscopy (fNIRS) has been shown to be effective at classifying motor task types, which can be potentially used for assessing motor performance level. In this work, we use fNIRS data for predicting the performance scores in a standardized bi-manual motor task used in surgical certification and propose a deep-learning framework 'Brain-NET' to extract features from the fNIRS data. Our results demonstrate that the Brain-NET is able to predict bi-manual surgical motor skills based on neuroimaging data accurately ( R2=0.73). Furthermore, the classification ability of the Brain-NET model is demonstrated based on receiver operating characteristic (ROC) curves and area under the curve (AUC) values of 0.91. Hence, these results establish that fNIRS associated with deep learning analysis is a promising method for a bedside, quick and cost-effective assessment of bi-manual skill levels.

Identifying mechanisms of change in a magic-themed hand-arm bimanual intensive therapy programme for children with unilateral spastic cerebral palsy: a qualitative study using behaviour change theory

BackgroundThere has been much research into how to promote upper-limb skills to achieve functional independence in children with unilateral spastic cerebral palsy (USCP). One researched intervention is the Breathe Magic programme, which follows the protocol of hand-arm bimanual intensive therapy (HABIT) whilst, incorporating magic tricks to develop children’s motor skills and bimanual skills. However, whilst research has found the programme to be effective, there has been little consideration of how the intervention leads to a positive outcome: what the psychological, social and physical mechanisms of action are.MethodsQualitative semi-structured interviews with 21 children with USCP who participated in the Breathe Magic HABIT intervention, and focus groups with 17 parents and/or carers were undertaken. Analysis was conducted through the lens of the COM-B behaviour change model using a combined deductive framework and inductive thematic analysis. Reliability of coding was confirmed through random extraction and double coding of a portion of responses and the calculation of inter-rater reliability.ResultsBreathe Magic brings about change and positive outcomes by increasing children’s psychological and physical capabilities, providing social opportunities, and enhancing reflective and automatic motivation. Additionally, a number of enablers to engaging in the intervention were identified, particularly under psychological capabilities, social opportunities and both reflective and automatic motivation. Very few barriers were raised; those that were raised were of relatively low frequency of reporting.ConclusionsBy conducting a theory-based qualitative process evaluation, this study demonstrated the mechanisms of change behind the Breathe Magic HABIT intervention for children with USCP. Breathe Magic was found to be a well-structured combination of intended and unintended mechanisms of change. Overall, the success of Breathe Magic was observed through not only its intended mechanisms to enhance hand skills, but also through unintended psychological improvements in children’s hand function, as well as social and motivational benefits resulting from interaction between children and parents.

Motor and spatial representations of action: corticospinal excitability in M1 after training with a bimanual skill.

The purpose of the study was twofold: (1) determine if different time delays (30min or 6h) between training and a post-training test with a rhythmic bimanual pattern (90° relative phase) would be associated with different levels of consolidation for the motor and spatial representations of the pattern; and (2) determine if training with the rhythmic bimanual pattern would lead to enhanced corticospinal excitability in M1 linked to changes in motor and spatial performance measures. Coordination accuracy and stability of the 90° pattern improved over practice. Coordination accuracy and stability were the same after a 30-min or 6-h delay between training and the post-training test, indicating equivalent levels of consolidation in the motor representation. The 6-h delay interval resulted in shorter visual recognition times compared to the 30-min delay and was centered on the trained 90° pattern. These findings indicate the consolidation of the spatial representation was more time sensitive compared to the motor representation in the current task. Motor evoked potentials (MEPs) from the first dorsal interosseous muscle (FDI) generated by single-pulse transcranial magnetic stimulation (TMS) were measured at baseline (before training) and at 6-min and 21-min intervals post-training with the 90° pattern. Increased corticospinal excitability in M1 was evidenced by larger MEPs of the FDI muscle at the 6-min interval. This increased excitability after training is a novel finding after training with a difficult and initially unstable rhythmic bimanual pattern. No significant correlations were found between the MEP data and behavioral data; thus, the increased excitability in M1 may have been linked to the difficulty in performing the pattern, consolidation processes, or both.

Synchronization between instructor and observer when learning a complex bimanual skill

While learning from an instructor by watching a ‘how-to’ video has become common practice, we know surprisingly little about the relation between brain activities in instructor and observers. In this fMRI study we investigated the temporal synchronization between instructor and observers using intersubject correlation in the naturalistic setting of learning to fold origami. Brain activity of the blindfolded instructor during action production was compared to the observers while they viewed the instructor’s video-taped actions. We demonstrate for the first time that the BOLD activity in the instructor’s and observer’s brain are synchronized while observing and learning a manual complex task with the goal of reproducing it. We can rule out that this synchrony originates from visual feedback. Observers exhibiting higher synchrony with the instructor in the ventral premotor cortex, while viewing the video for the first time, were more successful in reproducing the origami afterwards. Furthermore, changes in instructor-observer synchrony across observational learning sessions occur in cerebellar areas, as well as differences in instructor-observer synchrony between learning and the counting folds, our non-learning control. Not only known cerebellar motor production areas show synchrony, shedding new light on the involvement of the cerebellum in action observation and learning.