Andrzej Przybyla

Contralesional motor deficits after unilateral stroke reflect hemisphere-specific control mechanisms

We have proposed a model of motor lateralization, in which the left and right hemispheres are specialized for different aspects of motor control: the left hemisphere for predicting and accounting for limb dynamics and the right hemisphere for stabilizing limb position through impedance control mechanisms. Our previous studies, demonstrating different motor deficits in the ipsilesional arm of stroke patients with left or right hemisphere damage, provided a critical test of our model. However, motor deficits after stroke are most prominent on the contralesional side. Post-stroke rehabilitation has also, naturally, focused on improving contralesional arm impairment and function. Understanding whether contralesional motor deficits differ depending on the hemisphere of damage is, therefore, of vital importance for assessing the impact of brain damage on function and also for designing rehabilitation interventions specific to laterality of damage. We, therefore, asked whether motor deficits in the contralesional arm of unilateral stroke patients reflect hemisphere-dependent control mechanisms. Because our model of lateralization predicts that contralesional deficits will differ depending on the hemisphere of damage, this study also served as an essential assessment of our model. Stroke patients with mild to moderate hemiparesis in either the left or right arm because of contralateral stroke and healthy control subjects performed targeted multi-joint reaching movements in different directions. As predicted, our results indicated a double dissociation; although left hemisphere damage was associated with greater errors in trajectory curvature and movement direction, errors in movement extent were greatest after right hemisphere damage. Thus, our results provide the first demonstration of hemisphere specific motor control deficits in the contralesional arm of stroke patients. Our results also suggest that it is critical to consider the differential deficits induced by right or left hemisphere lesions to enhance post-stroke rehabilitation interventions.

Dynamic dominance varies with handedness: reduced interlimb asymmetries in left-handers

Our previous studies of interlimb asymmetries during reaching movements have given rise to the dynamic-dominance hypothesis of motor lateralization. This hypothesis proposes that dominant arm control has become optimized for efficient intersegmental coordination, which is often associated with straight and smooth hand-paths, while non-dominant arm control has become optimized for controlling steady-state posture, which has been associated with greater final position accuracy when movements are mechanically perturbed, and often during movements made in the absence of visual feedback. The basis for this model of motor lateralization was derived from studies conducted in right-handed subjects. We now ask whether left-handers show similar proficiencies in coordinating reaching movements. We recruited right- and left-handers (20 per group) to perform reaching movements to three targets, in which intersegmental coordination requirements varied systematically. Our results showed that the dominant arm of both left- and right-handers were well coordinated, as reflected by fairly straight hand-paths and low errors in initial direction. Consistent with our previous studies, the non-dominant arm of right-handers showed substantially greater curvature and large errors in initial direction, most notably to targets that elicited higher intersegmental interactions. While the right, non-dominant, hand-paths of left-handers were slightly more curved than those of the dominant arm, they were also substantially more accurate and better coordinated than the non-dominant arm of right-handers. Our results indicate a similar pattern, but reduced lateralization for intersegmental coordination in left-handers. These findings suggest that left-handers develop more coordinated control of their non-dominant arms than right-handers, possibly due to environmental pressure for right-handed manipulations.

Aging reduces asymmetries in interlimb transfer of visuomotor adaptation

Hemispheric asymmetry reduction in older adults (HAROLD) has been reported in previous imaging studies that employed not only cognitive, but also motor tasks. However, whether age-related reductions in asymmetry of hemispheric activations affect the symmetry of motor behavior in older adults remains largely untested. We now examine the effect of aging on lateralization of motor adaptation and transfer by investigating adaptation to novel visuomotor transformations in both old and young age groups. We have previously reported substantial asymmetries in interlimb transfer of learning these transformations in young adults, and attributed these asymmetries in transfer to hemispheric lateralization for motor control, as detailed by our dynamic dominance hypothesis. Based on the HAROLD model, we reasoned that older adults should recruit more symmetrical hemispheric activity, and thus show more symmetrical transfer of adaptation across the arms. Half of the subjects in each age group first adapted to a rotated visual display with the left arm, then with the right arm; and the other half in the reversed order. Naïve performance with one arm and the same-arm performance following opposite arm adaptation were compared to determine the extent of transfer in each age group. Our results showed that interlimb transfer of initial direction information only occurred from the nondominant to dominant arm in young adults, whereas it occurred in both directions in older adults. Our findings clearly indicate substantially reduced asymmetry in visuomotor adaptation in older adults, and suggest that this reduced motor asymmetry might be related to diminished hemispheric lateralization for motor control.

Strength of the Cervical Spine in Compression and Bending

Study Design. Cadaveric motion segment experiment. Objectives. To compare the strength in bending and compression of the human cervical spine and to investigate which structures resist bending the most. Summary of Background Data. The strength of the cervical spine when subjected to physiologically reasonable complex loading is unknown, as is the role of individual structures in resisting bending. Methods. A total of 22 human cervical motion segments, 64 to 89 years of age, were subjected to complex loading in bending and compression. Resistance to flexion and to extension was measured in consecutive tests. Sagittal-plane movements were recorded at 50 Hz using an optical two-dimensional “MacReflex” system. Experiments were repeated 1) after surgical removal of the spinous process, 2) after removal of both apophyseal joints, and 3) after the disc-vertebral body unit had been compressed to failure. Results were analyzed using t tests, analysis of variance, and linear regression. Results were compared with published data for the lumbar spine. Results. The elastic limit in flexion was reached at 8.5° (SD, 1.7°) with a bending moment of 6.7 Nm (SD, 1.7 Nm). In extension, values were 9.5° (SD, 1.6°) and 8.4 Nm (3.5 Nm), respectively. Spinous processes (and associated ligaments) provided 48% (SD, 17%) of the resistance to flexion. Apophyseal joints provided 47% (SD, 16%) of the resistance to extension. In compression, the disc-vertebral body units reached the elastic limit at 1.23 kN (SD, 0.46 Nm) and their ultimate compressive strength was 2.40 kN (SD, 0.96 kN). Strength was greater in male specimens, depended on spinal level and tended to decrease with age. Conclusions. The cervical spine has approximately 20% of the bending strength of the lumbar spine but 45% of its compressive strength. This suggests that the neck is relatively vulnerable in bending.

Sensorimotor performance asymmetries predict hand selection

Handedness is most often measured by questionnaires that assess an individuals preference for using a particular hand to perform a variety of tasks. While such assessments have proved reliable, they do not address the underlying neurobehavioral processes that give rise to the choice of which hand to use. Recent research has indicated that handedness is associated with hemispheric specializations for different aspects of sensorimotor performance. We now hypothesize that an individuals choice of which hand to use for a given task should result from an interaction between these underlying neurobehavioral asymmetries with task conditions. We test this hypothesis by manipulating two factors in targeted reaching movements: (1) region of workspace and (2) visual feedback conditions. The first manipulation modified the geometric and dynamic requirements of the task for each arm, whereas the second modified the sensorimotor performance asymmetries, an effect predicted by previous literature. We expected that arm choice would be reflected by an interaction between these factors. Our results indicated that removing visual feedback both improved the relative performance of the non-dominant arm and increased the choice to use this arm for targets near midline, an effect that was enhanced for targets requiring larger movement amplitudes. We explain these findings in the context of the dynamic dominance hypothesis of handedness and discuss their implications for the link between hemispheric asymmetries in neural control and hand preference.

Preferred directions of arm movements are independent of visual perception of spatial directions

Directional preferences have previously been demonstrated during horizontal arm movements. These preferences were characterized by a tendency to exploit interaction torques for movement production at the shoulder or elbow, indicating that the preferred directions depend on biomechanical, and not on visual perception-based factors. We directly tested this hypothesis by systematically dissociating visual information from arm biomechanics. Sixteen subjects performed a free-stroke drawing task that required performance of fast strokes from the circle center toward the perimeter, while selecting stroke directions in a random order. Hand position was represented by a cursor displayed in the movement plane. The free-stroke drawing was performed twice, before and after visuomotor adaptation to a 30° clockwise rotation of the perceived hand path. The adaptation was achieved during practicing pointing movements to eight center-out targets. Directional preferences during performance of the free-stroke drawing task were revealed in ten out of the sixteen subjects. The orientation and strength of these preferences were largely the same in both conditions, showing no significant effect of the visuomotor adaptation. In both conditions, the major preferred directions were characterized by higher contribution of interaction torque to net torque at the shoulder as well as by relatively low inertial resistance and the sum of squared shoulder and elbow muscle torques. These results support the hypothesis that directional preferences are largely determined by biomechanical factors. However, this biomechanical effect can decrease or even disappear in some subjects when movements are performed in special conditions, such as the virtual environment used here.

The influence of target sensory modality on motor planning may reflect errors in sensori-motor transformations

Multi-sensory integration studies have shown that combining heterogeneous signals can optimize motor performance by reducing errors inherent to any single modality. However, it has also been suggested that errors could arise from erroneous transformations between heterogeneous coordinate systems. Here we investigated the effect of visuo-proprioceptive integration on the control of multi-joint arm movements by manipulating target modality. When the target was visual, movement control required the integration of visual target signals with proprioceptive signals about limb configuration. In contrast, when the target was the unseen fingertip, movement control relied solely on proprioceptive signals since visual feedback of hand position was precluded. We hypothesized that a faulty integration of visual target signals with proprioceptive arm signals would result in a less accurate planning of visually-targeted movements with respect to proprioceptively-targeted movements. Different inter-joint coordinations patterns were tested by varying starting hand position. Results showed larger initial trajectory deviations from target direction for visually-targeted movements involving substantial shoulder and elbow motions. Inverse dynamic analysis revealed that these deviations were associated with less efficient intersegmental coordination. The control of visually-targeted movements thus appeared sub-optimal compared to proprioceptively-targeted movements when considering theoretical models of motor planning assuming kinematic or dynamic optimizations. Additional experiments further highlighted the effect of target position, and visual feedback of starting hand position, on motor planning for proprioceptively- and visually-targeted movements. Our findings suggest that the integration of heterogeneous sensory signals related to hand and target positions introduces errors in motor planning.

Contralesional Arm Preference Depends on Hemisphere of Damage and Target Location in Unilateral Stroke Patients

Background. Previous research has shown that during simulated activities of daily living, right-handed stroke patients use their contralesional arm more after left- than right-hemisphere stroke. These findings were attributed to a hand preference effect. However, these decisions about when to use the contralesional arm may be modulated by where in the work space the task is performed, a factor that could be used in physical rehabilitation to influence recovery by decreasing learned nonuse. Objective. To examine how target location and side of stroke influences arm selection choices for simple reaching movements. Methods. A total of 14 right-handed stroke patients (7 with left-hemisphere and 7 with right-hemisphere damage [RHD]), with similar degrees of hemiparesis (Fugl-Meyer motor score), and 16 right-handed controls participated in this experiment. In a pseudorandom fashion, 32 targets were presented throughout the reachable horizontal plane work space, and the participants were asked to select 1 hand to reach the target on each trial. Results. The group with left-hemisphere damage chose their contralesional arm significantly more often than the group with RHD. Patients with RHD also chose their left (contralesional) arm significantly less often than the control group. However, these patterns of choice were most pronounced in the center of the workspace. Conclusion. Both the side of hemisphere damage and work space location played a significant role in the choice of whether to use the contralesional arm for reaching. These findings have implications for structuring rehabilitation for unilateral stroke patients.