Robert Forget

Reference systems for coding spatial information in normal subjects and a deafferented patient.

To produce accurate goal-directed arm movements, subjects must determine the precise location of target object. Position of extracorporeal objects can be determined using: (a) an egocentric frame of reference, in which the target is localized in relation to the position of the body; and/or (b) an allocentric system, in which target position is determined in relation to stable visual landmarks surrounding the target (Bridgeman 1989; Paillard 1991). The present experiment was based on the premise that (a) the presence of a structured visual environment enables the use of an allocentric frame of reference, and (b) the sole presence of a visual target within a homogeneous background forces the registration of the target location by an egocentric system. Normal subjects and a deafferented patient (i.e., with an impaired egocentric system) pointed to visual targets presented in both visual environments to evaluate the efficiency of the two reference systems. For normals, the visual environment conditions did not affect pointing accuracy. However, kinematic parameters were affected by the presence or absence of a structured visual surrounding. For the deafferented patient, the presence of a structured visual environment permitted a decrease in spatial errors when compared with the unstructured surrounding condition (for movements with or without visual feedback of the trajectory). Overall, results support the existence of an egocentric and an allocentric reference system capable of organizing extracorporeal space during arm movements directed toward visual targets.

Role of afferent information in the timing of motor commands: A comparative study with a deafferented patient

The accuracy of the motor system in synchronizing simultaneous movements initiations was tested in two conditions: (1) when the motor commands were triggered by an external signal (reactive condition), and (2) when subjects self-paced their movement onsets (self-paced condition). The task consisted of initiating simultaneously ipsilateral finger extension and heel raising. Eight normal subjects and a deafferented patient were tested. In the reactive condition, both normal subjects and the deafferented patient exhibited a precession of finger initiation over heel raising. This delay corresponds to the difference observed in the reaction time of the two limbs when measured independently. It reflects the difference in conduction times of the efferent pathways, as if the two motor commands were released simultaneously through a common triggering signal in the motor cortex. In contrast, in the self-paced condition normal subjects showed precession of heel over finger onsets, suggesting that synchrony is based upon the evaluation of afferent information. Unlike normal subjects, the patient showed no heel precession in the self-paced condition. These findings suggest that reactive and self-paced responses are produced through two different control modes and that afferent information contributes to the timing of motor commands in the self-paced mode.

The role of proprioceptive information for the production of isometric forces and for handwriting tasks

A patient showing a total loss of all the large sensory myelinated fibers but intact peripheral motor system produced simple isometric force pulses and more complex tasks like handwriting and drawing. Overall, the patient was able to perform the isometric force task with an accuracy that approached that of normal subjects. The writing tasks, however, proved to be more challenging. In absence of vision, the different forms and cursive trajectories forming letters (morphocinetic components) were preserved but their localization within the constraints of the graphic space (topocinetic components) were severely impaired. These results demonstrate that, in absence of visual information, proprioceptive information is necessary to calibrate the hand in space.

Evidence for a contribution of the motor cortex to the long‐latency stretch reflex of the human thumb.

1. In normal subjects, transcranial magnetic stimulation of the hand region of the motor cortex evokes motor responses only in contralateral hand muscles at a latency of about 19‐24 ms. In contrast, stimulation of the motor cortex of three mirror movement subjects evoked, nearly simultaneously, motor responses in hand muscles on both sides of the body at latencies similar to those of normal subjects. In these subjects no other neuroanatomical pathways appear to be abnormally directed across the mid‐line. Thus, their mirror movements are probably due to a projection of the corticospinal tract to homologous motoneurone pools on each side of the body. 2. We reasoned that if the motor cortex contributes to the generation of long‐latency stretch reflex responses then in these mirror movement subjects stretching a muscle on one side of the body should produce long‐latency reflex responses in the ipsilateral and the homologous contralateral muscle. 3. To test this idea experiments were done on normal human subjects and on the subjects with mirror movements. The electromyographic (EMG) activity of the flexor pollicis longus muscle (FPL) on each side of the body was recorded. Stretch of the distal phalanx of the thumb of one hand produced a series of distinct reflex EMG responses in the ipsilateral FPL. The earliest response, when present, began at 25 ms (S.D. = 3.5 ms) and was followed by responses at 40 (S.D. = 3.9 ms) and 56 ms (S.D. = 4.3 ms). There was no difference, either in timing or intensity, between the ipsilateral FPL EMG responses of normal subjects and those of the mirror movement subjects. 4. No response of any kind was observed in the contralateral (unstretched) FPL of normal subjects. In contrast, we observed in all three mirror movement subjects EMG responses in the contralateral (unstretched) FPL beginning at 45‐50 ms. The latency of this response is considerably shorter than the fastest voluntary kinaesthetic reaction time, which was on average 130 ms (S.D. = 11 ms). The contralateral long‐latency EMG response observed in the mirror movement subjects was on average 30% (range 5‐60%) of that on the ipsilateral side. No short‐latency response (25 ms) was ever observed in the contralateral FPL of these subjects. 5. These observations are quite consistent with the idea that the long‐latency stretch reflex responses of hand and finger muscles are produced, at least in part, by the motor cortex.

Gait of a deafferented subject without large myelinated sensory fibers below the neck

We evaluated the gait pattern of a deafferented subject who suffered a permanent loss of large sensory myelinated fibers below the neck following an acute episode of purely sensory neuropathy 21 years ago.The subject has developed several strategies to achieve a secure gait, namely: (1) a reduction of the degrees of freedom by freezing the knee articulations during the stance phase, (2) a preservation of body balance by enlarging his base of support, and (3) visual monitoring of his step by stabilizing the head-trunk linkage together with a characteristic forward tilt. As a result, the gait of the deafferented subject lacks the fluidity of normal gait. Compared with normal subjects, the gait pattern of the deafferented subject is characterized by a shorter cycle length, a longer cycle duration, a slower speed, and a lower cadence. Using a dual-task paradigm, the attentional demands for walking were particularly important (as indexed by longer probe reaction times) during the double-support phase, suggesting that the deafferented subject uses the double-support phase as a transitory stable phase to update cognitively the postural features necessary for generating his next step. NEUROLOGY 1996;47: 109-115

Mirror drawing in a deafferented patient and normal subjects Visuoproprioceptive conflict

Results on a mirror drawing task showed that a deafferented patient had no problem completing the pattern, whereas normal subjects needed more than four trials to attain a similar performance. The results suggest the presence of integrated visual and proprioceptive maps. The inversion of visual coordinates requires the need for a recalibration. Without proprioception, the task is more like a simple visual tracking task.

EVALUATION OF CUTANEOUS AND PROPRIOCEPTIVE SENSATION IN CHILDREN: A RELIABILITY STUDY

Forty‐three healthy children aged between six and 12 years were tested to determine the. intra‐rater reliability of four clinical cutaneous and proprioceptive sensory assessment tools: touch pressure, vibration perception, thermal discrimination and kinaesthesis. The tests were carried out bilaterally on proximal and distal upper‐ and lower‐ extremity sites. The mean intraclass coefficients represented good to excellent reliability, which suggests that these assessment tools allow objective and reproducible measurements of cutaneous and proprioceptive sensation in children. The results were compared with existing data in the literature: in general, children and adults obtain similar sensory scores, and sex, age and laterality have no significant effect on the results for any test. However, the touch‐pressure and vibration scores were significantly influenced by the site tested, the index fingerpad being the most sensitive area in both tests.

Control of single-joint movements in deafferented patients: evidence for amplitude coding rather than position control

Two deafferented patients and several control subjects participated in a series of experiments to investigate how accurate single-joint movements are programed, spatially calibrated, and updated in the absence of proprioceptive information. The deafferented patients suffered from a permanent and severe loss of large sensory myelinated fibers below the neck. Subjects performed, with and without vision, sequences of forearm supinations and pronations with two temporal delays between each movement (0 s and 8 s). Overall, the lack of proprioception did not yield any significant decrease in movement accuracy when vision was available. Without vision, the absence of proprioceptive afferents yielded (1) significantly larger spatial errors, (2) amplitude errors similar to those of control subjects, and (3) a significant drift when an 8-s delay was introduced between two successive movements. Subjects also performed, without vision, a 20∘ supination followed by a 20∘ pronation that brought back the wrist to the starting position. On some trials, the supination was blocked unexpectedly by way of a magnetic brake. When the supination was blocked, subjects were already on the second target and no pronation was required when the brake was released. The defferented patients, unaware of the procedure, always produced a 20∘ pronation. These data confirm that deafferented patients were not coding a final position. It rather suggests that they coded an amplitude and translated the spatial distance between the two targets in a corresponding force pulse. Overall, the results highlight the powerful and key role of proprioceptive afferents for calibrating the spatial motor frame of reference.

Motor performance following a mild traumatic brain injury in children: an exploratory study

Mild Traumatic Brain Injury (TBI) is a common occurrence in the paediatric population and, as the concept of motor performance has not been assessed specifically in this population, the purpose of this study was to determine if motor performance deficits are present and can be objectively identified in a sample of children having sustained a mild TBI (Glasgow Coma Scale score 13-15). Twenty-eight children aged between 5 and 15 years were recruited immediately post-trauma. Subjects were considered normal on standard neurological exam at the time of discharge. They were assessed 13-18 days post-trauma using the Bruininks-Oseretsky Test of Motor Proficiency, a norm referenced clinical standardized assessment tool. Compared to published norms, motor performance was significantly lower in domains of balance, response speed and running speed an agility (t-test p < 0.01), and significantly higher in domains of upper extremity coordination and visual motor control (t-test p < 0.01). Although excellent performance can be observed in domains requiring upper limb coordination, motor planning and execution of motor tasks, deficits in balance and response speed can be identified in a significant number of children even after mild TBI. More specific and sensitive evaluations are necessary to identify the exact nature of the problems and evaluate their functional impact on daily activities.

Control of wrist position and muscle relaxation by shifting spatial frames of reference for motoneuronal recruitment: possible involvement of corticospinal pathways

It has previously been established that muscles become active in response to deviations from a threshold (referent) position of the body or its segments, and that intentional motor actions result from central shifts in the referent position. We tested the hypothesis that corticospinal pathways are involved in threshold position control during intentional changes in the wrist position in humans. Subjects moved the wrist from an initial extended to a final flexed position (and vice versa). Passive wrist muscle forces were compensated with a torque motor such that wrist muscle activity was equalized at the two positions. It appeared that motoneuronal excitability tested by brief muscle stretches was also similar at these positions. Responses to mechanical perturbations before and after movement showed that the wrist threshold position was reset when voluntary changes in the joint angle were made. Although the excitability of motoneurons was similar at the two positions, the same transcranial magnetic stimulus (TMS) elicited a wrist extensor jerk in the extension position and a flexor jerk in the flexion position. Extensor motor‐evoked potentials (MEPs) elicited by TMS at the wrist extension position were substantially bigger compared to those at the flexion position and vice versa for flexor MEPs. MEPs were substantially reduced when subjects fully relaxed wrist muscles and the wrist was held passively in each position. Results suggest that the corticospinal pathway, possibly with other descending pathways, participates in threshold position control, a process that pre‐determines the spatial frame of reference in which the neuromuscular periphery is constrained to work. This control strategy would underlie not only intentional changes in the joint position, but also muscle relaxation. The notion that the motor cortex may control motor actions by shifting spatial frames of reference opens a new avenue in the analysis and understanding of brain function.