Jean-Louis Thonnard

Dissociating the role of ventral and dorsal premotor cortex in precision grasping.

Small-object manipulation is essential in numerous human activities, although its neural bases are still essentially unknown. Recent functional imaging studies have shown that precision grasping activates a large bilateral frontoparietal network, including ventral (PMv) and dorsal (PMd) premotor areas. To dissociate the role of PMv and PMd in the control of hand and finger movements, we produced, by means of transcranial magnetic stimulation (TMS), transient virtual lesions of these two areas in both hemispheres, in healthy subjects performing a grip–lift task with their right, dominant hand. We found that a virtual lesion of PMv specifically impaired the grasping component of these movements: a lesion of either the left or right PMv altered the correct positioning of fingers on the object, a prerequisite for an efficient grasping, whereas lesioning the left, contralateral PMv disturbed the sequential recruitment of intrinsic hand muscles, all other movement parameters being unaffected by PMv lesions. Conversely, we found that a virtual lesion of the left PMd impaired the proper coupling between the grasping and lifting phases, as evidenced by the TMS-induced delay in the recruitment of proximal muscles responsible for the lifting phase; lesioning the right PMd failed to affect dominant hand movements. Finally, an analysis of the time course of these effects allowed us to demonstrate the sequential involvement of PMv and PMd in movement preparation. These results provide the first compelling evidence for a neuronal dissociation between the different phases of precision grasping in human premotor cortex.

ABILHAND-Kids A measure of manual ability in children with cerebral palsy

Objective: To develop a clinical tool for measuring manual ability (ABILHAND-Kids) in children with cerebral palsy (CP) using the Rasch measurement model. Methods: The authors developed a 74-item questionnaire based on existing scales and experts’ advice. The questionnaire was submitted to 113 children with CP (59% boys; mean age, 10 years) without major intellectual deficits (IQ > 60) and to their parents, and resubmitted to both groups after 1 month. The children’s and parents’ responses were analyzed separately with the WINSTEPS Rasch software to select items presenting an ordered rating scale, sharing the same discrimination, and fitting a unidimensional scale. Results: The final ABILHAND-Kids scale consisted of 21 mostly bimanual items rated by the parents. The parents reported a finer perception of their children’s ability than the children themselves, leading to a wider range of measurement, a higher reliability (R = 0.94), and a good reproducibility over time (R = 0.91). The item difficulty hierarchy was consistent between the parents and the experts. The ABILHAND-kids measures are significantly related to school education, type of CP, and gross motor function. Conclusions: ABILHAND-Kids is a functional scale specifically developed to measure manual ability in children with CP providing guidelines for goal setting in treatment planning. Its range and measurement precision are appropriate for clinical practice.

The cutaneous contribution to adaptive precision grip

Only after injury, or perhaps prolonged exposure to cold that is sufficient to numb the fingers, do we suddenly appreciate the complex neural mechanisms that underlie our effortless dexterity in manipulating objects. The nervous system is capable of adapting grip forces to a wide range of object shapes, weights and frictional properties, to provide optimal and secure handling in a variety of potentially perturbing environments. The dynamic interplay between sensory information and motor commands provides the basis for this flexibility, and recent studies supply somewhat unexpected evidence of the essential role played by cutaneous feedback in maintaining and acquiring predictive grip force control. These examples also offer new insights into the adaptive control of other voluntary movements.

Temporal Dissociation between Hand Shaping and Grip Force Scaling in the Anterior Intraparietal Area

In humans, both clinical and functional imaging studies have evidenced the critical role played by the posterior parietal cortex, and particularly by the anterior intraparietal area (AIP), in skilled hand movements. However, the exact contribution of AIP to precision grasping remains debated. Here we used transcranial magnetic stimulation (TMS) to induce virtual lesions of the left and/or right AIP in subjects performing a grip-lift task with either hand. We found that, during movement preparation, a virtual lesion of AIP had distinct consequences on precision grasping of either hand depending on its time of occurrence: TMS applied 270–220 ms before the fingers contacted the manipulandum altered specifically the hand shaping, whereas lesions induced 170–120 ms before contact time only affected the grip force scaling. The lateralization of these two processes in AIP is also strikingly different: whereas a bilateral lesion of AIP was necessary to impair hand shaping, only a unilateral lesion of the left AIP altered the grip force scaling in either hand. The present study shows that, during movement preparation, AIP is responsible for processing two distinct, temporally dissociated, precision grasping parameters, regardless of the hand in use. This indicates that the contribution of AIP to hand movements is “effector- independent,” a finding that may explain the invariance of grasping movements performed with either hand.

Finger pad friction and its role in grip and touch

Many aspects of both grip function and tactile perception depend on complex frictional interactions occurring in the contact zone of the finger pad, which is the subject of the current review. While it is well established that friction plays a crucial role in grip function, its exact contribution for discriminatory touch involving the sliding of a finger pad is more elusive. For texture discrimination, it is clear that vibrotaction plays an important role in the discriminatory mechanisms. Among other factors, friction impacts the nature of the vibrations generated by the relative movement of the fingertip skin against a probed object. Friction also has a major influence on the perceived tactile pleasantness of a surface. The contact mechanics of a finger pad is governed by the fingerprint ridges and the sweat that is exuded from pores located on these ridges. Counterintuitively, the coefficient of friction can increase by an order of magnitude in a period of tens of seconds when in contact with an impermeably smooth surface, such as glass. In contrast, the value will decrease for a porous surface, such as paper. The increase in friction is attributed to an occlusion mechanism and can be described by first-order kinetics. Surprisingly, the sensitivity of the coefficient of friction to the normal load and sliding velocity is comparatively of second order, yet these dependencies provide the main basis of theoretical models which, to-date, largely ignore the time evolution of the frictional dynamics. One well-known effect on taction is the possibility of inducing stick–slip if the friction decreases with increasing sliding velocity. Moreover, the initial slip of a finger pad occurs by the propagation of an annulus of failure from the perimeter of the contact zone and this phenomenon could be important in tactile perception and grip function.

Internal models of the motor system that explain predictive grip force control

Only after injury, or perhaps prolonged exposure to cold that is sufficient to numb the fingers, do we suddenly appreciate the complex neural mechanisms that underlie our effortless dexterity in manipulating objects. The nervous system is capable of adapting grip forces to a wide range of object shapes, weights and frictional properties, to provide optimal and secure handling in a variety of potentially perturbing environments. The dynamic interplay between sensory information and motor commands provides the basis for this flexibility, and recent studies supply somewhat unexpected evidence of the essential role played by cutaneous feedback in maintaining and acquiring predictive grip force control. These examples also offer new insights into the adaptive control of other voluntary movements.

Hand impairments and their relationship with manual ability in children with cerebral palsy.

OBJECTIVE To study hand impairments and their relationship with manual ability in children with cerebral palsy. DESIGN Cross-sectional survey. PATIENTS A total of 101 children with cerebral palsy (mean age 10 years, age range 6-15 years) were assessed. METHODS Three motor and 3 sensory impairments were measured on both hands. Motor impairments included grip strength (Jamar dynamometer), gross manual dexterity(Box and Block Test) and fine finger dexterity (Purdue Peg-board Test). Sensory impairments included tactile pressure detection (Semmes-Weinstein aesthesiometer), stereognosis(Manual Form Perception Test) and proprioception (passive mobilization of the metacarpophalangeal joints). Manual ability was measured with the ABILHAND-Kids questionnaire. The relationship between hand impairments and manual ability was studied through correlation coefficients and a multiple linear forward stepwise regression analysis. RESULTS Motor impairments were markedly more prevalent than sensory ones. Gross manual dexterity on the dominant hand and grip strength on the non-dominant hand were the best independent predictors of the childrens manual ability,predicting 58% of its variance. CONCLUSION Hand impairments and manual ability are not related in a predictable straightforward relationship. It is important that, besides hand impairments, manual ability is also measured and treated, as it is not simply the integration of hand functions in daily activities.

Texture-induced vibrations in the forearm during tactile exploration

Humans can detect and discriminate between fine variations of surface roughness using active touch. It is hitherto believed that roughness perception is mediated mostly by cutaneous and subcutaneous afferents located in the fingertips. However, recent findings have shown that following abolishment of cutaneous afferences resulting from trauma or pharmacological intervention, the ability of subjects to discriminate between textures roughness was not significantly altered. These findings suggest that the somatosensory system is able to collect textural information from other sources than fingertip afference. It follows that signals resulting of the interaction of a finger with a rough surface must be transmitted to stimulate receptor populations in regions far away from the contact. This transmission was characterized by measuring in the wrist vibrations originating at the fingertip and thus propagating through the finger, the hand and the wrist during active exploration of textured surfaces. The spectral analysis of the vibrations taking place in the forearm tissues revealed regularities that were correlated with the scanned surface and the speed of exploration. In the case of periodic textures, the vibration signal contained a fundamental frequency component corresponding to the finger velocity divided by the spatial period of the stimulus. This regularity was found for a wide range of textural length scales and scanning velocities. For non-periodic textures, the spectrum of the vibration did not contain obvious features that would enable discrimination between the different stimuli. However, for both periodic and non-periodic stimuli, the intensity of the vibrations could be related to the microgeometry of the scanned surfaces.

Stability of the Braced Ankle A Biomechanical Investigation

We measured the bare ankle and the braced angle- torque relationships in 12 uninjured volunteers under static and dynamic conditions within the full range of inversion motion. These relationships were measured with a specially designed mechanical device that al lowed inversion movements with angular velocities up to 850 deg/sec. In testing the bare ankle under static conditions, the torque showed a 10-fold increase within the full range of motion (average, from 0.9 N-m at 7° to about 8 N-m at 48° of inversion). The slope of the angle-torque relationship increased under dynamic conditions giving higher torque values (up to 18 N-m on average). Both orthoses induced similar additional torques that increased linearly, up to about 6 N-m at 45°, with higher angles of inversion. These additional torques are small compared with the amount of stress applied to the foot during a typical ankle sprain situa tion, such as recovering from a jump. Therefore, we propose that orthotic devices increase the ankle torque, counteracting the inversion movement, and also prevent the start of the inversion movement by preloading and maintaining the ankle in a proper ana tomic position with optimal contact between the artic ular surfaces.

Effects of chronic median nerve compression at the wrist on sensation and manual skills

Abstract The aim of this study was to analyse the functional impairments caused by chronic median nerve compression at the wrist on hand sensation and manual skill. Hand function was assessed in 11 patients (8 women and 3 men) with severe carpal tunnel syndrome (CTS) and compared with that of an age- and sex-matched control group. Apart from CTS, the subjects were healthy and the electrodiagnostic examination was normal. The pressure and vibration detection thresholds of the index finger were partially impaired and statistically different (P<0.05) when compared with controls, suggesting a reduction of tactile acuity in the territory of the median nerve. The thermal thresholds were identical in both groups, suggesting that the small-diameter fibres were not affected. When a small object was lifted and positioned in space, the coordination between the grip force and the vertical lifting force did not seem to be affected in our patients. They were able to modify their grip force according to the friction between the fingertips and the object, i.e. the more slippery the object, the higher the grip force. The unimanual Purdue Pegboard subtest results suggest that digital dexterity was also not significantly perturbed in our sample of CTS patients when compared with controls. Despite the severe abnormalities of median nerve conduction, our results suggest that chronic median nerve compression occurring in CTS induces partial impairment of tactile sensibility with minor impact on grasp force regulation and digital dexterity.