Non-perturbed Trials Research Articles

Efficacy of shock wave therapy and ultrasound therapy in non-insertional Achilles tendinopathy: a randomised clinical trial.

Physiotherapists and physicians continue to seek effective conservative treatments for Achilles tendinopathy. This study aimed to subjectively and objectively determine the therapeutic efficacy of radial shock wave therapy (RSWT) and ultrasound therapy in non-insertional Achilles tendinopathy. Thirty-nine patients with non-insertional Achilles tendinopathy were randomly assigned to three experimental groups, i.e., RSWT (group A), ultrasound therapy (group B), and placebo ultrasound (group C) groups. Before the intervention and at weeks 1 and 6 after the treatment, the patients were assessed using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire and posturographic measurements of step initiation performed on the force platforms under two different conditions (non-perturbed transit and perturbed transit). Six weeks after therapy, all groups exhibited significantly increased VISA-A scores against the measurement at week 1 after therapy. The post-therapy percentage changes in VISA-A scores were significantly greater in group A compared to group B. The three-way ANOVA demonstrated that treatment type affected sway range in the frontal plane and mean velocity of the centre of foot pressure displacements in the sagittal and frontal planes during quiet standing before step initiation. The Bonferroni post-hoc test showed that the means of all those variables were significantly smaller for group A than for group B patients. The three-way ANOVA revealed an effect of the platform arrangement on transit time and double-support period. The Bonferroni post-hoc test revealed statistically longer transit time for the perturbed vs. non-perturbed trials; a reverse relationship was observed for the double-support period. The VISA-A showed that RSWT was significantly more effective than sonotherapy for alleviation of pain intensity as well as function and activity improvement in patients with non-insertional Achilles tendinopathy. Therefore, RSWT therapy can be used in clinical practice by physiotherapists to alleviate the symptoms of non-insertional Achilles tendinopathy. Objective data registered by force platforms during quiet standing before and after step initiation did not prove useful for monitoring the progress of treatment applied to patients with non-insertional Achilles tendinopathy between consecutive therapy interventions.Clinical trial registration:https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617000860369, identifier (ACTRN12617000860369).

Dynamics in interbrain synchronization while playing a piano duet.

Humans interact with each other through actions that are implemented by sensory and motor processes. To investigate the role of interbrain synchronization emerging during interpersonal action coordination, electroencephalography data from 13 pairs of pianists were recorded simultaneously while they performed a duet together. The study aimed to investigate whether interbrain phase couplings can be reduced to similar bottom-up driven processes during synchronous play, or rather represent cognitive top-down control required during periods of higher coordination demands. To induce such periods, one of the musicians acted as a confederate who deliberately desynchronized the play. As intended, on the behavioral level, the perturbation caused a breakdown in the synchronization of the musicians' play and in its stability across trials. On the brain level, interbrain synchrony, as measured by the interbrain phase coherence (IPC), increased in the delta and theta frequency bands during perturbation as compared to non-perturbed trials. Interestingly, this increase in IPC in the delta band was accompanied by the shift of the phase difference angle from in-phase toward anti-phase synchrony. In conclusion, the current study demonstrates that interbrain synchronization is based on the interpersonal temporal alignment of different brain mechanisms and is not simply reducible to similar sensory or motor responses.

Assessing Balance Loss and Stability Control in Older Adults Exposed to Gait Perturbations under Different Environmental Conditions: A Feasibility Study

This study investigated the feasibility of a perturbation-based balance protocol that incorporates a novel computer-controlled movable platform, the Surefooted Trainer, to induce losses of balance during overground walking under various environmental conditions. Twenty apparently healthy older adults (66.7 ± years old) participated in this study. The acceptability and safety of the perturbation-based balance protocol were assessed by tracking adherence, adverse events, and subjective physical and mental demands after the intervention. Additionally, biomechanical variables during perturbed and non-perturbed trials were analyzed and compared with behavioral outcomes. Overall, 95% of the participants completed the study. There were no serious or non-serious adverse events. The margin of stability and step length after perturbations were significantly lower during slip-perturbations in which the environmental conditions were more challenging. For trip-perturbation conditions, the maximum trunk angle was higher during the trials that resulted in losses of balance. We conclude that the Surefooted Trainer is an acceptable and valid device for an overground walking perturbation-based assessment and training protocol in older adults.

Exposure to trips and slips with increasing unpredictability while walking can improve balance recovery responses with minimum predictive gait alterations.

IntroductionThe primary study aim was to determine if repeated exposure to trips and slips with increasing unpredictability while walking can improve balance recovery responses when predictive gait alterations (e.g. slowing down) are minimised. The secondary aim was to determine if predictive gait alterations acquired through exposure to perturbations at a fixed condition would transfer to highly unpredictable conditions.MethodsTen young adults were instructed to step on stepping tiles adjusted to their usual step length and to a metronome adjusted to their usual cadence on a 10-m walkway. Participants were exposed to a total of 12 slips, 12 trips and 6 non-perturbed trials in three conditions: 1) right leg fixed location, 2) left leg fixed location and 3) random leg and location. Kinematics during non-perturbed trials and pre- and post-perturbation steps were analysed.ResultsThroughout the three conditions, participants walked with similar gait speed, step length and cadence(p>0.05). Participants’ extrapolated centre of mass (XCoM) was anteriorly shifted immediately before slips at the fixed location (p<0.01), but this predictive gait alteration did not transfer to random perturbation locations. Improved balance recovery from trips in the random location was indicated by increased margin of stability and step length during recovery steps (p<0.05). Changes in balance recovery from slips in the random location was shown by reduced backward XCoM displacement and reduced slip speed during recovery steps (p<0.05).ConclusionsEven in the absence of most predictive gait alterations, balance recovery responses to trips and slips were improved through exposure to repeated unpredictable perturbations. A common predictive gait alteration to lean forward immediately before a slip was not useful when the perturbation location was unpredictable. Training balance recovery with unpredictable perturbations may be beneficial to fall avoidance in everyday life.

Coordination of pincer grasp and transport after mechanical perturbation of the index finger.

Our understanding of reach-to-grasp movements has evolved from the original formulation of the movement as two semi-independent visuomotor channels to one of interdependence. Despite a number of important contributions involving perturbations of the reach or the grasp, some of the features of the movement, such as the presence or absence of coordination between the digits during the pincer grasp and the extent of spatio-temporal interdependence between the transport and the grasp, are still unclear. In this study, we physically perturbed the index finger into extension during grasping closure on a minority of trials to test whether modifying the movement of one digit would affect the movement of the opposite digit, suggestive of an overarching coordinative process. Furthermore, we tested whether disruption of the grasp results in the modification of kinematic parameters of the transport. Our results showed that a continuous perturbation to the index finger affected wrist velocity but not lateral displacement. Moreover, we found that the typical flexion of the thumb observed in nonperturbed trials was delayed until the index finger counteracted the extension force. These results suggest that physically perturbing the grasp modifies the kinematics of the transport component, indicating a two-way interdependence of the reach and the grasp. Furthermore, a perturbation to one digit affects the kinematics of the other, supporting a model of grasping in which the digits are coordinated by a higher-level process rather than being independently controlled.NEW & NOTEWORTHY A current debate concerning the neural control of prehension centers on the question of whether the digits in a pincer grasp are controlled individually or together. Employing a novel approach that perturbs mechanically the grasp component during a natural reach-to-grasp movement, this work is the first to test a key hypothesis: whether perturbing one of the digits during the movement affects the other. Our results support the idea that the digits are not independently controlled.

Primate superior colliculus neurons activated by unexpected sensation.

Midbrain superior colliculus (SC) contains a variety of neuronal types, influencing a rich spectrum of functions beyond gaze orienting. Here, we report on a novel class of SC neurons in the rhesus monkey (Macaca mulatta) that are activated by an unexpected perturbation in a goal-directed arm-movement task. One monkey subject reached for and pressed an illuminated target on a working panel upon a visual go-signal, while maintaining visual fixation elsewhere. On 50% of trials, a task perturbation occurred-the working panel abruptly and unexpectedly moved against the subject's hand after he pressed the target. During the performance, we recorded single SC neurons and found neurons activated exclusively for the task perturbation. These perturbation neurons were localized in the deep lateral zone of the SC, were silent during non-perturbed trials, did not appear to respond to task-irrelevant stimuli, and they had intriguingly long neuronal latencies. If the perturbation neurons' activity relates to the hand-target contact, it may reflect the saliency of an unexpected sensation, i.e. a sensation that is not self-induced and thus cannot be predicted on a basis of the monkey's motor program.

Perturbations in Action Goal Influence Bimanual Grasp Posture Planning

ABSTRACT The authors examined the effects of perturbations in action goal on bimanual grasp posture planning. Sixteen participants simultaneously reached for 2 cylinders and placed either the left or the right end of the cylinders into targets. As soon as the participants began their reaching movements, a secondary stimulus was triggered, which indicated whether the intended action goal for the left or right hand had changed. Overall, the tendency for a single hand to select end-state comfort compliant grasp postures was higher for the nonperturbed condition compared to both the perturbed left and perturbed right conditions. Furthermore, participants were more likely to plan their movements to ensure end-state comfort for both hands during nonperturbed trials, than perturbed trials, especially object end-orientation conditions that required the adoption of at least one underhand grasp posture to satisfy bimanual end-state comfort. Results indicated that when the action goal of a single object was perturbed, participants attempted to reduce the cognitive costs associated with grasp posture replanning by maintaining the original grasp posture plan, and tolerating grasp postures that result in less controllable final postures.

Corrections in Grasp Posture in Response to Modifications of Action Goals

There is ample evidence that people plan their movements to ensure comfortable final grasp postures at the end of a movement. The end-state comfort effect has been found to be a robust constraint during unimanual movements, and leads to the inference that goal-postures are represented and planned prior to movement initiation. The purpose of this study was to examine whether individuals make appropriate corrections to ensure comfortable final goal postures when faced with an unexpected change in action goal. Participants reached for a horizontal cylinder and placed the left or right end of the object into the target disk. As soon as the participant began to move, a secondary stimuli was triggered, which indicated whether the intended action goal had changed or not. Confirming previous research, participants selected initial grasp postures that ensured end-state comfort during non-perturbed trials. In addition, participants made appropriate on-line corrections to their reach-to-grasp movements to ensure end-state comfort during perturbed trials. Corrections in grasp posture occurred early or late in the reach-to-grasp phase. The results indicate that individuals plan their movements to afford comfort at the end of the movement, and that grasp posture planning is controlled via both feedforward and feedback mechanisms.

Unpredictable elbow joint perturbation during reaching results in multijoint motor equivalence

Motor equivalence expresses the idea that movement components reorganize in the face of perturbations to preserve the value of important performance variables, such as the hand's position in reaching. A formal method is introduced to evaluate this concept quantitatively: changes in joint configuration due to unpredictable elbow perturbation lead to a smaller change in performance variables than expected given the magnitude of joint configuration change. This study investigated whether motor equivalence was present during the entire movement trajectory and how magnitude of motor equivalence was affected by constraints imposed by two different target types. Subjects pointed to spherical and cylindrical targets both with and without an elbow joint perturbation produced by a low- or high-stiffness elastic band. Subjects' view of their arm was blocked in the initial position, and the perturbation condition was randomized to avoid prediction of the perturbation or its magnitude. A modification of the uncontrolled manifold method variance analysis was used to investigate how changes in joint configuration on perturbed vs. nonperturbed trials (joint deviation vector) affected the hand's position or orientation. Evidence for motor equivalence induced by the perturbation was present from the reach onset and increased with the strength of the perturbation after 40% of the reach, becoming more prominent as the reach progressed. Hand orientation was stabilized more strongly by motor equivalent changes in joint configuration than was three-dimensional position regardless of the target condition. Results are consistent with a recent model of neural control that allows for flexible patterns of joint coordination while resisting joint configuration deviations in directions that affect salient performance variables. The observations also fit a general scheme of synergic control with referent configurations defined across different levels of the motor hierarchy.

Dopamine replacement therapy does not restore the ability of Parkinsonian patients to make rapid adjustments in motor strategies according to changing sensorimotor contexts

The ability of dopamine replacement to restore rapid motor adjustments in Parkinson's disease (PD) was investigated. Medicated and non-medicated patients performed finger-to-nose movements while simultaneously bending the trunk forward, without vision. Trunk motion was blocked unexpectedly, necessitating rapid adjustments in arm trajectories. Patients exhibited irregular hand paths, plateaus in hand velocity, and prolonged movement times, which were significantly greater in perturbed trials. Medication improved kinematics but perturbation-induced disturbances persisted and did not approximate the levels of non-perturbed trials nor those of controls. Dopaminergic replenishment in PD may therefore have limited restorative benefits for rapid context-specific motor control.

Sequential control signals determine arm and trunk contributions to hand transport during reaching in humans.

When reaching towards objects placed outside the arm workspace, the trunk assumes an active role in transport of the hand by contributing to the extent of movement while simultaneously maintaining the direction of reach. We investigated the spatial-temporal aspects of the integration of the trunk motion into reaching. Specifically, we tested the hypothesis that the efficiency ('gain') of the arm-trunk co-ordination determining the contribution of the trunk to the extent of hand movement may vary substantially with the phase of reaching. Sitting subjects made fast pointing movements towards ipsi- and a contralateral targets placed beyond the reach of the right arm so that a forward trunk motion was required to assist in transporting the hand to the target. Sight of the arm and target was blocked before the movement onset. In randomly selected trials, the trunk motion was unexpectedly prevented by an electromagnet. Subjects were instructed to make stereotypical movements whether or not the trunk was arrested. In non-perturbed trials, most subjects began to move the hand and trunk simultaneously. In trunk-blocked trials, it was impossible for the hand to cover the whole pointing distance but the hand trajectory and velocity profile initially matched those from the trials in which the trunk motion was free, approximately until the hand reached its peak velocity. The arm inter-joint co-ordination substantially changed in response to the trunk arrest at a minimal latency of 40 ms after the perturbation onset. The results suggest that when the trunk was free, the influence of the trunk motion on the hand trajectory and velocity profile was initially neutralized by appropriate changes in the arm joint angles. Only after the hand had reached its peak velocity did the trunk contribute to the extent of pointing. Previous studies suggested that the central commands underlying the transport component of arm movements are completed when the hand reaches peak velocity. These studies, together with the present finding that the trunk only begins to contribute to the hand displacement at peak hand velocity, imply that the central commands that determine the contributions of the arm and the trunk to the transport of the hand are generated sequentially, even though the arm and trunk move in parallel.

Mechanical perturbation of the wrist during one-handed catching

In the present study, the co-ordination of grasp and transport components of one-handed catching was examined following mechanical perturbations applied to the wrist. Six skilled catchers (mean age=27.5 years) performed 64 trials in which tennis balls were projected at approximately 8 m s −1. The trial blocks consisted of 10 non-perturbed trials (NPTs) (baseline), and a block of 54 trials of which 20 trials were perturbed. The perturbation was in the form of a resistive force (12 N) applied via a piece of cord attached to a mechanical brake. In baseline trials participants reached maximal wrist velocity closer to the time of hand–ball contact (237 ms ± 68) than in the perturbed (309 ms ± 61) condition. Furthermore the wrist velocity profile of five out of six participants exhibited a double peak immediately after a perturbation. However, aperture variables such as the relative moment of final hand closure (approximately 70% of overall movement time) were not typically affected. The stability of grasp and transport coupling for one-handed catching was shown to vary from trial to trial. Skilled performers exploited redundant degrees of freedom in the motor system when faced with a sudden, unexpected change in task constraints.

The reach-to-grasp movement in Parkinson's disease: response to a simultaneous perturbation of object position and object size.

This study assessed the adaptive response of the reach-to-grasp movement of 12 Parkinson's disease (PD) and 12 control subjects to a simultaneous perturbation of target object location and size. The main aim was to test further the reported dysfunction of PD subjects in the simultaneous activation of movement components. Participants were required to reach 30 cm to grasp a central illuminated cylinder of either small (0.7 cm) or large (8 cm) diameter. For a small percentage of trials (20/100) a visual perturbation was introduced unexpectedly at the onset of the reaching action. This consisted of a shift of illumination from the central cylinder to a cylinder of differing diameter, which was positioned 20 degrees to the left (n = 10) or to the right (n = 10). The subject was required to grasp the newly illuminated cylinder. For the Parkinson's disease subject group, the earliest response to this 'double' perturbation was in the parameter of peak reaching acceleration, which was on average 50 ms earlier for 'double' perturbed than for non-perturbed trials. The grasp component response followed more than 500 ms after the earliest transport response. For the control subjects initial signs of a response to the 'double' perturbation were seen almost simultaneously in the transport parameter of peak arm deceleration, and in the manipulation parameter of maximum grip aperture, but these changes were not evident until more than 400 ms after movement onset. These results indicate that the basal ganglia can be identified as part of a circuit which is involved in the integration of parallel neutral pathways, and which exercise flexibility in the degree to which these components are 'coupled' functionally. With basal ganglia dysfunction the activation of integration centres that at first gate the flow of information to the parallel channels of reach and grasp seems inefficient.

Reorganization of prehension components following perturbation of object size.

This study provides a kinematic comparison of the response of 12 older persons (ages 60-70) and 12 young persons (ages 20-26) to a perturbation of object size during a reach-to-grasp movement. For 80 out of 100 trials, each participant reached to grasp an illuminated cylinder of either small or large diameter (0.7 and 8.0 cm, respectively). For 20 out of 100 trials, a visual perturbation occurred at movement onset. This perturbation consisted of a switch of illumination from 1 to the other cylinder. For the switch from large to small cylinder, participants changed the distal grasp from whole-hand prehension to precision grip. For the opposite switch, participants changed from precision grip to whole-hand prehension. The older participants successfully adapted to these perturbations but showed a more conservative approach. Generally the approach time as the hand neared the object was prolonged, and the coordination between transport and manipulation components was maintained when comparing perturbed with nonperturbed trials. Young participants showed a more flexible pattern with a decrease or loss of temporal coupling between the components. It is hypothesized that the more rigid movement pattern of older participants to unanticipated motor requirements could be a contributory factor to the higher incidence of accidents for this group.

Parkinson's disease: reorganization of the reach to grasp movement in response to perturbation of the distal motor patterning

This study assessed the kinematic changes to the reach to grasp movement in response to a perturbation of object size in 15 Parkinson's disease (PD) and 15 control subjects. For non-perturbed trials subjects reached 35 cm to grasp and lift either an illuminated small (0.7 cm) or large (8 cm) diameter cylinder. For perturbed trials (20%), illumination shifted unexpectedly from the small to the large or from the large to the small cylinder at the onset of the reach. For Condition One trials subjects were given no instructions as to which grasp to use. With perturbation, they thus naturally changed grasp from precision grip to whole hand prehension or vice versa. The results for the PD subjects indicated a slowness at the transition from one to another grasp. This contrasted to the smooth transitions when perturbation required only a change of grasp aperture (precision grip—Condition Two; whole hand prehension—Condition Three). PD subjects thus showed dysfunction in the suppression/activation of different grasp programs rather than deficits in the on-line modification of an operating program.

Selective perturbation of visual input during prehension movements

Prehension involves processing information in two hypothesized visuomotor channels: one for extrinsic object properties (e.g., the spatial location of objects) and one for intrinsic objects properties (e.g., shape and size). The present study asked how the two motor components that correspond to these channels (transport and grasp, respectively) are related. One way to address this question is to create a situation where unexpected changes occur at the input level of one of the visuomotor channels, and to observe how the movement reorganizes. If transport and grasp are independent components, then changing the object location, for example, should affect only the transport, not the grasp component. Subjects were requested to reach, grasp and lift as accurately as possible one of three dowels using the distal pads of the thumb and index finger. On certain trials, upon movement initiation towards the middle dowel, the dowel was made to instantaneously change its location to one of the two other positions, requiring the subject to reorient the hand to the new dowel location. Results consisted of comparing the movement characteristics of the transport and grasp components of these perturbed movements with appropriate control movements. Kinematics of the wrist trajectory showed fast adjustments, within 100 ms, to the change of dowel position. This duration seems to correspond to the minimum delay required within the visuomotor system for visual and/or proprioceptive reafferents to influence the ongoing movement. In addition, these delays are much shorter than has been found for conditions where object location changes before movement initiation (approximately 300 ms). The faster times may relate to the dynamic character of the deviant limb position signals, with the only constraint being the physiological delays for visual and kinaesthetic signals to influence the movement. A spatiotemporal variability analysis of the movement trajectories for non-perturbed trials showed variability to be greatest during the acceleration part of the movement, interpreted as due to control by a relatively inaccurate directional coding mechanism. Control during the deceleration phase, marked by low trajectory variability, was seen to be due to a sensorimotor process, using motor output signals, and resulting in an optimized trajectory supporting a successful grasp. Analysis of the grasp component of prehension showed that perturbing object location influenced the movement of the fingers suggesting a kinematic coupling of the two components. However, forthcoming work shows that, when object size changes, and location remains constant, there is a clear temporal dissociation of the two components of prehension.(ABSTRACT TRUNCATED AT 400 WORDS)