Ingo Helmich

Hemispheric Differences of Motor Execution: A Near-Infrared Spectroscopy Study

Distal movements of the limbs are predominantly controlled by the contralateral hemisphere. However, functional neuroimaging studies do not unequivocally demonstrate a lateralization of the cerebral activation during hand movements. While some studies show a predominant activation of the contralateral hemisphere, other studies provide evidence for a symmetrically distributed bihemispheric activation. However, the divergent results may also be due to methodological shortcomings. Therefore, the present study using functional near-infrared spectroscopy examines cerebral activation in both hemispheres during motor actions of the right and left hands. Twenty participants performed a flexion/extension task with the right- or left-hand thumb. Cerebral oxygenation changes were recorded from 48 channels over the primary motor, pre-motor, supplementary motor, primary somatosensory cortex, subcentral area, and the supramarginal gyrus of each hemisphere. A consistent increase of cerebral oxygenation was found for oxygenated and for total hemoglobin in the hemisphere contralateral to the moving hand, regardless of the laterality. These findings are in line with previous data from localization [1-3] and brain imaging studies [4-6]. The present data support the proposition that there is no hemispheric specialization for simple distal motor tasks. Both hemispheres are equally activated during movement of the contralateral upper limb.

Neural Control of Posture in Individuals with Persisting Postconcussion Symptoms.

INTRODUCTION Postural instability has been shown to characterize individuals who suffered from long-term symptoms after mild traumatic brain injury. However, recordings of neural processes during postural control are difficult to realize with standard neuroimaging techniques. Thus, we used functional nearinfrared spectroscopy to investigate brain oxygenation of individuals with persistent postconcussion symptoms (pPCS) during postural control in altered environments. METHODS We compared brain oxygenation and postural sway during balance control in three groups: individuals suffering from pPCS, individuals with a history of mild traumatic brain injury but without pPCS, and healthy controls. Individuals were investigated during postural control tasks with six different conditions: i) eyes opened, ii) eyes closed, and iii) blurred visual input, each while standing a) on a stable and b) an unstable surface. RESULTS In all groups, during the eyes closed/unstable surface condition as compared with the other conditions, the postural sway increased as well as the brain oxygenation in frontal brain cortices. In the most difficult balance condition, as compared with the other two groups, subjects with pPCS applied more force over time to keep balance as measured by the force plate system with a significantly greater activation in frontopolar/orbitofrontal areas of the right hemisphere. CONCLUSIONS As subjects with pPCS applied more force over time to control balance, we propose that with regard to cognitive processes, the increase of cerebral activation in these individuals indicates an increase of attention-demanding processes during postural control in altered environments.

Neuropsychological functions of hand movements and gestures change in the presence or absence of speech

In order to address previous controversies whether hand movements and gestures are linked to mental concepts or solely to the process of speaking, in the present study we investigate the neuropsychological functions of the entire spectrum of unimanual and bimanual hand movements and gestures when they either accompany speaking or when they act as the only means to communicate in the absence of speech. The results showed that the hand movement activity regarding all types of hand movements and gestures stayed constant with and without speaking. The analysis of the Structure of hand movements showed that executions shifted from in space hand movements with a phase structure during the condition without speech to more irregular on body hand movements without a phase structure during the co-speech condition. The gestural analysis revealed that pantomime gestures increase under conditions without speech whereas emotional motions and subject-oriented actions primarily occur when speaking. The present results provide evidence that the overall hand movement activity does not differ between co-speech conditions and conditions without speech, but that the hands adopt different neuropsychological functions. We conclude that the hands primarily externalise mental concepts in conditions without speaking but that their use shifts to more self-regulation and to endorsing verbal output with emotional connotations when they accompany speech.

Hand movements with a phase structure and gestures that depict action stem from a left hemispheric system of conceptualization.

The present study addresses the previously discussed controversy on the contribution of the right and left cerebral hemispheres to the production and conceptualization of spontaneous hand movements and gestures. Although it has been shown that each hemisphere contains the ability to produce hand movements, results of left hemispherically lateralized motor functions challenge the view of a contralateral hand movement production system. To examine hemispheric specialization in hand movement and gesture production, ten right-handed participants were tachistoscopically presented pictures of everyday life actions. The participants were asked to demonstrate with their hands, but without speaking what they had seen on the drawing. Two independent blind raters evaluated the videotaped hand movements and gestures employing the Neuropsychological Gesture Coding System. The results showed that the overall frequency of right- and left-hand movements is equal independent of stimulus lateralization. When hand movements were analyzed considering their Structure, the presentation of the action stimuli to the left hemisphere resulted in more hand movements with a phase structure than the presentation to the right hemisphere. Furthermore, the presentation to the left hemisphere resulted in more right and left-hand movements with a phase structure, whereas the presentation to the right hemisphere only increased contralateral left-hand movements with a phase structure as compared to hand movements without a phase structure. Gestures that depict action were primarily displayed in response to stimuli presented in the right visual field than in the left one. The present study shows that both hemispheres possess the faculty to produce hand movements in response to action stimuli. However, the left hemisphere dominates the production of hand movements with a phase structure and gestures that depict action. We therefore conclude that hand movements with a phase structure and gestures that represent action stem from a left hemispheric system of conceptualization.

Persistent Postconcussive Symptoms Are Accompanied by Decreased Functional Brain Oxygenation

Diagnostic methods are considered a major concern in the determination of mild traumatic brain injury. The authors examined brain oxygenation patterns in subjects with severe and minor persistent postconcussive difficulties and a healthy control group during working memory tasks in prefrontal brain regions using functional near-infrared spectroscopy. The results demonstrated decreased working memory performances among concussed subjects with severe postconcussive symptoms that were accompanied by decreased brain oxygenation patterns. An association appears to exist between decreased brain oxygenation, poor performance of working memory tasks, and increased symptom severity scores in subjects suffering from persistent postconcussive symptoms.

Brain oxygenation patterns during the execution of tool use demonstration, tool use pantomime, and body-part-as-object tool use

Divergent findings exist whether left and right hemispheric pre- and postcentral cortices contribute to the production of tool use related hand movements. In order to clarify the neural substrates of tool use demonstrations with tool in hand, tool use pantomimes without tool in hand, and body-part-as-object presentations of tool use (BPO) in a naturalistic mode of execution, we applied functional Near InfraRed Spectroscopy (fNIRS) in twenty-three right-handed participants. Functional NIRS techniques allow for the investigation of brain oxygenation during the execution of complex hand movements with an unlimited movement range. Brain oxygenation patterns were retrieved from 16 channels of measurement above pre- and postcentral cortices of each hemisphere. The results showed that tool use demonstration with tool in hand leads to increased oxygenation as compared to tool use pantomimes in the left hemispheric somatosensory gyrus. Left hand executions of the demonstration of tool use, pantomime of tool use, and BPO of tool use led to increased oxygenation in the premotor and somatosensory cortices of the left hemisphere as compared to right hand executions of either condition. The results indicate that the premotor and somatosensory cortices of the left hemisphere constitute relevant brain structures for tool related hand movement production when using the left hand, whereas the somatosensory cortex of the left hemisphere seems to provide specific mental representations when performing tool use demonstrations with the tool in hand.

Active assistive forced exercise provides long-term improvement to gait velocity and stride length in patients bilaterally affected by Parkinson's disease

Forced exercise training presents a valid method of improving symptoms of Parkinsons disease such as rigor, dyskinesia and gait dysfunctions. Brain imaging data suggest that use of active assistive forced exercise could improve Parkinsonian symptoms more effectively than passive assistive forced exercise. However, the long-term effects of active versus passive assistive forced exercise on the symptoms of Parkinsons disease are unknown. Here, 24 patients showing bilateral effects of Parkinsons disease underwent a 12 week intervention of either passive or active assistive forced exercise. We analyzed tremor scores, gait patterns, and scores on the Unified Parkinsons Disease Rating Scale-III from three timepoints--before beginning the intervention, upon completion of the intervention, and twelve weeks after completion of the intervention. Participation in both passive and active assistive forced exercise increased gait velocity (0.5 km/h), swing phase (2%), monopedal stance phase (2%), elongated stride length (11 cm) and decreased double stance phase (4%). However, with participation in active assistive forced exercise, postural and kinetic tremor were also reduced and gait velocity and stride length were increased long-term. Given these findings, we conclude that future treatment for patients bilaterally affected by Parkinsons disease should carefully consider the type of assistive forced exercise intervention to be used.