Bimanual Task Research Articles

Hand preference for unimanual and bimanual tasks: Evidence from questionnaires and preferential reaching

ABSTRACT The current research compared hand selection in a preferential reaching paradigm with unimanual (i.e., pick-up cup) and bimanual (pick-up cup and pour from pitcher) tasks. In addition, relationships between self-report, questionnaire-based hand preference (unimanual and bimanual) and patterns of hand selection were assessed. Data offer support for a division of labour between the hands in at the midline; however, bimanual selection otherwise reflects consideration of object proximity (i.e., location) and comfort (i.e., biomechanical constraints). When grasping cups in right space, the right-hand was used to stabilize the cup and left-hand to mobilize the pitcher, whereas the opposite pattern was observed in left-space. Unimanual hand selection was also driven by object location. Subsequent analyses revealed a relationship between unimanual measures, but not bimanual measures of hand preference. Overall, findings support the notion that questionnaire data are associated with hand preference for grasping to a certain extent; however, use of a comprehensive battery of assessments is recommended when assessing and/or predicting handedness.

Identification of motor patterns during bimanual tasks in children with unilateral cerebral palsy

We developed and validated an electronically administered patient-specific visual analogue survey (PVS) to evaluate changes in hand function after treatment with injectable collagenase clostridium histolyticum (CCH) in Dupuytren's contracture. The items in the PVS were authored and ranked in importance by the patients.In an open-label trial for patients with Dupuytren's contracture receiving CCH injection, 109 patients completed the PVS on the day of injection, day of manipulation and 30-day follow-up. For external validation, patients also completed standard patient-reported outcome measures, the Overall Treatment Effects Scale and QuickDASH, and underwent physician assessment of contracture via goniometry and the table top test.Responses were highly individualised with no single activity being chosen as important by more than 8% of patients. Sports-related activities were mentioned most often (23%). The PVS was highly responsive to changes in patients' conditions with CCH injection (effect size=1.49), much more so than the QuickDASH (effect size=0.50). Additionally, the PVS had no floor or ceiling effects, whereas the QuickDASH ceiling approached 20% post-injection. The PVS had excellent internal consistency (Cronbach's α=0.95) and correlated strongly with the QuickDASH post-injection (Spearman's=−0.67). PVS scores were significantly higher for patients reporting their condition had improved versus those reporting no change after injection. The test–retest reliability of the PVS was poor to fair, in part due to allowing patients to choose different activities at test and retest. However, test–retest reliability was good (intraclass correlation coefficient >0.7) and better than QuickDASH among patients who rated the same activities at test and retest.The PVS is simple to administer and enables individualised assessment in a large number of patients. It is also readily adaptable for use in other diseases, particularly within musculoskeletal medicine.Therapeutic II: Prospective cohort.

Training 90° bimanual coordination at high frequency yields dependence on kinesthetic information and poor performance of dyadic unimanual coordination.

Two groups of participants were trained to be proficient at performing bimanual 90° coordination either at a high (2.5Hz) or low (0.5Hz) frequency with both kinesthetic and visual information available. At high frequency, participants trained for twice as long to achieve performance comparable to participants training at low frequency. Participants were then paired within (low-low or high-high) or between (low-high) frequency groups to perform a visually coupled dyadic unimanual 90° coordination task, during which they were free to settle at any jointly determined frequency to synchronize their rhythmic movements. The results showed that the coordination skill was frequency-specific. For dyads with one or both members who had learned the 90° bimanual coordination at low frequency, the performance settled at a low frequency (≈0.5Hz) with more successfully synchronized trials. For dyads with both members who had learned the 90° bimanual coordination at high frequency, they struggled with the task and performed poorly. The dyadic coordination settled at a higher frequency (≈1.5Hz) on average, but with twice the variability in settling frequency and significantly fewer synchronized trials. The difference between the dyadic coordination and bimanual tasks was that only visual information was available to couple the movements in the former while both kinesthetic and visual information were available in the latter. Therefore, the high frequency group must have relied on kinesthetic information to perform both coordination tasks while the low frequency group was well able to use visual information for both. In the mixed training pairs, the low frequency trained member of the pair was likely responsible for the better performance. These conclusions were consistent with results of previous studies.

Effect of dual tasking on a dynamic balance task in children with and without DCD.

The purpose of this study was to compare performance of children with Developmental Coordination Disorder (DCD) and typically developing (TD) children in a dual task paradigm with a dynamic balance task on the Wii Fit as primary task and a concurrent cognitive (counting) or a concurrent bimanual fine motor task as secondary tasks. Using a cross-sectional design, 25 children with DCD and 38 TD children were assessed with the Movement Assessment Battery for Children, 2nd edition (MABC-2) and Divided Attention (DA) task of the KiTAP. Next, the single- and dual-tasks were performed and the level of interference or facilitation of the dual tasks was calculated. Regression analysis determined the predictive value of the DA and MABC-2 component balance outcomes on the dual task performance. On the motor and attentional tasks, the group of children with DCD scored significantly below the level of the TD children. The dual task effect showed similar interference and facilitation of tasks in the different dual-task conditions in both groups. In the dual task-cognitive condition, the divided attention abilities and the MABC-2 balance score predicted 25% of the Wii Fit dynamic balance task performance, whereas in the dual task-motor condition this was higher (31.6%). In both conditions, DA was a stronger predictor than MABC balance score and appears to be an important factor to consider when developing motor task training for children with DCD.

Cerebellar Activation During Simple and Complex Bimanual Coordination: an Activation Likelihood Estimation (ALE) Meta-analysis.

Bimanual coordination is an important part of everyday life and recruits a large neural network, including the cerebellum. The specific role of the cerebellum in bimanual coordination has not yet been studied in depth, although several studies indicate a differential role of the anterior and posterior cerebellum depending on the complexity of the coordination. An activation likelihood estimation (ALE) meta-analysis was used combining the data of several functional MRI studies involving bimanual coordination tasks with varying complexities to unravel the involvement of the different areas of the cerebellum in simple and complex bimanual coordination. This study confirms the general bimanual network as found by Puttemans et al. (Puttemans et al. in J Neurosci 25:4270-4278, 2005) and highlights the differences between preferred in-phase (simultaneous movements of homologous muscle groups) and anti-phase movement conditions (alternating movements of homologous muscle groups), and more complex, non-preferred bimanual movements (e.g., out-of-phase movements). Our results show a differential role for the anterior and posterior vermis in bimanual coordination, with a role for the anterior vermis in anti-phase and complex bimanual coordination, and an exclusive role for the posterior vermis in complex bimanual movements. In addition, the way complexity was manipulated also seems to play a role in the involvement of the anterior and posterior vermis. We hypothesize that the anterior vermis is involved in sequential/spatial control, while the posterior vermis is involved in temporal control of (bimanual) coordination, though other factors such as (visual) feedback and continuity of the movement also seem to have an impact. More studies are needed to unravel the specific role of the cerebellar vermis in bimanual coordination.

Insights Gained From Activity Monitors for Upper Limb Stroke Rehabilitation

<h3>Research Objectives</h3> To determine if measures derived from wrist-worn activity monitors can be used as a proxy for functional arm/hand behaviors of chronic stroke survivors. <h3>Design</h3> Cross-sectional study. <h3>Setting</h3> Laboratory. <h3>Participants</h3> Chronic stroke survivors (n=20; 7 females, age: 58.4 (SD=8.9) years with mild-severe arm motor impairments (Fugl-Meyer Assessment (FMA) score: 39.4 (17.3) [1]). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The Chedoke Arm and Hand Activity Inventory-7 (CAHAI), the FMA and the Reaching Performance Scale (RPS) were administered. For the CAHAI, participants were outfitted with two wrist-worn activity monitors (MiGo, Flint Rehabilitation Devices) and video recorded. Each video was annotated to identify movements of each arm and time in active movements. For each arm, time in active movement, movement counts, and percentage of arm use were computed from the MiGo and compared to the video recording metrics [2-3]. <h3>Results</h3> Movement metrics derived from the MiGo were strongly related to metrics from the video annotations (active movement time: r2=0.946; movement counts: r2=0.893). Asymmetries in arm use for bimanual tasks were quantified as a ratio (paretic/total movements) and expressed as a percentage of paretic arm use: 28.6 (12.6)%; and time in active movement for the paretic arm: 37.5 (10.6)% (neurotypical symmetry ratio: ∼50% [4]). Altogether, the relationship between each of the three clinical measures and MiGo metrics (Movement count, Movement time) ranged from moderate to strong (r2=0.539-0.746). <h3>Conclusions</h3> Time in active movements may be a more intuitive outcome than movement count for stroke survivors, and a valid proxy for the more standard movement count metric. Perspectives from users would provide insight about the meaningfulness of each metric for future efforts to effect durable gains in paretic arm use in the natural environment [5]. <h3>Author(s) Disclosures</h3> JR is a full-time employee of Flint Rehabilitation Devices, LLC. DZ is a full-time employee and co-owner of Flint Rehabilitation Devices, LLC.

Performance of Bimanual Finger Coordination Tasks in Speakers Who Stutter

Stuttering is a neurodevelopmental speech disorder characterized by the symptoms of speech repetition, prolongation, and blocking. Stuttering-related dysfluency can be transiently alleviated by providing an external timing signal such as a metronome or the voice of another person. Therefore, the existence of a core motor timing deficit in stuttering has been speculated. If this is the case, then motoric behaviors other than speech should be disrupted in stuttering. This study examined motoric performance on four complex bimanual tasks in 37 adults who stutter and 31 fluent controls. Two tasks utilized bimanual rotation to examine motor dexterity, and two tasks used the bimanual mirror and parallel tapping movements to examine timing control ability. Video-based analyses were conducted to determine performance accuracy and speed. The results showed that individuals who stutter performed worse than fluent speakers on tapping tasks but not on bimanual rotation tasks. These results suggest stuttering is associated with timing control for general motor behavior.

Long term effects of cueing procedural memory reactivation during NREM sleep

Targeted memory reactivation (TMR) has recently emerged as a promising tool to manipulate and study the sleeping brain. Although the technique is developing rapidly, only a few studies have examined how the effects of TMR develop over time. Here, we use a bimanual serial reaction time task (SRTT) to investigate whether the difference between the cued and un-cued sequence of button presses persists long-term. We further explore the relationship between the TMR benefit and sleep spindles, as well as their coupling with slow oscillations. Our behavioural analysis shows better performance for the dominant hand. Importantly, there was a strong effect of TMR, with improved performance on the cued sequence after sleep. Closer examination revealed a significant benefit of TMR at 10 days post-encoding, but not 24 h or 6 weeks post-encoding. Time spent in stage 2, but not stage 3, of NREM sleep predicted cueing benefit. We also found a significant increase in spindle density and SO-spindle coupling during the cue period, when compared to the no-cue period. Together, our results demonstrate that TMR effects evolve over several weeks post-cueing, as well as emphasising the importance of stage 2, spindles and the SO-spindle coupling in procedural memory consolidation.

Handlebar Robotic System for Bimanual Motor Control and Learning Research.

Robotic devices can be used for motor control and learning research. In this work, we present the construction, modeling and experimental validation of a bimanual robotic device. We tested some hypotheses that may help to better understand the motor learning processes involved in the interlimb coordination function. The system emulates a bicycle handlebar with rotational motion, thus requiring bilateral upper limb control and a coordinated sequence of joint sub-movements. The robotic handlebar is compact and portable and can register in a fast rate both position and forces independently from arms, including prehension forces. An impedance control system was implemented in order to promote a safer environment for human interaction and the system is able to generate force fields, suitable for implementing motor learning paradigms. The novelty of the system is the decoupling of prehension and manipulation forces of each hand, thus paving the way for the investigation of hand dominance function in a bimanual task. Experiments were conducted with ten healthy subjects, kinematic and dynamic variables were measured during a rotational set of movements. Statistical analyses showed that movement velocity decreased with practice along with an increase in reaction time. This suggests an increase of the task planning time. Prehension force decreased with practice. However, an unexpected result was that the dominant hand did not lead the bimanual task, but helped to correct the movement, suggesting different roles for each hand during a cooperative bimanual task.

Cross-frequency coupling explains the preference for simple ratios in rhythmic behaviour and the relative stability across non-synchronous patterns.

Rhythms are important for understanding coordinated behaviours in ecological systems. The repetitive nature of rhythms affords prediction, planning of movements and coordination of processes within and between individuals. A major challenge is to understand complex forms of coordination when they differ from complete synchronization. By expressing phase as ratio of a cycle, we adapted levels of the Farey tree as a metric of complexity mapped to the range between in-phase and anti-phase synchronization. In a bimanual tapping task, this revealed an increase of variability with ratio complexity, a range of hidden and unstable yet measurable modes, and a rank-frequency scaling law across these modes. We use the phase-attractive circle map to propose an interpretation of these findings in terms of hierarchical cross-frequency coupling (CFC). We also consider the tendency for small-integer attractors in the single-hand repeated tapping of three-interval rhythms reported in the literature. The phase-attractive circle map has wider basins of attractions for such ratios. This work motivates the question whether CFC intrinsic to neural dynamics implements low-level priors for timing and coordination and thus becomes involved in phenomena as diverse as attractor states in bimanual coordination and the cross-cultural tendency for musical rhythms to have simple interval ratios. This article is part of the theme issue 'Synchrony and rhythm interaction: from the brain to behavioural ecology'.

Cognition and motor learning in a Parkinson's disease cohort: importance of recall in episodic memory.

Impaired motor learning in individuals with Parkinson's disease is often attributed to deficits in executive function, which serves as an important cognitive process supporting motor learning. However, less is known about the role of other cognitive domains and its association with motor learning in Parkinson's disease. The objective of this study was to investigate the associations between motor learning and multiple domains of cognitive performance in individuals with Parkinson's disease. Twenty-nine participants with Parkinson's disease received comprehensive neuropsychological testing, followed by practice of a bimanual finger sequence task. A retention test of the finger sequence task was completed 24 h later. Hierarchical linear regressions were used to examine the associations between motor learning (acquisition rate and retention) and cognitive performance in five specific cognitive domains, while controlling for age, sex, and years of Parkinson's disease diagnosis. We found that a higher acquisition rate was associated with better episodic memory, specifically better recall in visual episodic memory, in individuals with Parkinson's disease. No significant associations were observed between retention and cognitive performance in any domains. The association between motor acquisition and episodic memory indicates an increased dependency on episodic memory as a potential compensatory cognitive strategy used by individuals with Parkinson's disease during motor learning.

Bilateral Interference in Motor Performance in Homologous vs. Non-homologous Proximal and Distal Effectors.

Performance of bimanual motor actions requires coordinated and integrated bilateral communication, but in some bimanual tasks, neural interactions and crosstalk might cause bilateral interference. The level of interference probably depends on the proportions of bilateral interneurons connecting homologous areas of the motor cortex in the two hemispheres. The neuromuscular system for proximal muscles has a higher number of bilateral interneurons connecting homologous areas of the motor cortex compared to distal muscles. Based on the differences in neurophysiological organization for proximal vs. distal effectors in the upper extremities, the purpose of the present experiment was to evaluate how the level of bilateral interference depends on whether the bilateral interference task is performed with homologous or non-homologous effectors as the primary task. Fourteen participants first performed a unilateral primary motor task with the dominant arm with (1) proximal and (2) distal controlled joysticks. Performance in the unilateral condition with the dominant arm was compared to the same effector’s performance when two different bilateral interference tasks were performed simultaneously with the non-dominant arm. The two different bilateral interference tasks were subdivided into (1) homologous and (2) non-homologous effectors. The results showed a significant decrease in performance for both proximal and distal controlled joysticks, and this effect was independent of whether the bilateral interference tasks were introduced with homologous or non-homologous effectors. The overall performance decrease as a result of bilateral interference was larger for proximal compared to distal controlled joysticks. Furthermore, a proximal bilateral interference caused a larger performance decrement independent of whether the primary motor task was controlled by a proximal or distal joystick. A novel finding was that the distal joystick performance equally interfered with either homologous (distal bilateral interference) or non-homologous (proximal bilateral interference) interference tasks performed simultaneously. The results indicate that the proximal–distal distinction is an important organismic constraint on motor control and for understanding bilateral communication and interference in general and, in particular, how bilateral interference caused by homologous vs. non-homologous effectors impacts motor performance for proximal and distal effectors. The results seem to map neuroanatomical and neurophysiological differences for these effectors.

Evaluation of Explicit Motor Timing Ability in Young Tennis Players

A crucial ability for athletes playing sports that involve coincidence timing actions is the motor timing ability. The efficiency of perceptual and motor processes underlying the motor timing ability has been related to the motor experience gained in interceptive sports, such as tennis. In the present study, the motor timing ability in young tennis players (TP) and age-matched control participants (CTRL) was compared by means of a synchronization paradigm. Participants were asked to perform finger-opposition movements in synch to a metronome beating 0.5 and 2 Hz in (1) a bimanual coordination test, which compared the performance of the dominant hand with that of the contralateral hand, and (2) a movement lateralization test, which compared the motor performance of the dominant hand during single-hand and bimanual tasks (BTs). The motor performance was evaluated through movement strategy [defined by touch duration (TD), inter-tapping interval (ITI), and movement frequency] and movement accuracy (temporal accuracy defined by the synchronization error and spatial accuracy defined by the percentage of correct touches—%CORR_SEQ). Results showed that motor expertise significantly influences movement strategy in the bimanual coordination test; TD of TP was significantly higher than those of CTRL, specifically at 0.5 Hz. Furthermore, overall ITI values of TP were lower than those of CTRL. Lastly, in the movement lateralization test, the %CORR_SEQ executed with the right dominant hand by TP in the BT was significantly higher than those of CTRL. A discussion about the role of motor expertise in the timing ability and the related neurophysiological adaptations is provided.

Cognition and action: a latent variable approach to study contributions of executive functions to motor control in older adults.

Aging is associated with profound alterations in motor control that may be exacerbated by age-related executive functioning decline. Executive functions span multiple facets including inhibition (suppressing unwanted response tendencies), shifting (switching between cognitive operations), and updating (managing working memory content). However, comprehensive studies regarding the contributions of single facets of executive functioning to movement control in older adults are still lacking. A battery of nine neuropsychological tasks was administered to n = 92 older adults in order to derive latent factors for inhibition, shifting, and updating by structural equation modeling. A bimanual task was used to assess complex motor control. A sample of n = 26 young adults served as a control group to verify age-related performance differences. In older adults, structural equation models revealed that performance on the most challenging condition of the complex motor task was best predicted by the updating factor and by general executive functioning performance. These data suggest a central role for working memory updating in complex motor performance and contribute to our understanding of how individual differences in executive functioning relate to movement control in older adults.

Distinct connectivity profiles predict different in-time processes of motor skill learning

Learning through intensive practice has been largely observed in motor, sensory and higher-order cognitive processing. Neuroimaging studies have shown that learning phases are associated with different patterns of functional and structural neural plasticity in spatially distributed brain systems. Yet, it is unknown whether distinct neural signatures before practice can foster different subsequent learning stages over time. Here, we employed a bimanual implicit sequence reaction time task (SRTT) to investigate whether the rates of early (one day after practice) and late (one month after practice) post-training motor skill learning were predicted by distinct patterns of pre-training resting state functional connectivity (rs-FC), recorded with functional MRI. We observed that both motor learning descriptors were positively correlated with the strength of rs-FC among pairs of regions within a SRTT-relevant network comprising cerebellar as well as cortical and subcortical motor areas. Crucially, we detected a double dissociation such that early post-training learning was significantly associated with the functional connections within cerebellar regions, whereas late post-training learning was significantly related to the functional connections between cortical and subcortical motor areas. These findings indicate that spontaneous brain activity prospectively carries out behaviorally relevant information to perform experience-dependent cognitive operations far distant in time.

Hand pose selection in a bimanual fine-manipulation task.

Many daily tasks involve the collaboration of both hands. Humans dexterously adjust hand poses and modulate the forces exerted by fingers in response to task demands. Hand pose selection has been intensively studied in unimanual tasks, but little work has investigated bimanual tasks. This work examines hand poses selection in a bimanual high-precision-screwing task taken from watchmaking. Twenty right-handed subjects dismounted a screw on the watch face with a screwdriver in two conditions. Results showed that although subjects used similar hand poses across steps within the same experimental conditions, the hand poses differed significantly in the two conditions. In the free-base condition, subjects needed to stabilize the watch face on the table. The role distribution across hands was strongly influenced by hand dominance: the dominant hand manipulated the tool, whereas the nondominant hand controlled the additional degrees of freedom that might impair performance. In contrast, in the fixed-base condition, the watch face was stationary. Subjects used both hands even though single hand would have been sufficient. Importantly, hand poses decoupled the control of task-demanded force and torque across hands through virtual fingers that grouped multiple fingers into functional units. This preference for bimanual over unimanual control strategy could be an effort to reduce variability caused by mechanical couplings and to alleviate intrinsic sensorimotor processing burdens. To afford analysis of this variety of observations, a novel graphical matrix-based representation of the distribution of hand pose combinations was developed. Atypical hand poses that are not documented in extant hand taxonomies are also included.NEW & NOTEWORTHY We study hand poses selection in bimanual fine motor skills. To understand how roles and control variables are distributed across the hands and fingers, we compared two conditions when unscrewing a screw from a watch face. When the watch face needed positioning, role distribution was strongly influenced by hand dominance; when the watch face was stationary, a variety of hand pose combinations emerged. Control of independent task demands is distributed either across hands or across distinct groups of fingers.

Evaluation of improved bi-manual endoscopic resection using a customizable 3D-printed manipulator system designed for use with standard endoscopes: a feasibility study using a porcine ex-vivo model.

Background and study aims A major drawback of endoscopic en-bloc resection technique is its inability to perform bimanual tasks. Although endoscopic platforms that enable bimanual tasks are commercially available, they are neither approved for various locations nor adaptable to specific patients and indications. Methods Based on evolution of an adaptive 3D-printable platform concept, system variants with different characteristic properties were evaluated for ESD scenarios, ex-vivo in two locations in the stomach and colorectum. Results In total 28 ESDs were performed (7 antrum, 7 corpus in inversion, 7 cecum, 7 rectum) in a porcine ex-vivo setup. ESD was feasible in 21 cases. Investigated manipulator variants are differently well suited for performing ESD within the varying interventions scenarios. Dual-arm manipulators allowed autonomous ESD, while single-arm flexible manipulators could be used more universally due to their compact design, especially for lesions difficult to access. Pediatric scopes were too frail to guide the overtube-manipulators in extremely angled positions. Working in the rectum was impaired using long-sized manipulator arms. Conclusions The presented endoscopic platform based on 3D-printable and customizable manipulator structures might be a promising approach for future improvement of ESD procedure. With regard to localization, especially flexible manipulators attached to standard endoscopes appear to be most promising for further application of specific and individualised manipulator systems.

Motoric and Perceptual Kinesthetic Symmetry in Bi-Manual Interactions

Abstract Bi-manual (two-handed) actions have shown notable success in rehabilitative and therapeutic applications from the point of motor symmetry. Recent studies have shown that symmetry in actions is attributed to sensorimotor perception than mere co-activation of homologous muscles. In this paper, we present a study of symmetric and asymmetric haptic (specifically force) feedback on human perception and motor action during bi-manual spatial tasks. To the best of our knowledge, ours is the first procedure to specifically test the perceptual aspect of bi-manual actions in contrast to other works that typically characterize the physical/bio-mechanical aspects. Thereby in our experiment, healthy individuals were tasked with stretching a virtual spring using two symmetrically located haptics devices that provide an equal amount of resistive force on each hand while pulling the spring. In this experiment, we implement four kinesthetic conditions, namely (1) feedback on both hands, (2) feedback only on dominant hand, (3) feedback only on non-dominant hand, and (4) no feedback as our control. Our first goal was to determine if there exists a range of spring stiffness in which the individual incorrectly perceives bi-manual forces when the feedback is deactivated on one hand. Subsequently, we also wanted to investigate what range of spring stiffness would lead to such perceptual illusions. Our analysis shows that not only does such a range exist, it is wide enough so as to be potentially utilized in future rehabilitative applications.

Effects of Level of Immersion on Virtual Training Transfer of Bimanual Assembly Tasks

The availability of consumer-facing virtual reality (VR) headsets makes virtual training an attractive alternative to expensive traditional training. Recent works showed that virtually trained workers perform bimanual assembly tasks equally well as ones trained with traditional methods. This paper presents a study that investigated how levels of immersion affect learning transfer between virtual and physical bimanual gearbox assembly tasks. The study used a with-in subject design and examined three different virtual training systems i.e., VR training with direct 3D inputs (HTC VIVE Pro), VR training without 3D inputs (Google Cardboard), and passive video-based training. 23 participants were recruited. The training effectiveness was measured by participant’s performance of assembling 3D-printed copies of the gearboxes in two different timings: immediately after and 2 weeks after the training. The result showed that participants preferred immersive VR training. Surprisingly, despite being less favourable, the subjects’ performance of video-based training were similar to training on HTC VIVE Pro. However, video training led to a significant performance decrease in the retention test session 2 weeks after the training.

Long-Term Hand Function Outcomes of the Surgical Management of Complete Brachial Plexus Birth Injury

Hand function outcomes of primary nerve reconstruction for total brachial plexus birth injury (BPBI) are confounded by nerve roots left in continuity, inclusion of secondary procedures, and no assessment of the ability to perform activities of daily living. The purpose of this study was to evaluate the long-term hand function outcomes in a cohort of patients with a complete BPBI who had no nerve root in continuity prior to primary nerve reconstruction targeting the lower trunk. This single-center retrospective case series of complete BPBI included patients who underwent primary nerve reconstruction. The outcomes were assessed using the active movement scale (AMS) and brachial plexus outcome measure preoperatively and at the age of 4 and 8 years. Fifty patients with a complete BPBI, of whom 82% (41/50) had an avulsion of C8-T1, underwent primary nerve reconstruction at a mean age of 4.1 months. Compared with the preoperative AMS scores, a statistically significant increase of AMS scores was observed at 4 and 8 years of age for all movements except forearm pronation. Between 4 and 8 years of age, there was a statistically significant improvement of external rotation of the shoulder and elbow flexion as well as diminution of thumb flexion. In the brachial plexus outcome measure assessment, there were 83% (24/29) at 4 years and 81% (21/26) at 8 years who had sufficient functional movement to perform wrist, finger, and thumb activities. Functional hand outcome was restored to sufficiently perform bimanual activity tasks in 81% (21/26) of patients with a complete BPBI at 8 years of age. This affirmed that primary nerve reconstruction reinnervating the lower trunk can result in a functional extremity. Therapeutic IV.