Voluntary Wrist Movements Research Articles

Bereitschaftspotential in Multiple System Atrophy.

Objective: Multiple system atrophy (MSA) is a neurodegenerative disorder manifesting as parkinsonism, cerebellar ataxia, and autonomic dysfunction. It is categorized into MSA with predominant parkinsonism (MSA-P) and into MSA with predominant cerebellar ataxia (MSA-C). The pathophysiology of motor control circuitry involvement in MSA subtype is unclear. Bereitschaftspotential (BP) is a feasible clinical tool to measure electroencephalographic activity prior to volitional motions. We recorded BP in patients with MSA-P and MSA-C to investigate their motor cortical preparation and activation for volitional movement.Methods: We included eight patients with MSA-P, eight patients with MSA-C, and eight age-matched healthy controls. BP was recorded during self-paced rapid wrist extension movements. The electroencephalographic epochs were time-locked to the electromyography onset of the voluntary wrist movements. The three groups were compared with respect to the mean amplitudes of early (1,500–500 ms before movement onset) and late (500–0 ms before movement onset) BP.Results: Mean early BP amplitude was non-significantly different between the three groups. Mean late BP amplitude in the two patient groups was significantly reduced in the parietal area contralateral to the movement side compared with that in the healthy control group. In addition, the late BP of the MSA-C group but not the MSA-P group was significantly reduced at the central parietal area compared with that of the healthy control group.Conclusions: Our findings suggest that patients with MSA exhibit motor cortical dysfunction in voluntary movement preparation and activation. The dysfunction can be practicably evaluated using late BP, which represents the cerebello-dentato-thalamo-cortical pathway.

Feasibility of proportional EMG control for a hand exoskeleton: A Fitts’ Law approach

Abstract Although many hand exoskeletons have been developed to provide natural hand movements for patients, extraction of motion intents is one of the challenging issues to perform activities of daily living (ADLs). This paper describes a noninvasive electromyography (EMG)-based proportional control for grasping tasks. To perform grasping tasks in ADLs, three degree of freedoms (DOFs) for thumb adduction/abduction, thumb flexion/extension, and four fingers flexion/extension are required at least. In this work, a 2-D Fitts’ Law test is designed as a suitable alternative of real grasping tasks to perform a real-time EMG control for three DOFs required for grasping. The test setup was built to evaluate a user can generate three commands for direct proportional EMG control. Three EMG signals induced by voluntary wrist and thumb movements were recorded to extract users’ intentions, and each signal was used to activate each degree of freedom in Fitts’ law task. A user was asked to move the cursor into the target using three commands such as cursor right, cursor up, and cursor to the initial position. Healthy subjects were performed our developed interface and the results show that the developed interface performed better than that of our previous study using a pattern recognition method. Although there are several issues remain to be resolved, we expect that proportional EMG control could be used to help SCI or stroke patient for controlling a hand exoskeleton.

Time-course of coherence in the human basal ganglia during voluntary movements.

We are interested in characterizing how brain networks interact and communicate with each other during voluntary movements. We recorded electrical activities from the globus pallidus pars interna (GPi), subthalamic nucleus (STN) and the motor cortex during voluntary wrist movements. Seven patients with dystonia and six patients with Parkinson’s disease underwent bilateral deep brain stimulation (DBS) electrode placement. Local field potentials from the DBS electrodes and scalp EEG from the electrodes placed over the motor cortices were recorded while the patients performed externally triggered and self-initiated movements. The coherence calculated between the motor cortex and STN or GPi was found to be coupled to its power in both the beta and the gamma bands. The association of coherence with power suggests that a coupling in neural activity between the basal ganglia and the motor cortex is required for the execution of voluntary movements. Finally, we propose a mathematical model involving coupled neural oscillators which provides a possible explanation for how inter-regional coupling takes place.

Motor control and position sense: action-perception coupling.

According to previous studies, muscles become active in response to deviations from a threshold (referent) position of body segments. To test the hypothesis that corticospinal pathways set and reset the referent position in a task-specific way, we evaluated corticospinal influences at wrist positions established before and after voluntary motion as well as before and after involuntary motion elicited by the sudden removal of a load. Although tonic electromyogram (EMG) levels at pre- and post-unloading wrist positions were different, the corticospinal influences and thus the referent wrist position remained the same. These influences and the referent position changed, however, when subjects voluntarily moved their wrists to the other position. Thus, referent control strategies underlying the two types of motor actions are fundamentally different. We also tested the hypothesis that somatosensory afferents inform the brain about the deviation (P) of body segments from the centrally set referent position, R. To identify the actual position (Q) of body segments and form the position sense (PS), the central and afferent signals are combined. The PS rule was confirmed by demonstrating that: subjects are able to successfully reproduce involuntary changes in position elicited by sudden unloading of wrist flexors by making voluntary wrist movements; successfully reproduce elbow joint positions under different constant loads; subjects may not be aware of elbow flexion elicited by tendon vibration until a certain limit (no-motion illusion). In conclusion, R and P are additive components of PS and, contrary to conventional assumptions, PS is independent of sense of effort or efference copy.

Model-based prediction of fusimotor activity and its effect on muscle spindle activity during voluntary wrist movements

Muscle spindles provide critical information about movement position and velocity. They have been shown to act as stretch receptors in passive muscle, however, during active movements their behavior is less clear. In particular, spindle responses have been shown to be out-of-phase or phase advanced with respect to their expected muscle length-sensitivity. Whether this apparent discrepancy of spindle responses between passive and active movements is due to fusimotor (γ-drive) remains unresolved, since the activity of fusimotor neurons during voluntary non-locomotor movements are largely unknown. We developed a computational model to predict fusimotor activity and to investigate whether fusimotor activity could explain the empirically observed phase advance of spindle responses. The model links a biomechanical wrist model to length- and γ-drive-dependent transfer functions of type Ia and type II muscle spindle activity. Our simulations of two wrist-movement tasks suggest that (i) experimentally observed type Ia and type II activity profiles can to a large part be explained by appropriate, i.e. strongly modulated and task-dependent, γ-drive. That (ii) the empirically observed phase advance of type Ia or of type II profiles during active movement can be similarly explained by appropriate γ-drive. In summary, the simulation predicts that a highly task-modulated activation of the γ-system is instrumental in producing a large part of the empirically observed muscle spindle activity for voluntary wrist movements.

Model-based prediction of fusimotor activity during active wrist movements

Muscle spindles, whose activity is determined by muscle length changes and by fusimotor drive (i.e. γ-drive), provide critical information about movement position and velocity [1]. However, task-dependent fusimotor drive remains largely unknown [2], since no fusimotor neurons have ever been recorded during active, voluntary upper limb movements, whether in animals nor in humans. So far an estimation of γ-drive could only be obtained through an indirect inference of fusimotor activity from observed muscle spindle activity. Our aim was to model the effect of γ-drive on muscle spindles and to simulate voluntary wrist movements for which the spindle responses are empirically known.

Simple spike activities of Purkinje cells in voluntary wrist movement

Simple spike activities of Purkinje cells in voluntary wrist movement

Direct evidence for a binding between cognitive and motor functions in humans: a TMS study.

During voluntary motor actions, the cortico-spinal (CS) excitability is known to be modulated, on the one hand by cognitive (intention-related) processes and, on the other hand, by motor (performance-related) processes. Here, we studied the way these processes interact in the tuning of CS excitability during voluntary wrist movement. We used transcranial magnetic stimulation (TMS) both as a reliable tool for quantifying the CS excitability, through the motor-evoked potentials (MEPs), and as a central perturbation evoking a movement (because the stimulation intensity was above threshold) with subjects instructed to prepare (without changing their muscle activation) either to "let go" or to "resist" to this evoked movement. We studied the simultaneous evolution of both the motor performance and the MEPs in the wrist flexor and extensor, separately for the successful trials (on average, 66% of the trials whatever the condition) and the unsuccessful trials; this allowed us to dissociate the intention- and performance-related processes. To their great surprise, subjects were found able to cognitively prepare themselves to resist a TMS-induced central perturbation; they all reported an important cognitive effort on the evoked movement. Moreover, because TMS only evoked short-latency MEPs (and no long-latency components), the amplitude of these short-latency MEPs was found to be related in a continuous way to the actual movement whatever the prior intention. These results demonstrate that prior intention allows an anticipatory modulation of the CS excitability, which is not only selective (as already known) but also efficient, giving the intended motor behavior a real chance to be realized. This constitutes a direct evidence of the role of the CS excitability in the binding between cognitive and motor processes in humans.

Firing Properties of Spinal Interneurons during Voluntary Movement. II. Interactions between Spinal Neurons

The relationship between the activity of pairs of simultaneously recorded spinal interneurons (INs) in the cervical enlargement was studied in five monkeys performing voluntary wrist movements. The tendency for INs to exhibit similar response properties and synchronized firing was tested as a function of physical distance between the cells and their correlational linkages with forearm muscles. Nearby INs tended to have more similar torque and direction turning (signal correlation) and more similar response profiles (e.g., tonic vs phasic firing) than INs that were far apart. This suggests that nearby cells receive common synaptic input. In contrast, the trial-to-trial covariation of rate around the mean rate for all trials (noise correlation) was independent of the distance between the neurons. Furthermore, signal and noise correlation were independent, suggesting different underlying mechanisms. Surprisingly, spike-to-spike correlation between INs was relatively infrequent and weak, as measured by cross-correlation histograms. In contrast, single motor units (SMUs) in forearm muscles fired more synchronously, particularly for SMUs in single extensor muscles. Either common drive to INs is too weak to induce synchronized firing, or there is an active decorrelation mechanism within IN networks.

Electromyographic and biomechanical characteristics of segmental postural adjustments associated with voluntary wrist movements. Influence of an elbow support.

This study re-investigates the characteristics of segmental postural adjustments associated with rapid mono-articular movements and analyses their dependence on initial postural conditions. Subjects performed rapid voluntary wrist flexions and extensions while maintaining their upper limb posture as stable as possible, with or without an elbow support. Surface electromyographic activity (EMG) was recorded from Flexor carpi ulnaris, Extensor carpi radialis, Biceps brachii, Triceps brachii and Deltoideus anterior. The kinematics of the three joints and kinetics in the support condition were also recorded. A planar mechanical model was used to determine the muscle torque required to keep the upper limb posture constant while performing wrist movements. All subjects showed anticipatory postural adjustments (APA) which, unlike those described for whole-body postural control, could not counteract in advance the perturbing inter-segmental forces created by the movement. Postural muscles were activated before the wrist movement with a chronology specific to the direction of the wrist movement. Some postural muscular activities anticipated that of the prime-movers in accordance with muscle torque, which had to be applied to the joints to keep the upper limb posture constant. These results reveal that the central nervous system (CNS) uses the same organization of the motor command for the control of both segmental and whole-body posture: APA and corrective postural adjustments (CPA), which are based on well-organized anticipatory postural muscle activities (APMA), except that APA can be non-efficient in segmental postural control. The presence or absence of an elbow support influenced the level of activation of postural muscle but not their chronology. This result suggests that the CNS uses a sequence of APMA: a postural muscle synergy which is predetermined as a function of the intended direction of the movements and modulates the gain towards certain muscles, in accordance with the gravitational effects, and supports reaction changes.

Effects of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potentials in upper limb muscles

To better understand the mechanisms behind proprioceptive neuromuscular facilitation (PNF), an important method in motor rehabilitation, we investigated the effects of assuming a PNF posture relative to a neutral posture on the initiation of voluntary movement (Experiment 1) and the excitability of the motor cortex (Experiment 2) using a wrist extension task. The initiation of voluntary wrist movement was operationalized in terms of the electromyographic reaction time (EMG-RT), and the excitability of the motor cortex in terms of motor evoked potentials (MEPs). Compared to the neutral position, we found that (1) the facilitation position changed the muscle discharge order enhancing the movement efficiency of the joint, (2) the facilitation position led to a reduction in EMG-RT, the magnitude of which depended on the proximity of the muscle to the movement joint, and (3) MEP amplitude increased and MEP latency decreased in the facilitation position as a function of the proximity of the muscle to the joint. These findings corroborate the presumed effects of PNF and provide insights into the neurophysiological mechanisms underlying the PNF method.

Directional tuning of human forearm muscle afferents during voluntary wrist movements.

1. Single unit activity was recorded with the microneurography technique from sixteen spindle afferents and one Golgi tendon organ afferent originating from the forearm extensor muscles. Impulse rates were studied while subjects performed unobstructed aiming movements at the wrist in eight different directions 45 deg apart. In addition, similar imposed movements were performed while the subject was instructed to remain relaxed. Movement amplitudes were about 5 deg and the speed 10-30 deg x s(-1). Joint movements were translated to movements of a cursor on a monitor to provide visual feedback. 2. Individual spindle afferents modulated their activity over a number of targets, i.e. were broadly tuned, during these aiming movements. The preferred direction for a spindle afferent was the same during both passive and active movements, indicating that the fusimotor effects associated with active contractions had little or no effect on the direction of tuning. 3. The direction of tuning of individual spindle afferents could be predicted from the biomechanically inferred length changes of the parent muscle. Thus spindle afferents responded as stretch receptors, i.e. impulse rates increased with lengthening and decreased with shortening, in active as well as passive movements. 4. Spindles from muscles, which continuously counteracted gravity exhibited a stretch response and directional tuning during the phase of movement alone whereas their position sensitivity was poor. In contrast, spindle afferents from the muscles that had no or minimal antigravity role were directionally tuned during both the dynamic and the static phase of the aiming task and their position sensitivity was substantially higher. 5. In spite of the limited data base from three extensor muscles it could be demonstrated that wrist joint position was remarkably well encoded in the ensemble muscle spindle data. In some cases the ensemble muscle spindle data encoded the instantaneous trajectory of movement as well.

Common modulation of motor unit pairs during slow wrist movement in man.

1. The activity of 36 pairs of single motor units were recorded with intramuscular wire electrodes from m. extensor carpi radialis while subjects performed slow wrist extension and flexion movements. Periods of steady position holding were interposed between movements. 2. The discharge trains from pairs of motor units were analysed statistically in the time and frequency domains. During extension movements, when the muscle recorded from was the agonist, coherence between motor units was significant below 12 Hz, with a peak at 6-12 Hz in 30 of 36 pairs (83 %). The magnitude of coherence decreased during position holding compared to movements in 26 pairs, while the difference in average firing rate was small. 3. During movements, but not during position holding, coherence estimates between single motor units and acceleration showed a significant peak at 6-12 Hz in 56 out of 62 motor units, suggesting that a modulation of motor unit discharge contributed to angular acceleration at these frequencies. Common motor unit modulation was present at 3 Hz as well, although the coupling between motor unit activity was weaker than at 6-12 Hz. 4. It is concluded that a 6-12 Hz common modulation of agonist motor units is a distinguishing feature of slow voluntary wrist movements, extending the previously established notion of an 8-10 Hz rhythmic organization of slow finger movements to more proximal limb segments. It is suggested that the 6-12 Hz input is specific for movements and is normally absent or much weaker during steady maintenance of position or force.

Resetting voluntary movement using peripheral nerve stimulation: influence of loading conditions and relative effectiveness.

The effect of peripheral nerve stimulation on voluntary rhythmic flexion-extension movements at the wrist was studied in nine normal volunteers, and the results compared with the effect of cortical stimulation on the same task. In the first part of the study, magnetic stimulation was given over the inner aspect of the right arm at levels which, at rest, resulted in a wrist flexion twitch of at least 10 degrees. We were able to confirm that this form of (peripheral-nerve) stimulation is an effective means of phase-resetting voluntary wrist movements. In addition, and unlike magnetic stimulation applied over the contralateral motor cortex, changes in the standing torque load, against which the subjects moved, had little influence on the effectiveness of this form of stimulation. Similarly, the amplitude and direction of the averaged first post-stimulus position peak ("P1"), previously identified as important determinants of the resetting induced by a cortical stimulus, were largely independent of the loading torque. In a second part to the study, we directly compared, for a constant loading torque, the resetting induced by magnetic cortical stimulation with that following magnetic stimulation of peripheral nerves. The relationship between the amplitude of P1 and the associated resetting index was identical for both forms of stimulation. Our observations indicate that magnetic stimulation of peripheral nerves is an effective means of resetting voluntary movement. It differs from magnetic cortical stimulation in that the effects of peripheral nerve stimulation are little altered by changes in loading torque. When differences in the size of P1 are allowed for, both peripheral nerve and cortical stimulation are equally effective means of resetting voluntary rhythmical movement.

Activity of spinal interneurons and their effects on forearm muscles during voluntary wrist movements in the monkey.

We studied the activity of 577 neurons in the C6-T1 spinal cord of three awake macaque monkeys while they generated visually guided, isometric flexion/extension torques about the wrist. Spike-triggered averaging of electromyographic activity (EMG) identified the units' correlational linkages with </=12 forearm muscles. One hundred interneurons produced changes in the level of average postspike EMG with onset latencies consistent with mono- or oligosynaptic connections to motoneurons; these were classified as premotor interneurons (PreM-INs). Most PreM-INs (82%) produced postspike facilitations in forearm muscles. Earlier spike-related features, often beginning before the trigger spike, were seen in spike-triggered averages from 72 neurons. Postspike effects were present in one muscle for 64% of the PreM-INs. Neurons with divergent linkages to larger "muscle fields" usually generated postspike effects in synergistic muscles. Fifty-eight percent of the PreM-INs had postspike effects in flexor muscles only and 29% in extensor muscles only. Postspike effects were distributed relatively evenly among the primary flexor and extensor muscles studied. The mean percent change in EMG level from baseline and the mean onset latencies for postspike facilitations and postspike suppressions were similar. PreM-INs exhibited a variety of response patterns during the generation of isometric wrist torque. The response patterns and output effects of 24% of the PreM-INs were consistent with a strict reciprocal organization of flexor and extensor muscle control. For another 60% of the PreM-INs, there was a congruent relation between activity and output effects for only one direction of torque production. These neurons were active for both flexion and extension torques, including 37 neurons that exhibited bidirectional increases in discharge rate. The relatively small number of postspike suppressions observed suggests that inhibitory interneurons were silent when their target muscles were recruited. Compared with premotor neurons in the motor cortex, the red nucleus and the C8-T1 dorsal root ganglia, spinal PreM-INs affected flexor muscles in greater proportions and had smaller muscle fields. The magnitudes of postspike facilitations were similar in all premotor populations. Bidirectional activity, common for PreM-INs, was rare for corticomotoneuronal and premotor dorsal root ganglion cells, which discharge only for torques in their preferred direction.

Neuronal activity in the monkey ventrolateral thalamus following perturbations of voluntary wrist movements.

Extracellular single-cell recordings were made from the cerebellar thalamus (89 neurones) and the VPLc (53 neurones) of three conscious monkeys. The animals were trained to perform wrist movement paradigms including: (a) visually triggered skilled, voluntary movements; (b) 100-ms duration torque pulse perturbations applied during a hold period (termed Pa perturbations); (c) 100-ms perturbations that commenced 100 ms after the visual trigger but during preparation before a skilled, voluntary movement (termed Pb perturbations); and (d) 100-ms perturbations during the skilled, voluntary movement (termed Pm perturbations). These Pb and Pm perturbations were used to identify central and peripheral influences on patterns of neuronal discharge in the ventrolateral thalamus. There was no systematic difference between the responses to Pb and Pm perturbations of neurones in the cerebellar thalamus and those in VPLc. The responses of VPLc and cerebellar thalamic neurones to Pa perturbations were considered to represent transduction of peripheral afferent input, and these responses were compared with the responses to the other types of perturbations. Up to 40% of neurones in cerebellar thalamus and VPLc responded to Pb and Pm perturbations in a similar pattern to that which followed Pa perturbations, and therefore most likely represented faithful transduction of peripheral input. However, the response of over half the neurones in VPLc and cerebellar thalamus to Pb or Pm perturbations differed from Pa perturbations in a manner suggesting that central influences had gated the peripheral input. The short-latency response in cerebellar thalamus which was modified by central influences is appropriately timed to contribute to the "intended" response to perturbations of motor cortical neurones.

The bionic glove: An electrical stimulator garment that provides controlled grasp and hand opening in quadriplegia

Objective: This report describes the operation of the Bionic Glove, a new functional electrical stimulation (FES) device designed to improve the function of the paralyzed hand after spinal cord injury (SCI) or stroke. Design: Signals from a sensor in the glove detecting voluntary wrist movement are used to control FES of muscles either to produce hand-grasp or to open the hand. When the glove is donned, conductive areas on its inside surface automatically make contact with self-adhesive electrodes on the skin. Setting and Patients: This report concerns nine people with SCI who have used the device in their daily lives for up to a year or more. Measurements were made at clinics in Edmonton, Miami, and Chicago as part of a multicenter clinical trial. Outcome Measures and Results: The mean peak force of tenodesis grasp in the nine subjects increased from 2.6N (passive) to 11.3N (glove active). Active force was significantly greater than passive grasp force even when muscles were fatigued after repetitive grasp-release cycles. Most manual tasks improved significantly with the use of the glove, as judged by the number of tasks completed in a minute or the subjects' qualitative ratings of task difficulty. Conclusion: The Bionic Glove can provide significant improvement of hand function in people with C6-C7 SCI.

The relationship between monkey ventrolateral thalamic nucleus activity and kinematic parameters of wrist movement

Extracellular recordings were made from single neurones in the cerebellar thalamus (75 neurones) and the VPLc (44 neurones) of four conscious moving monkeys. The experiment was designed to establish whether the discharge of ventrolateral thalamic neurones encodes information about kinematic parameters. The animals were trained to resist unexpected perturbations of the wrist and to perform skilled, voluntary wrist movements, producing stereotyped reflex and active movements with a wide range of durations and amplitudes. Statistical analysis of the discharge pattern associated with individual trials of movement was performed. In various maintained wrist positions there was a significant correlation (P < 0.05) between frequency of tonic discharge and joint position in 40% of the cerebellar thalamic neurones and in 54% of VPLc neurones. The phasic neuronal discharge associated with stereotyped movement often appeared ‘velocity or acceleration-like’. However, statistical analyses revealed that the phasic discharge of only a small percentage of cerebellar thalamic and VPLc neurones was correlated with duration of movement, peak velocity or acceleration. The percentage of cerebellar thalamic neurones with discharge correlated to kinematic parameters was much greater when an unexpected change in the gain between joint angle and screen display led to errors in tracking the target. It is concluded that the cerebelao-thalamo-cortical (CTC) pathway carries information regarding maintained joint position but not velocity or acceleration of movement during a stereotyped task. However, the CTC pathway has a greater capacity to signal information about movement velocity and acceleration when there is a mismatch between the intended and actual movement.

The relationship between monkey ventrolateral thalamic nucleus activity and kinematic parameters of wrist movement

Extracellular recordings were made from single neurones in the cerebellar thalamus (75 neurones) and the VPLc (44 neurones) of four conscious moving monkeys. The experiment was designed to establish whether the discharge of ventrolateral thalamic neurones encodes information about kinematic parameters. The animals were trained to resist unexpected perturbations of the wrist and to perform skilled, voluntary wrist movements, producing stereotyped reflex and active movements with a wide range of durations and amplitudes. Statistical analysis of the discharge pattern associated with individual trials of movement was performed. In various maintained wrist positions there was a significant correlation ( P < 0.05) between frequency of tonic discharge and joint position in 40% of the cerebellar thalamic neurones and in 54% of VPLc neurones. The phasic neuronal discharge associated with stereotyped movement often appeared ‘velocity or acceleration-like’. However, statistical analyses revealed that the phasic discharge of only a small percentage of cerebellar thalamic and VPLc neurones was correlated with duration of movement, peak velocity or acceleration. The percentage of cerebellar thalamic neurones with discharge correlated to kinematic parameters was much greater when an unexpected change in the gain between joint angle and screen display led to errors in tracking the target. It is concluded that the cerebelao-thalamo-cortical (CTC) pathway carries information regarding maintained joint position but not velocity or acceleration of movement during a stereotyped task. However, the CTC pathway has a greater capacity to signal information about movement velocity and acceleration when there is a mismatch between the intended and actual movement.

Modification of motor control of wrist extension by mesh-glove electrical afferent stimulation in stroke patients

Objective: To study the effect of mesh-glove afferent stimulation on motor control of voluntary wrist movement in stroke patients who have chronic neurological deficits. Design: Case series. Motor control was evaluated by surface EMG of the arm muscles and kinematics of voluntary wrist movements on 3 occasions: before and immediately after the initial session of mesh-glove stimulation, and then after a daily mesh-glove stimulation program conducted over several months. Setting: Tertiary care center. Patients: The inclusion criteria were: a history of stroke lasting longer than 6 months; completion of a rehabilitation program during early recovery; and preserved cognitive and communicative ability. Fourteen referred patients (age 63 ± 9yr; time since stroke 31 ± 22 mo) fulfilled the criteria and completed the daily stimulation program. Intervention: A single initial and then daily mesh-glove electrical afferent stimulation was applied to the hand of the involved upper limb for 20 to 30min. Main Outcome Measures: Surface EMGs from the affected biceps brachii and wrist extensor muscles and amplitudes of wrist movements were analyzed. Results: The single, initial mesh-glove application had no effect on outcome measures. Following a daily mesh-glove stimulation program, however, both the amplitude of wrist extension movement and wrist extensor integrated EMG were significantly increased while coactivation of biceps brachii decreased. These findings were most prominent in subjects with partially preserved voluntary wrist movements. Conclusion: We conclude that daily mesh-glove stimulation can modify altered motor control and improve voluntary wrist extension movement in stroke subjects with chronic neurological deficits.