Coin Rotation Task Research Articles

Young basketball players have better manual dexterity performance than sportsmen and non-sportsmen of the same age: a cross-sectional study.

Manual dexterity is a key skill in motor development. There are conflicting studies on the influence of sports practice on this skill and on which type of sport trains this ability the most in youth. Manual dexterity is usually assessed with expensive and time-consuming tools not easily available to facilities such as schools or sports clubs. The aim of this study was to assess differences in manual dexterity performance between young basketball players, sportsmen, and non-sportsmen. A further aim was to analyze whether the coin rotation task was a reliable tool for assessing manual dexterity. Based on the characteristics of the sport, we hypothesized that basketball players had better manual dexterity performances. Seventy-eight participants were included in the study and categorized into "basketball", "sports", and "non-sports" groups. Manual dexterity was assessed with the grooved pegboard, the coin rotation task, and the handgrip tests. The basketball group showed better performance in all tests. Significant differences were found between the basketball group and sports group and between the basketball group and non-sport group in the grooved pegboard (p < 0.05) and in the handgrip (p < 0.05) tests. Test-retest reliability of the coin rotation task scores was moderate in the basketball group (ICC2,1 0.63-0.6). Basketball practice could positively influence manual dexterity. The coin rotation task showed an acceptable construct of validity.

Feasibility and usability of a new home-based immersive virtual reality headset-based dexterity training in multiple sclerosis.

Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living and quality of life. The aim of this study was to evaluate the feasibility, usability and patient engagement/satisfaction of a home-based immersive virtual reality (VR) headset-based dexterity training in persons with multiple sclerosis (pwMS). In addition, preliminary efficacy data on the impact of this new training on manual dexterity were collected. Single arm prospective study. After a waiting period of two weeks, pwMS performed a specifically developed home-based VR headset-based dexterity training using the Oculus quest 2 for two weeks with five training sessions/week, each session for approximately 20 minutes. Primary endpoints were feasibility (measured by the adherence rate), usability (System Usability Scale, SUS) and patient engagement/satisfaction (Custom User Engagement Questionnaire, CUEQ). Secondary exploratory efficacy endpoints, measured before and after the waiting period as well as after the training intervention, were the Nine-hole-Peg-Test (9HPT), Coin rotation task (CRT), Handheld JAMAR dynamometer, Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and the Multiple Sclerosis Impact Scale 29 (MSIS 29). Eleven pwMS (mean age 49 ± 10.87 SD, mean EDSS 4.28 ± 1.48 SD) participated in the study. Feasibility (adherence rate: 81.8%), usability (median SUS score 94 (IQR=78-96)) and patient engagement/satisfaction (median 8 on scale of 1-10) of the VR training was very high. In addition, the CRT for the dominant hand improved significantly after training (p=0.03). The good results on feasibility, usability, and patient engagement/satisfaction qualify this home-based immersive VR headset-based dexterity training approach for the use in home-based neurorehabilitation in pwMS. Improved fine motor skills for the dominant hand suggest preliminary efficacy, but this needs to be proven in a future randomized-controlled trials.

The Behavioral Mapping of Psychomotor Slowing in Psychosis Demonstrates Heterogeneity Among Patients Suggesting Distinct Pathobiology.

Psychomotor slowing (PS) occurs in up to half of schizophrenia patients and is linked to poorer outcomes. As standard treatment fails to improve PS, novel approaches are needed. Here, we applied the RDoC framework using 3 units of analysis, ie, behavior, self-report, and physiology to test, whether patients with PS are different from patients without PS and controls. Motor behavior was compared between 71 schizophrenia patients with PS, 25 without PS, and 42 healthy controls (HC) using 5 different measures: (1) for behavior, an expert rating scale: Motor score of the Salpêtrière Retardation Rating Scale, (2) for self-report, the International Physical Activity Questionnaire; and for physiology, (3) Actigraphy, which accounts for gross motor behavior, (4) Gait velocity, and (5) coin rotation task to assess manual dexterity. The ANCOVAs comparing the 3 groups revealed differences between patients with PS and HC in expert ratings, self-report, and instrumental measures (all P ≤ .001). Patients with PS also scored higher in expert ratings and had lower instrumental activity levels compared to patients without PS (all P ≤ .045). Instrumental activity levels correlated with an expert rating of PS (rho = -0.51, P-fdr corrected <.001) and classified similarly at 72% accuracy. PS is characterized by slower gait, lower activity levels, and slower finger movements compared to HC. However, only actigraphy and observer ratings enable to clearly disentangle PS from non-PS patients. Actigraphy may become the standard assessment of PS in neuroimaging studies and clinical trials.

Combining Repetitive Transcranial Magnetic Stimulation and Video Game-Based Training to Improve Dexterity in Parkinson's Disease: Study Protocol of a Randomized Controlled Trial.

Introduction: Patients with Parkinson's disease (PD) often exhibit difficulties with dexterity during the performance of activities of daily living (ADL) due to dysfunctional supplementary motor area (SMA). The aim of this clinical trial protocol work is to describe how the effectiveness of a combined repetitive transcranial magnetic stimulation (rTMS) over SMA and video-game-based skill training (VBT) in PD will be evaluated. The short and long-term benefits are assessed.Methods and analysis: A single-blind (patients) stratified (based on Hoehn & Yahr) parallel randomized sham-controlled rTMS-VBT study with a baseline and two follow-up measurements (3 and 12 weeks) is being conducted. These measurements include the dexterity questionnaire 24 (DextQ-24) as a primary outcome, and nine hole peg test and coin rotation task as main secondary dexterity outcomes. Further secondary outcomes will be the subscale II of the movement disorders society unified PD rating scale (MDS-UPDRS) to assess improvements on overall ADL and the Parkinson's Disease Questionnaire-39 to assess quality of life. Thirty-six outpatients (from one neurorehabilitation center) with PD (diagnosis based on brain bank criteria) will be recruited who report difficulties with dexterity in performing ADL. All PD patients will receive a 45-min VBT three times a week for 3 weeks. The PD patients randomized in the experimental group will receive VBT preceded by real rTMS, being intermittent theta burst (iTBS) stimulation sessions. The PD patients randomized to the control group receive a VBT with sham rTMS.Discussion: The study will provide evidence to determine whether a combined iTBS and VBT skill intervention is more effective than a VBT intervention alone to improve dexterity in PD.Ethics and dissemination: The study was approved by the Ethics Committee for Northwest and Central Switzerland (EKNZ), Switzerland 2019–00433. The study will be conducted in accordance with the Helsinki Declaration and the Guidelines of Good Clinical Practice. Informed consent will be signed prior to subject enrolment. Dissemination will include submission to international peer-reviewed professional journals and presentation at international congresses.The study protocol has been registered in the clinicaltrials.gov registry with the identification code: NCT04699149.

Validity and reliability of Persian version of the Arm Function in Multiple Sclerosis Questionnaire

Introduction This study aimed to determine the validity and reliability of the Persian version of the Arm Function in Multiple Sclerosis Questionnaire which is a self-report questionnaire for persons with multiple sclerosis (MS). Method This methodological study was performed in the following stages: translation, validity, internal consistency, and test–retest reliability of Persian-AMSQ. The Nine-Hole Peg Test (9HPT), Coin Rotation Task (CRT), and Functional Independence Measure (FIM) for construct validity were used. Psychometric testing was done to ascertain the validity and reliability of the questionnaire. Results In this study, 155 people with MS participated. There were no major linguistic or cultural difficulties in the translation of AMSQ. Face and content validity confirmed by experts and people with MS. The internal consistency was high (Cronbach’s α = 0.99). Test–retest reliability, as measured with intra-class coefficient, was 0.98. Correlations with 9HPT (r = 0.54), CRT (r = 0.16), and FIM (r = −0.54) were significant ( p &lt; 0.05). Conclusion The Persian-AMSQ appears to be a valid and reliable questionnaire for measuring upper extremity dysfunction in MS.

Somatosensory temporal discrimination threshold changes during motor learning

Purpose Mechanisms underlying the somatosensory temporal discrimination threshold and its relationship with motor control have been reported; however, little is known regarding the change in temporal processing of tactile information during motor learning. We investigated the somatosensory temporal discrimination threshold changes during motor learning in a feedback-control task. Materials and methods We included 15 healthy individuals. The somatosensory temporal discrimination threshold was measured on the index finger. A 10-session coin rotation task was performed, with 2 min’ training per session. The coin rotation scores were determined through tests (continuous coin rotation at 180° at maximum speed for 10 s). The coin rotation test score and the somatosensory temporal discrimination threshold were determined at baseline and after 5 and 10 sets of training, as follows: pre-test; training5set (1 set × 5); post-test5block; training5set (1 set × 5); and post-test10block. The coin rotation score and the somatosensory temporal discrimination threshold were compared between the tests. The latter was also compared between the right (the within-subject control) and left fingers. Results The coin rotation score showed significant differences among all tests. In the somatosensory temporal discrimination threshold, there was a significant difference between the pre-test and post-test5block values, pre-test and post-test10block values of the left side and between the right and left sides in the post-test5block and the post-test10block values. Conclusions The somatosensory temporal discrimination threshold decreased along with task-performance progress following motor learning during a feedback-control task.

Validation and diagnostic accuracy of coin rotation task for manual dexterity and coordination in children with specific learning disorder

Background This study aimed at determining validity, reliability, and diagnostic accuracy of Coin Rotation Task (CRT) in assessing manual dexterity and coordination of children with specific learning disorder (SLD). Methods In this non-experimental cross-sectional study, 120 children (typically developing children = 60, children with SLD = 60, mean age ± SD =9.18 ± 0.55) were recruited. Test–retest reliability and construct validity of CRT were assessed. Multivariate regression analysis was performed on CRT scores by considering age and gender as covariates and children with SLD with mild dexterity impairment and severe dexterity impairment (SDI) as outcome variables. Receiver-operating characteristics (ROC) curve analysis was carried out to derive validity parameters. Results Test-retest reliability of the CRT scores in both subtests were excellent in children with SLD (ICC2,1: 0.93–0.95) and good to excellent in typically developing children (ICC2,1: 0.72–0.82). Acceptable construct validity of CRT was also found. The CRT cut-off points were 23 (sensitivity= 89.29%, specificity= 70.37%) and 28 (sensitivity= 80.33%, specificity= 86.36%) for discriminating children with SLD and SDI from typically developing children in dominant and non-dominant hand, respectively. Conclusions The present study indicated good to excellent test-retest reliability, acceptable validity, and high diagnostic accuracy for diagnosing children with SLD based on their dexterity impairment level. Implications for Rehabilitation The Coin Rotation Task (CRT) was modified and validated for use in children. The CRT is a reliable and valid tool with high diagnostic accuracy. The CRT has a good ability for discriminating children with specific learning disorder with severe dexterity impairment form typically developing children. Treatment plans and research designs can be performed by using this valid, reliable, and easy to administer tool.

Single Session Transcranial Magnetic Stimulation Ameliorates Hand Gesture Deficits in Schizophrenia.

Social interaction is impaired in schizophrenia, including the use of hand gestures, which is linked to poor social perception and outcome. Brain imaging suggests reduced neural activity in a left-lateralized frontoparietal network during gesture preparation; therefore, gesturing might be improved through facilitation of left hemispheric brain areas or via disruption of interhemispheric inhibition from the right homolog. This study tested whether repetitive transcranial magnetic stimulation (rTMS) protocols would improve gesture performance in schizophrenia. This randomized, placebo-controlled, double-blind, crossover trial applied 3 different protocols of rTMS separated by 48 h. Twenty right-handed schizophrenia patients and 20 matched healthy controls received facilitatory intermittent theta burst stimulation (iTBS) over the left inferior frontal gyrus (IFG), inhibitory continuous theta burst stimulation (cTBS) over right inferior parietal lobe (IPL), and placebo over left IPL in randomized order. Primary outcome was change in the test of upper limb apraxia (TULIA), rated from video recordings of hand gesture performance. Secondary outcome was change in manual dexterity using the coin rotation task. Participants improved on both tasks following rTMS compared with baseline. Only patients improved gesture performance following right IPL cTBS compared with placebo (P = .013). The results of the coin rotation parallel those of the TULIA, with improvements following right IPL cTBS in patients (P = .001). Single sessions of cTBS on the right IPL substantially improved both gesture performance accuracy and manual dexterity. The findings point toward an inhibition of interhemispheric rivalry as a potential mechanism of action.

Functional assessment using short tests in a patient with Pompe disease receiving enzyme replacement therapy: case report

Introduction: Pompe disease is characterized by the deficiency of the acid alfa glucosidase enzyme, which leads to a glycogen accumu­lation mainly in cardiac and skeletal muscles. Its onset may be early or late; the late form is more difficult to handle given the variety of presenta­tions. Enzyme replacement therapy has shown to improve gross motor function and lung function in patients.Case description: Female patient who presented chronic quadriparesis. She was diagnosed with Pompe disease, which required enzyme replace­ment therapy that helped improve the symptoms, which was evident with the performance of rapid functional evaluation tests.Discussion: Enzyme replacement therapy in Pompe disease modifies the natural history of the disease. A brief review of the literature about the functional tests that can be used to assess a patient with this disorder is presented.Conclusion: The 10-meter walk test, one-leg stance test, cervical flexion in supine position, five times sit to stand test, and coin rotation task are useful for clinical evaluation in patients with Pompe disease receiving enzyme replacement therapy.

Agreement Between Face-to-Face and Tele-assessment of Upper Limb Functioning in Patients with Parkinson Disease.

Upper limb disturbances are prevalent in patients with Parkinson disease (PD) and can limit their participation in activities of daily living. Tele-assessment of upper limb motor symptoms using an Internet application may be an alternative for addressing the growing demand for monitoring of disease progression. To evaluate the level of agreement between face-to-face and tele-assessment of patients with PD. Reliability study. Parkinson's Disease Association. Twenty-one patients with PD from a local association participated in the study. Patients attended a session for clinical face-to-face and real-time online tele-assessment. Upper limb measures of function (assessed with the Manual Ability Measure 16), dexterity (evaluated using the coin rotation task), motor speed (assessed by the finger tapping test), tremor (evaluated with the Fahn-Tolosa-Marin Tremor Rating Scale), and range of motion (using the Kinovea software) were recorded by two independent researchers. All the outcome measures evaluated showed a good interrater, intraclass correlation coefficient (ρ > 0.75). In addition, most confidence intervals were narrow and excluded 0.8. The lowest reliability was obtained for elbow flexion of the most affected upper limb (ρ = 0.75; confidence interval 0.49-0.89) and the highest reliability for finger tapping tests (ρ = 1; 1, 1). This study demonstrates high interrater reliability of upper limb tele-assessment in patients with PD compared to a face-to-face assessment. III.

Relación entre los síntomas musculoesqueléticos y la funcionalidad en personas con enfermedad de Parkinson

Introducción: La enfermedad de Parkinson (EP) es una de las enfermedades más frecuentes del sistema nervioso central, y además de los síntomas motores clásicos, ahora se sabe que los pacientes también sufren una variedad de síntomas no motores que afectan negativamente a la independencia funcional. Objetivo: El objetivo de este estudio fue evaluar la relación entre los síntomas musculoesqueléticos y la funcionalilidad en personas con EP. Materiales y Métodos: Este estudio es un estudio observacional transversal que involucra a pacientes con enfermedad de Parkinson utilizando los siguientes instrumentos: Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS- UPDRS), Fahn-Tolosa-Marín Tremor Rating Scale (TRS), Manual Ability Measure-16 (MAM-16), Evaluative Frailty Index for Physical Activity (EFIP), Coin Rotation Task (CRT), Fatigue Severity Scale (FSS), Brief Pain Inventory (BPI). Resultados: Se incluyeron 24 pacientes, con una edad media de 72,54 ± 9,4 años. Se encontró relación (p &lt; 0,05) entre las variables severidad del Parkinson, temblor, destreza, fatiga y dolor con las variables de funcionalidad. Conclusiones: Puntuaciones altas en las afecciones musculoesqueléticas se asocian con discapacidad. El enfoque de la gestión en la EP debe cambiar a una estrategia integral que incorpore el cuidado de síntomas motores como el temblor o la destreza y síntomas no motores como la fatiga y el dolor.

Deficient supplementary motor area at rest: Neural basis of limb kinetic deficits in Parkinson's disease.

Parkinson's disease (PD) patients frequently suffer from limb kinetic apraxia (LKA) affecting quality of life. LKA denotes an impairment of precise and independent finger movements beyond bradykinesia, which is reliably assessed by coin rotation (CR) task. BOLD fMRI detected activation of a left inferior parietal-premotor praxis network in PD during CR. Here, we explored which network site is most critical for LKA using arterial spin labeling (ASL). Based on a hierarchical model, we hypothesized that LKA would predominantly affect the functional integrity of premotor areas including supplementary motor areas (SMA). Furthermore, we suspected that for praxis function with higher demand on temporal-spatial processing such as gesturing, inferior parietal lobule (IPL) upstream to premotor areas would be essential. A total of 21 PD patients and 20 healthy controls underwent ASL acquisition during rest. Behavioral assessment outside the scanner involved the CR, finger tapping task, and the test of upper limb apraxia (TULIA). Whole-brain analysis of activity at rest showed a significant reduction of CR-related perfusion in the left SMA of PD. Furthermore, the positive correlation between SMA perfusion and CR, seen in controls, was lost in patients. By contrast, TULIA was significantly associated with the perfusion of left IPL in both patients and controls. In conclusion, the findings suggest that LKA in PD are linked to an intrinsic disruption of the left SMA function, which may only be overcome by compensatory network activation. In addition, gestural performance relies on IPL which remains available for functional recruitment in early PD.

T200. DISTINCT ASSOCIATIONS OF MOTOR DOMAINS WITH THE GENETIC RISK FOR PSYCHOSIS – DIFFERENT PATHWAYS TO MOTOR ABNORMALITIES IN SCHIZOPHRENIA?

BackgroundAberrant motor function is an integral part of Schizophrenia. In fact, abnormalities are frequently found in patients, in populations at risk, and in unaffected relatives. Motor abnormalities are suspected to be relevant for the clinical outcome and could probably predict the conversion from at-risk individuals to schizophrenia. Furthermore, motor function and has been argued as endophenotype of the disorder. Yet, which particular motor domain may classify as a potential endophenotype is unknown. We aimed to compare schizophrenia patients, unaffected first degree relatives and healthy controls for different motor domains. We expected impairments in all domains in patients and in some domains in relatives.MethodsWe included 43 schizophrenia patients, 34 unaffected first degree relatives of schizophrenia patients and 29 healthy control subjects, matched for age, gender and education level. We compared motor function of five domains between the groups. The domains comprise neurological soft sings (NSS), abnormal involuntary movements (dyskinesia), Parkinsonism, complex fine motor function applying the coin rotation task as well as finger tapping. Furthermore, we tested the association of motor function of the five domains with working memory, frontal lobe function and nonverbal intelligence for each group separately using within-group bivariate correlations.ResultsSchizophrenia patients showed poorer motor function in all tested domains compared to healthy controls. First-degree relatives had intermediate ratings with aberrant function in two motor domains. In detail, relatives had significantly more NSS and performed poorer in the finger tapping task than controls. In contrast, in relatives complex fine motor function was intact. Relatives did not differ from controls in dyskinesia or Parkinsonism severity.DiscussionTaken together, schizophrenia patients have motor abnormalities in all tested domains. Thus, motor abnormalities are a key element of the disorder. Likewise, first degree relatives presented motor deficits in two domains. A clear difference between relatives and healthy controls was found for NSS and finger tapping. Thus, NSS and finger tapping may be a potential marker of vulnerability for schizophrenia. The lack of association between genetic risk and dyskinesia or Parkinsonism suggests distinct pathobiological mechanisms in the various motor abnormalities in schizophrenia.

Clinical response to treatment in inpatients with depression correlates with changes in activity levels and psychomotor speed.

Monitoring clinical response to treatment in depressed inpatients, particularly identifying early improvement, may be sub-optimal. This may impact adversely on patients through longer admissions and sub-optimal pharmacotherapy. Psychomotor speed is a prominent neuropsychological function which changes as recovery occurs. This study examines simple techniques used to quantify psychomotor change and their potential to contribute to monitoring recovery. Activity levels were continuously monitored in patients diagnosed with a major depressive episode from four acute psychiatric wards using two actigraphs (commercial and scientific) for 3 weeks and linear regression used to calculate a gradient to express rate of change. Psychomotor speed was assessed using the simple Coin Rotation Task. Mood and functioning were rated using the Quick Inventory of Depressive Symptoms, Clinical Global Impression Scale and Functioning Assessment Short Test. The assessments were completed at baseline and follow-up (3 weeks), and correlations were calculated for all change measures. In all, 24 inpatients were recruited but not all completed baseline and follow-up measures. Change in activity count ( N = 16) and psychomotor speed ( N = 13) correlated significantly with improvement in clinical measures of depressive symptoms. Actigraphs were acceptable to hospital inpatients. The limited size of this pilot study precludes the analysis of predictive power or the influence of other variables such as depression subtypes, age, gender or variations related to medications. Early change in simple activity and psychomotor speed warrant further investigation for utility in measuring treatment response in depressed inpatients.

Limb Kinetic Apraxia Is an Independent Predictor for Quality of Life in Parkinson's Disease.

Impaired dexterity is a common symptom in Parkinson's disease (PD) and has been related to limb kinetic apraxia (LKA). LKA negatively influenced activities of daily living (ADL) in PD. However, the impact on quality of life (QoL) remains to be clarified, which was the aim of the current study. Eighty nondemented patients with PD and 60 age-matched, sex-matched healthy individuals participated in this study. The 39-item Parkinson's Disease Questionnaire was used to measure QoL. Dexterity was assessed by the coin rotation (CR) task and the ADL-related Dexterity Questionnaire 24. Nonmotor symptoms were monitored with part I of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, and motor symptoms were measured with parts II and III of the modified Movement Disorder Society-Unified Parkinson's Disease Rating Scale. Regression analysis revealed that dexterity scores controlled for parkinsonian motor symptoms were a strong and independent predictor of QoL in patients with PD. The study demonstrated that the strong association of impaired dexterity and QoL is independent of bradykinesia, thereby underscoring the clinical relevance of LKA in PD.

Theta burst stimulation over premotor cortex in Parkinson's disease: an explorative study on manual dexterity.

Dorsal pre-motor cortex (PMd) is thought to play a role in fine motor control. The aim of the present study was to investigate whether inhibitory or excitatory stimulation of PMd would have an impact on manual dexterity in Parkinson's disease (PD). Fifteen patients with PD participated in this study. High resolution structural MRI was used for neuro-navigated TBS. Participants were targeted with one train of TBS in three experimental sessions: sham stimulation over vertex, continuous TBS (cTBS) over PMd and intermittent TBS (iTBS) over PMd, respectively. Dexterity was measured by a coin rotation task (CRT), which is a valid measure to detect limb kinetic apraxia (LKA). Neither cTBS or iTBS significantly interfered with CRT. Post hoc sub-analysis in a group of PD patients (n=5) with stronger baseline impairment, indicating LKA, revealed further deterioration of dexterous performance for the cTBS condition (p=0.04). This sham controlled pilot study demonstrates that TBS over PMd does not significantly interfere with dexterity in PD. However, patients with dexterous impairment qualifying for LKA may be more susceptible to TBS.

Callosal apraxia: a 34-year follow-up study

ABSTRACTLoss of ability of the left upper limb (LUL) to correctly produce spatial and temporal components of skilled purposeful movements was reported 34 years ago in a woman with a callosal infarction. To learn about recovery, we recently reexamined this woman. This woman was tested for ideomotor apraxia by asking her to pantomime to command and to seeing pictures of tools. Whereas she performed normally with her right upper limb, her LUL remained severely apraxic, making many spatial (postural and movement) errors. Initially, she did not reveal loss of finger–hand deftness (limb-kinetic apraxia), and when tested again with the coin rotation task, her left hand performance was normal. Without vision, she could name objects placed in her left hand but not name numbers written in this hand. Since this woman had a callosal lesion, failure to recover cannot be accounted for by left hemisphere inhibition of her right hemisphere. Although failure for her LUL to improve may have been related to not using her LUL for skilled actions, her right hemisphere was able to observe transitive actions, and this failure of her LUL to produce skilled purposeful movements suggests her right hemisphere may have not had the capacity to learn these movement representations. Without vision, her ability to recognize objects with her left hand, but not numbers written on her left palm, suggests graphesthesia may require that her left hand did not have access to movement representations important for programming these numbers when writing.

P107. Disturbed fine motor performance is associated with altered structure and perfusion of the motor system in schizophrenia

Introduction Motor symptoms are an integral part of the clinical presentation of schizophrenia and disturbances of fine motor function are frequent. However, only limited knowledge exists on the neural correlates of fine motor skills in schizophrenia. We implemented a complex fine motor task to test associations with whole brain gray matter (GM) volume as well as cerebral blood flow (CBF). We aimed to investigate whether patients with difficulties of fine motor performance would show structural and cerebral blood flow alterations in the motor loop. Methods In total 42 schizophrenia patients (59.5% men, mean age=38.6±11.4) diagnosed according to DSM-V underwent MR-neuroimaging. All patients but four received antipsychotic treatment. Parkinsonism was assessed using the motor part of the Unified Parkinson Disease Rating Scale (UPDRS). Fine motor skills were assessed using the coin rotation task. The task is to rotate a coin (.5 swiss francs) using three fingers of the left hand (thumb, index, middle) through serial 180-degree turns as rapidly as possible. Deficits are indicated by the reduced number of half turns and coin drops. We processed structural images using standard SPM8 procedures, in particular voxel-based morphometry (VBM) toolbox. Resting state CBF was measured by arterial spin labeling (ASL). ASL data was analyzed with our custom written MATLAB programs (Federspiel et al., 2006; Walther et al., 2011). The main emphasis was to explore the effect of task performance on GM volume and CBF. Correlations of task performance (mean=10.7±4.1) and GM volume (covariates total intracranial volume and UPDRS) as well as CBF (covariate UPDRS) were calculated. A threshold of p - uncorr 0.001 (min. cluster size=17: equivalent to a map-wise false positive rate of alpha Results We found significant correlations of coin rotation scores and GM volume in the bilateral pre-supplementary motor area (pre-SMA) extending to the SMA, in the left primary motor cortex, the right superior frontal gyrus, bilateral the cerebellum and the left putamen. The pre-SMA cluster survived family wise error correction at cluster level. Significant correlations of CBF and the coin rotation scores were detected in the right SMA, the left primary motor cortex and in the right superior frontal gyrus (Area Fp1), the left inferior frontal gyrus and the right precuneus. Two clusters survived family wise error correction: right superior frontal gyrus and the left inferior frontal gyrus. Discussion Difficulties of fine motor task performance were associated with structural gray matter volume reduction in the motor loop, particularly in cortical motor control areas. In addition fine motor function in schizophrenia patients was linked with cerebral blood flow. These findings were corrected for parkinsonism. In sum, the results argue for specific alterations of the motor system in schizophrenia as source of impaired fine motor function beyond parkinsonism.

Home-based training to improve manual dexterity in patients with multiple sclerosis: A randomized controlled trial

Background: Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living (ADL) and quality of life. Objective: We aimed to evaluate the effectiveness of a standardized, home-based training program to improve manual dexterity and dexterity-related ADL in MS patients. Methods: This was a randomized, rater-blinded controlled trial. Thirty-nine MS patients acknowledging impaired manual dexterity and having a pathological Coin Rotation Task (CRT), Nine Hole Peg Test (9HPT) or both were randomized 1:1 into two standardized training programs, the dexterity training program and the theraband training program. Patients trained five days per week in both programs over a period of 4 weeks. Primary outcome measures performed at baseline and after 4 weeks were the CRT, 9HPT and a dexterous-related ADL questionnaire. Secondary outcome measures were the Chedoke Arm and Hand Activity Inventory (CAHAI-8) and the JAMAR test. Results: The dexterity training program resulted in significant improvements in almost all outcome measures at study end compared with baseline. The theraband training program resulted in mostly non-significant improvements. Conclusion: The home-based dexterity training program significantly improved manual dexterity and dexterity-related ADL in moderately disabled MS patients. Trial Registration NCT01507636.

Aging, aerobic activity and interhemispheric communication.

Recent studies have shown that during unimanual motor tasks, aging adults show bilateral recruitment of primary motor cortex (M1), while younger adults show a suppression of the ipsilateral motor cortex. Additional work has indicated that increased bilateral M1 recruitment in older adults may be deleterious when performing some motor tasks. However, higher levels of physical fitness are associated with improved dexterity and fitness may mitigate the loss of both inhibitory and excitatory communication in aging adults. The goal of this study was to assess dexterity and interhemispheric motor communication in physically fit and sedentary middle-age (40–60 years) right handed participants using tests of hand deftness and transcranial magnetic stimulation (TMS). To behaviorally assess the influence of interhemispheric communication on motor performance, participants also perform the coin rotation deftness task while maintaining pinch force with the opposite hand (bimanual condition). We correlated these behavioral measures with the ipsilateral silent period using TMS to assess interhemispheric inhibition. Our results show that the middle-aged adults who were physically fit had better dexterity of their right hand (finger tapping and peg-board). When performing the coin rotation task the fit group had no between hand differences, but the sedentary group’s left hand performance was inferior to the their right hand. We found that better dexterity correlated with ipsilateral silent period duration (greater inhibition) thereby supporting the postulate that fitness improves interhemispheric motor communication.