Complex Motor Research Articles

Dyad motor learning in a wrist-robotic environment: Learning together is better than learning alone

ObjectiveDyad motor practice is characterized by two learners alternating between physical and observational practice, which can lead to better motor outcomes and reduce practice time compared to physical practice alone. Robot-assisted therapy has become an established neurorehabilitation tool but is limited by high therapy cost and access. Implementing dyad practice in robot-assisted rehabilitation has the potential to improve therapeutic outcomes and/or to achieve them faster. This study aims to determine the effects of dyad practice on motor performance in a wrist-robotic environment to evaluate its potential use in robotic rehabilitation settings. MethodsForty-two healthy participants (18–35 years) were randomized into three groups (n = 14): Dyad practice, physical practice with rest and physical practice without rest. Participants practiced a 2 degree-of-freedom gamified wrist movement task for 20 trials using a custom-made wrist robotic device. A motor performance score (MPS) that captured temporal and spatial time-series kinematics was computed at baseline, the end of training and 24 h later to assess retention. ResultsMPS did not differ between groups at baseline. All groups revealed significant performance gains by the end of training. However, dyads outperformed the other groups at the end of training (p < 0.001) and showed higher retention after 24-h (p = 0.02). Median MPS improved by 46.5% in dyads, 25.3% in physical practice-rest, and 33.6% in physical practice-no rest at the end of training compared to baseline. ConclusionCompared to physical practice alone, dyad practice leads to superior motor outcomes in a robot-assisted motor learning task. Dyads still outperformed their counterparts 24-h after practice. Impact statementImproving motor function in complex motor tasks without increasing required practice time, dyad practice can optimize therapeutic resources. This is particularly impactful in robot-assisted rehabilitation regimens as it would help to improve patients' outcomes and increase care efficiency.

Ictal Semiology Important for Electrode Implantation and Interpretation of Stereoelectroencephalography.

Scalp video-electroencephalography (video-EEG) monitoring should be analyzed thoroughly to preoperatively evaluate stereoelectroencephalography (SEEG). Formulating the working hypotheses for the epileptogenic zone (EZ) considering "anatomo-electroclinical correlations" is the most crucial step, which determines the placement of SEEG electrodes. If these hypotheses are insufficient, precise EZ identification may not be achieved during SEEG recording.In ictal semiology analysis, temporal and spatial patterns with reference to ictal EEG changes are emphasized. In frontal lobe epilepsy, seizures often begin with relatively widespread synchronous activity, and complex motor symptoms manifest within seconds. Due to the wide area involved and intense interhemispheric connectivity, a comprehensive evaluation is often required. Hypotheses are formulated on the basis of the motor symptoms and emotional manifestations that are related to the prefrontal cortices. In temporal lobe epilepsy, EEG onset often precedes clinical onset. Propagation from the EZ to locations within and outside of the temporal lobe is examined from both the EEG and semiological standpoint. The characteristics of contralateral versive seizures, contralateral tonic seizures, and frequent focal onset bilateral tonic-clonic seizures indicate a higher risk of temporo-perisylvian epilepsy. In parietal/occipital lobe epilepsy, despite that some symptoms result from activity in the immediate vicinity, stronger connectivity with other regions usually contributes to the generation of prominent ictal semiology. Hence, multilobar electrode placement is often useful in practice. For insular epilepsy, it is important to understand the anatomy, function, and networks between other regions. A semiological approach is one of the most important clues for electrode implantation and interpretation of SEEG.

Investigation of Motor Development Levels of 04-06 Age Group Girls and Boys According to Bruininks-Oseretsky Test

Motor skills are the physical elements that enable movement. Basic skills at an early age form the basis for activities that require much more complex motor skills specific to sports. These basic skills are called basic motor skills and include activities such as throwing, jumping, running, catching and hitting. Basic movement skills form the basis of sport-specific skills to be acquired later. In this respect, it is important to measure the basic movement skills of children and to monitor these skill levels. In this study, it was aimed to investigate the motor development levels of children aged 04-06 according to the Bruininks-Oseretsky test.&#x0D; The population of the study consists of children between the ages of 4-6 attending kindergartens and nursery schools in Rize in 2018-2019 academic year. 286 healthy children, 150 males and 136 girls, were randomly chosen for the study's sample. The Bruininks-Oseretsky Motor Proficiency Test (BOT-2) was used in its abbreviated form for this experiment. Normality test was applied to the obtained data. It was observed that the data had normal distribution in some sub-groups and not normal distribution in some others. When comparing two independent groups in pairs, the t-test, or Mann-Whitney-U test, was used at a significance level of = 0,05, and the one-way ANOVA test, or Kruskal-Wallis H test, was used when comparing three or more groups.&#x0D; Test results showed that the difference between the gross motor skill levels of the children by gender and age was significant (Z0.05;-3,538; p

Effects of Simulated Visual Impairment Conditions on Movement and Anxiety during Gap Crossing.

This study investigated the effects of visual conditions associated with progressive eye disease on movement patterns and anxiety levels during gap-crossing tasks. Notably, 15 healthy young adults performed crossover platforms with a 10 cm gap at three different heights, namely equal (0 cm), raised (+15 cm), and lowered (-15 cm) levels, under four vision conditions, namely normal or corrected eyesight, 10° tunnel vision, 5° tunnel vision, and 5° tunnel vision with 0.04 occlusion. Leg movements during gap crossing were analyzed using three-dimensional motion analysis. The results highlighted a distinct motion pattern in the trajectories of participants' legs under the different visual conditions. Specifically, at the point where the gap-crossing movement began (D1), the normal or corrected eyesight conditions resulted in further separation between the steps compared with the other visual conditions. The highest point of the foot during movement (D2) did not differ between the visual conditions, except for the 0 cm step. Furthermore, anxiety levels, as quantified by the State-Trait Anxiety Inventory (STAI-S) questionnaire, were exacerbated under conditions of restricted visual information. In conclusion, visual impairments associated with progressive ocular diseases may perturb complex motor movement patterns, including those involved in gap-crossing tasks, with heightened anxiety potentially amplifying these disturbances.

BLUEPRINT TO TARGET THE SPINAL CORD MOTOR CIRCUITRY TO PRESERVE AND RESTORE MOBILITY IN OLD AGE

Abstract Spinal motor neurons are central for the initiation and modulation of all voluntary movements. Within the spinal cord, motor neurons form tens of thousands of excitatory (glutamatergic and cholinergic) and inhibitory (GABAergic and glycinergic) synapses along their dendritic arbor and soma. These synapses contain the information required to execute fine and complex motor commands and are together referred to as the motor circuitry. Once activated, motor neurons drive muscle contraction by releasing neurotransmitters from their axon terminals at neuromuscular junctions (NMJs). Thus, either the death of motor neurons or their disconnection from other neurons are skeletal muscles during aging would undoubtedly compromise motor function. We will show that motor neurons do not die in old female and male mice, rhesus monkeys, and humans. Instead, these neurons selectively and progressively shed excitatory synaptic inputs throughout the soma and dendritic arbor during aging. Thus, aged motor neurons contain a motor circuitry with a reduced ratio of excitatory to inhibitory synapses that may be responsible for the diminished ability to activate motor neurons to commence movements. Additionally, we will show that aged motor neurons present with aberrant changes in genes and molecular pathways with roles in glia-mediated synaptic pruning, inflammation, axonal regeneration, and oxidative stress. I will bring these findings together to suggest that motor neurons at a minimum contribute to the loss of their own synapses with advancing age and discuss possible avenues for therapeutic intervention.

In depth behavioral phenotyping unravels complex motor disturbances in Cstb-/- mouse, a model for progressive myoclonus epilepsy type 1.

Progressive myoclonus epilepsy type 1 (EPM1) is an autosomal recessively inherited childhood-adolescence onset neurodegenerative disease caused by mutations in the cystatin B (CSTB gene). The key clinical manifestation in EPM1 is progressive, stimulus-sensitive, in particular action-induced myoclonus. The cystatin B-deficient mouse model, Cstb-/-, has been described to present with myoclonic seizures and progressive ataxia. Here we describe results from in-depth behavioral phenotyping of the Cstb-/- mouse model in pure isogenic 129S2/SvHsd background covering ages from 1.5 to 6 months. We developed a method for software-assisted detection of myoclonus from video recordings of the Cstb-/- mice. Additionally, we observed that the mice were hyperactive and showed reduced startle response, problems in motor coordination and lack of inhibition. We were, however, not able to demonstrate an ataxic phenotype in them. This detailed behavioral phenotyping of the Cstb-/- mice reveals new aspects of this mouse model. The nature of the motor problems in the Cstb-/- mice seems to be more complex and more resembling the human phenotype than initially described.

A Study of Neurological Soft Signs and Cognition in Schizophrenia.

Neurological soft signs (NSS) are delicate neurological abnormalities that comprise deficits in motor coordination, problems with the sequencing of complex motor acts, and sensory integration difficulties. These are nonspecific with no specific localization in the brain. NSS are found in many patients with Schizophrenia. Cognitive dysfunctions are also present in more than two-thirds of patients with Schizophrenia. This study aims at assessing the NSS and its association with cognitive impairment in patients with Schizophrenia. A total of 100 Schizophrenia patients were included in the study. The Heidelberg scale was used for assessing the NSS. The Montreal Cognitive Assessment Scale(MoCA) for cognitive impairment, the Positive and Negative Syndrome Scale(PANSS) for Schizophrenia, and the Brief Psychiatric Rating Scale (BPRS) were used to assess the severity. Statistical analysis was performed by Pearson's Chi-square test, Kruskal-Wallis test, Wilcoxon rank testsand Spearman rank correlation along with mean and standard deviation. NSS were present in 68% (N=68) of the patients with motor coordination being maximally affected. Cognitive impairment was found in 73% (N=73) of patients with a MoCA score <26. Patients with predominant negative symptoms had higher NSS scores and lower MoCA scores. A "statistically significant" correlation was observed between cognitive impairment and NSS. Most patients with NSS and impaired cognition were in the "markedly ill" category of BPRS. A significant association was observed between cognitive deficits, negative symptoms, and NSS in Schizophrenia.NSS and cognitive dysfunctions are integral parts of Schizophrenia symptomdomains and need to be assessed as the negative symptoms and severity of illness are associated with NSS, especially problems with motor coordination and cognitive dysfunctions.

Anodal cerebellar t-DCS impacts skill learning and transfer on a robotic surgery training task

The cerebellum has demonstrated a critical role during adaptation in motor learning. However, the extent to which it can contribute to the skill acquisition of complex real-world tasks remains unclear. One particularly challenging application in terms of motor activities is robotic surgery, which requires surgeons to complete complex multidimensional visuomotor tasks through a remotely operated robot. Given the need for high skill proficiency and the lack of haptic feedback, there is a pressing need for understanding and improving skill development. We investigated the effect of cerebellar transcranial direct current stimulation applied during the execution of a robotic surgery training task. Study participants received either real or sham stimulation while performing a needle driving task in a virtual (simulated) and a real-world (actual surgical robot) setting. We found that cerebellar stimulation significantly improved performance compared to sham stimulation at fast (more demanding) execution speeds in both virtual and real-world training settings. Furthermore, participants that received cerebellar stimulation more effectively transferred the skills they acquired during virtual training to the real world. Our findings underline the potential of non-invasive brain stimulation to enhance skill learning and transfer in real-world relevant tasks and, more broadly, its potential for improving complex motor learning.

Tools and Methods for Diagnosing Developmental Dysgraphia in the Digital Age: A State of the Art.

Handwriting is a complex perceptual motor task that requires years of training and practice before complete mastery. Its acquisition is crucial, since handwriting is the basis, together with reading, of the acquisition of higher-level skills such as spelling, grammar, syntax, and text composition. Despite the correct learning and practice of handwriting, some children never master this skill to a sufficient level. These handwriting deficits, referred to as developmental dysgraphia, can seriously impact the acquisition of other skills and thus the academic success of the child if they are not diagnosed and handled early. In this review, we present a non-exhaustive listing of the tools that are the most reported in the literature for the analysis of handwriting and the diagnosis of dysgraphia. A variety of tools focusing on either the final handwriting product or the handwriting process are described here. On one hand, paper-and-pen tools are widely used throughout the world to assess handwriting quality and/or speed, but no universal gold-standard diagnostic test exists. On the other hand, several very promising computerized tools for the diagnosis of dysgraphia have been developed in the last decade, but some improvements are required before they can be available to clinicians. Based on these observations, we will discuss the pros and cons of the existing tools and the perspectives related to the development of a universal, standardized test of dysgraphia combining both paper-and-pen and computerized approaches and including different graphomotor and writing tasks.

Neuronal substrates of egg-laying behaviour at the abdominal ganglion of Drosophila melanogaster

Egg-laying in Drosophila is the product of post-mating physiological and behavioural changes that culminate in a stereotyped sequence of actions. Egg-laying harbours a great potential as a paradigm to uncover how the appropriate motor circuits are organized and activated to generate behaviour. To study this programme, we first describe the different phases of the egg-laying programme and the specific actions associated with each phase. Using a combination of neuronal activation and silencing experiments, we identify neurons (OvAbg) in the abdominal ganglion as key players in egg-laying. To generate and functionally characterise subsets of OvAbg, we used an intersectional approach with neurotransmitter specific lines—VGlut, Cha and Gad1. We show that OvAbg/VGlut neurons promote initiation of egg deposition in a mating status dependent way. OvAbg/Cha neurons are required in exploration and egg deposition phases, though activation leads specifically to egg expulsion. Experiments with the OvAbg/Gad1 neurons show they participate in egg deposition. We further show a functional connection of OvAbg neurons with brain neurons. This study provides insight into the organization of neuronal circuits underlying complex motor behaviour.

Different pedagogical approaches to motor imagery both demonstrate individualized movement patterns to achieve improved performance outcomes when learning a complex motor skill.

Cognitive training techniques such as motor imagery (MI)-cognitive simulation of movement, has been found to successfully facilitate skill acquisition. The MI literature emphasizes the need to accurately imitate key elements of motor execution to facilitate improved performance outcomes. However, there is a scarcity of MI research investigating how contemporary approaches to motor learning, such as nonlinear pedagogy (NLP), can be integrated into MI practice. Grounded in an ecological dynamics approach to human movement, NLP proposes that skilled action is an emergent process that results from continuous interactions between perceptual information of the environment and movement. This emergent process can be facilitated by the manipulation of key task constraints that aim to encourage learners to explore movement solutions that satisfy individual constraints (e.g., height and weight) and achieve successful performance outcomes. The aim of the present study was to explore the application of a NLP approach to MI approach for skill acquisition. Fourteen weightlifting beginners (two female and 12 male) participated in a 4-week intervention involving either NLP (i.e. analogy-based instructions and manipulation of task constraints) or a linear pedagogy (LP; prescriptive instructions of optimal technique, repetition of same movement form) to learn a complex weightlifting derivative. Performance accuracy, movement criterion (barbell trajectory type), kinematic data, and quantity of exploration/exploitation were measured pre-mid-post intervention. No significant differences (p = .438) were observed in the amount of exploration between LP (EER = 0.41) and NLP (EER = 0.26) conditions. Equivalent changes in rearward displacement (R×D) were observed with no significant differences between conditions for technique assessments 1, 2, or 3 (p = .13 - .67). Both NLP and LP conditions were found to primarily demonstrate 'sub-optimal' type 3 barbell trajectories (NLP = 72%; LP = 54%). These results suggest that MI instructions prescribing a specific movement form (i.e., LP condition) are ineffective in restricting available movements to a prescribed technique but rather the inherent task constraints appear to 'force' learners to explore alternative movement solutions to achieve successful performance outcomes. Although MI instructions prescribing specific techniques have previously supported improved skill development, the current findings indicate that learners may self-organise their movements regardless of MI instructions to satisfy individual and task constraints while achieving improved performance. Therefore, it may be beneficial to consider scripts that are more outcome focused and incorporate task constraints to facilitate learners' inherent exploration of individual task solutions.

Nonlinear Analysis of the Hand and Foot Force-Time Profiles in the Four Competitive Swimming Strokes.

Human locomotion on water depends on the force produced by the swimmer to propel the body forward. Performance of highly complex motor tasks like swimming can yield minor variations that only nonlinear analysis can be sensitive enough to detect. The purpose of the present study was to examine the nonlinear properties of the hand/feet forces and describe their variations across the four competitive swimming strokes performing segmental and full-body swimming. Swimmers performed all-out bouts of 25 m in the four swimming strokes, swimming the full-body stroke, with the arm-pull only and with the leg kicking only. Hand/foot force and swimming velocity were measured. The Higuchi's fractal dimension (HFD) and sample entropy (SampEn) were used for the nonlinear analysis of force and velocity. Both the arm-pull and leg kicking alone were found to produce similar peak and mean hand/foot forces as swimming the full-body stroke. Hand force was more complex in breaststroke and butterfly stroke; conversely, kicking conditions were more complex in front crawl and backstroke. Moreover, the arm-pull and kicking alone tended to be more complex (higher HFD) but more predictable (lower SampEn) than while swimming the full-body stroke. There was no loss of force production from segmental swimming to the full-body counterpart. In conclusion, the number of segments in action influences the nonlinear behavior of the force produced and, when combining the four limbs, the complexity of the hand/foot force tends to decrease.

Implementation and the effects of a Parkinson Network Therapy (PaNTher) on activities of daily living and health-related quality of life in Parkinson’s disease patients: study protocol of an mixed-method observational cohort study in outpatient care

IntroductionParkinson’s disease (PD) represents the fastest growing neurodegenerative disease with an increasing prevalence worldwide. It is characterised by complex motor and non-motor symptoms that lead to considerable disability. Specialised physiotherapy...

Using digital assessment technology to detect neuropsychological problems in primary care settings.

Screening for neurocognitive impairment and psychological distress in ambulatory primary and specialty care medical settings is an increasing necessity. The Core Cognitive Evaluation™ (CCE) is administered/scored using an iPad, requires approximately 8 min, assesses 3- word free recall and clock drawing to command and copy, asks questions about lifestyle and health, and queries for psychological distress. This information is linked with patients' self- reported concerns about memory and their cardiovascular risks. A total of 199 ambulatory patients were screened with the CCE as part of their routine medical care. The CCE provides several summary indices, and scores on 44 individual digital clock variables across command and copy tests conditions. Subjective memory concerns were endorsed by 41% of participants. Approximately 31% of participants reported psychological distress involving loneliness, anxiety, or depression. Patients with self-reported memory concerns scored lower on a combined delay 3- word/ clock drawing index (p < 0.016), the total summary clock drawing command/ copy score (p < 0.050), and clock drawing to command Drawing Efficiency (p < 0.036) and Simple and Complex Motor (p < 0.029) indices. Patients treated for diabetes and atherosclerotic cardiovascular disease (ASCVD) scored lower on selected CCE outcome measures (p < 0.035). Factor analyses suggest that approximately 10 underlying variables can explain digital clock drawing performance. The CCE is a powerful neurocognitive assessment tool that is sensitive to patient's subjective concerns about possible decline in memory, mood symptoms, possible cognitive impairment, and cardiovascular risk. iPad administration ensures total reliability for test administration and scoring. The CCE is easily deployable in outpatient ambulatory primary care settings.

3D muscle networks based on vibrational mechanomyography

Objective. Muscle network modeling maps synergistic control during complex motor tasks. Intermuscular coherence (IMC) is key to isolate synchronization underlying coupling in such neuromuscular control. Model inputs, however, rely on electromyography, which can limit the depth of muscle and spatial information acquisition across muscle fibers. Approach. We introduce three-dimensional (3D) muscle networks based on vibrational mechanomyography (vMMG) and IMC analysis to evaluate the functional co-modulation of muscles across frequency bands in concert with the longitudinal, lateral, and transverse directions of muscle fibers. vMMG is collected from twenty subjects using a bespoke armband of accelerometers while participants perform four hand gestures. IMC from four superficial muscles (flexor carpi radialis, brachioradialis, extensor digitorum communis, and flexor carpi ulnaris) is decomposed using matrix factorization into three frequency bands. We further evaluate the practical utility of the proposed technique by analyzing the network responses to various sensor-skin contact force levels, studying changes in quality, and discriminative power of vMMG. Main results. Results show distinct topological differences, with coherent coupling as high as 57% between specific muscle pairs, depending on the frequency band, gesture, and direction. No statistical decrease in signal strength was observed with higher contact force. Significance. Results support the usability vMMG as a tool for muscle connectivity analyses and demonstrate the use of IMC as a new feature space for hand gesture classification. Comparison of spectrotemporal and muscle network properties between levels of force support the robustness of vMMG-based network models to variations in tissue compression. We argue 3D models of vMMG-based muscle networks provide a new foundation for studying synergistic muscle activation, particularly in out-of-clinic scenarios where electrical recording is impractical.

Regular cannabis use alters the neural dynamics serving complex motor control.

Cannabis is the most widely used recreational drug in the United States and regular use has been linked to deficits in attention and memory. However, the effects of regular use on motor control are less understood, with some studies showing deficits and others indicating normal performance. Eighteen users and 23 nonusers performed a motor sequencing task during high-density magnetoencephalography (MEG). The MEG data was transformed into the time-frequency domain and beta responses (16-24 Hz) during motor planning and execution phases were imaged separately using a beamformer approach. Whole-brain maps were examined for group (cannabis user/nonuser) and time window (planning/execution) effects. As expected, there were no group differences in task performance (e.g., reaction time, accuracy, etc.). Regular cannabis users exhibited stronger beta oscillations in the contralateral primary motor cortex compared to nonusers during the execution phase of the motor sequences, but not during the motor planning phase. Similar group-by-time window interactions were observed in the left superior parietal, right inferior frontal cortices, right posterior insular cortex, and the bilateral motor cortex. We observed differences in the neural dynamics serving motor control in regular cannabis users compared to nonusers, suggesting regular users may employ compensatory processing in both primary motor and higher-order motor cortices to maintain adequate task performance. Future studies will need to examine more complex motor control tasks to ascertain whether this putative compensatory activity eventually becomes exhausted and behavioral differences emerge.

Learning juggling by gradually increasing difficulty vs. learning the complete skill results in different learning patterns.

Motor learning is central to sports, medicine, and other health professions as it entails learning through practice. To achieve proficiency in a complex motor task, many hours of practice are required. Therefore, finding ways to speed up the learning process is important. This study examines the impact of different training approaches on learning three-ball cascade juggling. Participants were assigned to one of two groups: practicing by gradually increasing difficulty and elements of the juggling movement ("learning in parts") or training on the complete skill from the start ("all-at-once"). Results revealed that although the all-at-once group in the early stages of learning showed greater improvement in performance, the "learning in parts" group managed to catch up, even over a relatively short period of time. The lack of difference in performance between the groups at the end of the training session suggests that the choice of training regime (between all-at-once and learning in parts), at least in the short term, can be selected based on other factors such as the learner's preference, practical considerations, and cognitive style.

Pomegranate Extract Administration Reverses Loss of Motor Coordination and Prevents Oxidative Stress in Cerebellum of Aging Mice.

The cerebellum is responsible for complex motor functions, like maintaining balance and stance, coordination of voluntary movements, motor learning, and cognitive tasks. During aging, most of these functions deteriorate, which results in falls and accidents. The aim of this work was to elucidate the effect of a standardized pomegranate extract during four months of supplementation in elderly mice to prevent frailty and improve the oxidative state. Male C57Bl/6J eighteen-month-old mice were evaluated for frailty using the "Valencia Score" at pre-supplementation and post-supplementation periods. We analyzed lipid peroxidation in the cerebellum and brain cortex and the glutathione redox status in peripheral blood. In addition, a set of aging-related genes in cerebellum and apoptosis biomarkers was measured via real-time polymerase chain reaction (RT-PCR). Our results showed that pomegranate extract supplementation improved the motor skills of C57Bl/6J aged mice in motor coordination, neuromuscular function, and monthly weight loss, but no changes in grip strength and endurance were found. Furthermore, pomegranate extract reversed the increase in malondialdehyde due to aging in the cerebellum and increased the reduced glutathione/oxidized glutathione (GSH/GSSG) ratio in the blood. Finally, aging and apoptosis biomarkers improved in aged mice supplemented with pomegranate extract in the cerebellum but not in the cerebral cortex.

FMRI changes during multi-limb movements in Parkinson's disease.

BackgroundWhile motor coordination problems are frequently reported among individuals with Parkinson’s disease (PD), the effects of the disease on the performance of multi-limb movements and the brain changes underlying impaired coordination are not well-documented.ObjectiveFunctional magnetic resonance imaging (fMRI) was used to examine differences in brain activity during a task that involved the coordination of non-homologous limbs (i.e., ipsilateral hand and foot) in individuals with and without PD.MethodsParticipants included 20 PD and 20 healthy control participants (HC). They were instructed to generate force in a coordinated manner by simultaneously contracting their ipsilateral hand and foot. PD were tested off their antiparkinsonian medication and on their more affected side, whereas the side in controls was randomized.ResultsAlthough both groups were able to coordinate the two limbs to produce the expected level of force, PD had a slower rate of force production and relaxation compared to HC. Additionally, their globus pallidus and primary motor cortex were underactive, whereas their pre-supplementary motor area (pre-SMA) and lateral cerebellum were overactive relative to HC. Importantly, in PD, the fMRI activity within the pre-SMA correlated with the rate of force decrease.ConclusionMulti-limb force control deficits in PD appear to be related to widespread underactivation within the basal ganglia-cortical loop. An overactivation of higher-level motor regions within the prefrontal cortex and lateral cerebellum may reflect increased cognitive control and performance monitoring that emerges during more complex motor tasks such as those that involve the coordination of multiple limbs.

Syncopes in adolescents in sport

The study analyzes current data on syncope in children and adolescents. The study presents the classification of syncope and briefly describes the clinical manifestations of neurally mediated syncope and the main methods of its diagnosis and treatment. Syncopes associated with organic cardiac pathologies and primary cardiac arrhythmias are caused by hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, coronary artery anomalies, primary long QT syndrome, WolffParkinsonWhite syndrome, and bradyarrhythmias. The diagnostic features of syncope in children and young athletes and modern approaches to treatment and prevention are discussed.&#x0D; Although most syncopes in athletes are not associated with physical activity and have a neurotransmitter genesis, a thorough medical examination is needed. Factors that induce the development of syncopes in athletes must be identified. A prerequisite for admission to sports is the exclusion of the cardiac and arrhythmogenic reasons of syncopes. The decision to expand the sports regime should be made only after a thorough collection of medical history, including family history, and a comprehensive examination. In addition, the degree of risk in view of injuries, provocation, or fatal events following the loss of consciousness during sports must be estimated. This is extremely relevant for sports such as swimming, complex coordination sports (gymnastics and acrobatics), auto and motor sports, and alpine skiing.&#x0D; Although syncopes are common problems in pediatric practice, with only a few cases with cardiac causes based on structural or primary electrical myocardial diseases, they pose the greatest danger in sports medicine. Thus, such conditions must be excluded in young athletes because sports load can aggravate cardiac pathologies, which cause syncopes, due to untimely diagnosis before the start of a sports career.