Winfred Mugge

Reduced Power Method: how to evoke low-bandwidth behaviour while estimating full-bandwidth dynamics

Many human motion control studies use system identification methods to estimate the human admittance (the frequency response function from force to position). Admittance was found to be affected by task instruction, environmental properties and perturbation properties. From literature it is known the frequency content (bandwidth) of the perturbation modulates the admittance, due to modulation of the reflexive feedback. However, reducing the perturbation bandwidth reduces the identifiable admittance bandwidth. Yet, the full dynamic range is necessary to understand the changes in control behaviour, and also to ensure accurate parametric fits of neuromusculoskeletal models to the estimated admittance. The goal of this study is to develop a perturbation signal that evokes low bandwidth control behaviour while it enables identification over the full admittance bandwidth. This study introduces the Reduced Power Method. Effectively, multisine torque perturbations are supplemented with reduced power (a small percentage of full power) beyond the perturbation bandwidth, large enough to allow accurate identification, and small enough not to influence control behaviour. The method was tested in an experimental study. The dynamic ankle control behaviour of subjects (n=10) was measured while performing a variety of tasks in face of continuous torque perturbations with and without the addition of reduced power. The estimated admittance varied substantially as a result of task instruction and perturbation bandwidth, but not as a result of the additional reduced power. In conclusion, the proposed method was successful in estimating the full dynamics of the admittance while the resulting control behaviour was adapted to the low-frequent full power perturbations.

Fixed Dystonia in Complex Regional Pain Syndrome: a Descriptive and Computational Modeling Approach

BackgroundComplex regional pain syndrome (CRPS) may occur after trauma, usually to one limb, and is characterized by pain and disturbed blood flow, temperature regulation and motor control. Approximately 25% of cases develop fixed dystonia. Involvement of dysfunctional GABAergic interneurons has been suggested, however the mechanisms that underpin fixed dystonia are still unknown. We hypothesized that dystonia could be the result of aberrant proprioceptive reflex strengths of position, velocity or force feedback.MethodsWe systematically characterized the pattern of dystonia in 85 CRPS-patients with dystonia according to the posture held at each joint of the affected limb. We compared the patterns with a neuromuscular computer model simulating aberrations of proprioceptive reflexes. The computer model consists of an antagonistic muscle pair with explicit contributions of the musculotendinous system and reflex pathways originating from muscle spindles and Golgi tendon organs, with time delays reflective of neural latencies. Three scenarios were simulated with the model: (i) increased reflex sensitivity (increased sensitivity of the agonistic and antagonistic reflex loops); (ii) imbalanced reflex sensitivity (increased sensitivity of the agonistic reflex loop); (iii) imbalanced reflex offset (an offset to the reflex output of the agonistic proprioceptors).ResultsFor the arm, fixed postures were present in 123 arms of 77 patients. The dominant pattern involved flexion of the fingers (116/123), the wrists (41/123) and elbows (38/123). For the leg, fixed postures were present in 114 legs of 77 patients. The dominant pattern was plantar flexion of the toes (55/114 legs), plantar flexion and inversion of the ankle (73/114) and flexion of the knee (55/114).Only the computer simulations of imbalanced reflex sensitivity to muscle force from Golgi tendon organs caused patterns that closely resembled the observed patient characteristics. In parallel experiments using robot manipulators we have shown that patients with dystonia were less able to adapt their force feedback strength.ConclusionsFindings derived from a neuromuscular model suggest that aberrant force feedback regulation from Golgi tendon organs involving an inhibitory interneuron may underpin the typical fixed flexion postures in CRPS patients with dystonia.

NMClab, a model to assess the contributions of muscle visco-elasticity and afferent feedback to joint dynamics.

The dynamic behavior of a neuromusculoskeletal system results from the complex mechanical interaction between muscle visco-elasticity resulting from (co-)contraction and afferent feedback from muscle spindles and Golgi tendon organs. As a result of the multiple interactions the individual effect of each of the structures to the overall dynamics is hard to recognize, if not impossible. Here a neuromuscular control (NMC) model is developed to analyze the functional contribution of the various physiological structures on the mechanical behavior of a limb. The dynamics of a joint are presented in admittances, i.e. the dynamic relation between input force (or torque) and the output displacement, which can be represented by either frequency or impulse response functions. With the model it can be shown that afferent feedback reduces, while muscle visco-elasticity increases, the stability margins. This implicates that there is a delicate balance between muscle co-contraction and afferent feedback, which depends on the joint specific physiological properties. The main application of the model is educational; it is implemented in a graphical user interface allowing users to explore the role of the various physiological structures on joint dynamics. Other applications of the model are more experimental, e.g. to elucidate experimentally measured admittances and to compare the quantified parameter values with the theoretically optimal ones. It is concluded that the NMC model is a useful and intuitive tool to investigate human motor control, in a theoretical as well as an experimental way.

Integration of sensory force feedback is disturbed in CRPS-related dystonia.

Complex regional pain syndrome (CRPS) is characterized by pain and disturbed blood flow, temperature regulation and motor control. Approximately 25% of cases develop fixed dystonia. The origin of this movement disorder is poorly understood, although recent insights suggest involvement of disturbed force feedback. Assessment of sensorimotor integration may provide insight into the pathophysiology of fixed dystonia. Sensory weighting is the process of integrating and weighting sensory feedback channels in the central nervous system to improve the state estimate. It was hypothesized that patients with CRPS-related dystonia bias sensory weighting of force and position toward position due to the unreliability of force feedback. The current study provides experimental evidence for dysfunctional sensory integration in fixed dystonia, showing that CRPS-patients with fixed dystonia weight force and position feedback differently than controls do. The study shows reduced force feedback weights in CRPS-patients with fixed dystonia, making it the first to demonstrate disturbed integration of force feedback in fixed dystonia, an important step towards understanding the pathophysiology of fixed dystonia.

Modeling movement disorders¿CRPS-related dystonia explained by abnormal proprioceptive reflexes

Humans control their movements using adaptive proprioceptive feedback from muscle afferents. The interaction between proprioceptive reflexes and biomechanical properties of the limb is essential in understanding the etiology of movement disorders. A non-linear neuromuscular model of the wrist incorporating muscle dynamics and neural control was developed to test hypotheses on fixed dystonia. Dystonia entails sustained muscle contractions resulting in abnormal postures. Lack of inhibition is often hypothesized to result in hyperreflexia (exaggerated reflexes), which may cause fixed dystonia. In this study the model-simulated behavior in case of several abnormal reflex settings was compared to the clinical features of dystonia: abnormal posture, sustained muscle contraction, increased stiffness, diminished voluntary control and activity-aggravation. The simulation results were rated to criteria based on characteristic features of dystonia. Three abnormal reflex scenarios were tested: (1) increased reflex sensitivity-increased sensitivity of both the agonistic and antagonistic reflex pathways; (2) imbalanced reflex offset-a static offset to the reflex pathways on the agonistic side only; and (3) imbalanced reflex sensitivity-increased sensitivity of only the agonistic reflex pathways. Increased reflex sensitivity did not fully account for the features of dystonia, despite distinct motor dysfunction, since no abnormal postures occurred. Although imbalanced reflex offset did result in an abnormal posture, it could not satisfy other criteria. Nevertheless, imbalanced reflex sensitivity with unstable force feedback in one of the antagonists closely resembled all features of dystonia. The developed neuromuscular model is an effective tool to test hypotheses on the underlying pathophysiology of movement disorders.

Stretch reflex responses in Complex Regional Pain Syndrome-related dystonia are not characterized by hyperreflexia

OBJECTIVE To evaluate if hyperreflexia (exaggerated reflexes) due to disinhibition is associated with dystonia in Complex Regional Pain Syndrome (CRPS). METHODS Stretch reflexes at the wrist were assessed in healthy controls (n=10) and CRPS-patients with dystonia (n=10). Subjects exerted a wrist flexion torque of 5% of maximum voluntary contraction torque (T(MVC)) to a manipulandum which applied ramp-and-hold stretches to the wrist flexors. Since reflex responses scale with background contraction, controls additionally performed the task at 1% and 3% T(MVC) to attain similar torques as patients who have reduced T(MVC). The M1 onset and the magnitudes of the short latency M1 and long latency M2 were assessed using the electromyographic signals (EMG) of the flexor carpi radialis. EMG of the extensor carpi radialis was recorded to monitor cocontraction. RESULTS Compared to controls, patients had a substantially reduced T(MVC). Ramp velocity had a significant effect on M1 onset time and magnitude. CONCLUSIONS Since M1 magnitude decreased with flexion torque, no significant difference was found between patients and controls at 5% T(MVC), while comparison at similar absolute torques (controls at 1% T(MVC)) resulted in significantly smaller M1 magnitudes for patients with dystonia. SIGNIFICANCE This study suggests that CRPS-patients with dystonia are not hyperreflexive.

Haptic guidance needs to be intuitive not just informative to improve human motor accuracy.

Humans make both random and systematic errors when reproducing learned movements. Intuitive haptic guidance that assists one to make the movements reduces such errors. Our study examined whether any additional haptic information about the location of the target reduces errors in a position reproduction task, or whether the haptic guidance needs to be assistive to do so. Holding a haptic device, subjects made reaches to visible targets without time constraints. They did so in a no-guidance condition, and in guidance conditions in which the direction of the force with respect to the target differed, but the force scaled with the distance to the target in the same way. We examined whether guidance forces directed towards the target would reduce subjects’ errors in reproducing a prior position to the same extent as do forces rotated by 90 degrees or 180 degrees, as it might because the forces provide the same information in all three cases. Without vision of the arm, both the accuracy and precision were significantly better with guidance directed towards the target than in all other conditions. The errors with rotated guidance did not differ from those without guidance. Not surprisingly, the movements tended to be faster when guidance forces directed the reaches to the target. This study shows that haptic guidance significantly improved motor performance when using it was intuitive, while non-intuitively presented information did not lead to any improvements and seemed to be ignored even in our simple paradigm with static targets and no time constraints.

Force control in the absence of visual and tactile feedback.

Motor control tasks like stance or object handling require sensory feedback from proprioception, vision and touch. The distinction between tactile and proprioceptive sensors is not frequently made in dynamic motor control tasks, and if so, mostly based on signal latency. We previously found that force control tasks entail more compliant behavior than a passive, relaxed condition and by neuromuscular modeling we were able to attribute this to adaptations in proprioceptive force feedback from Golgi tendon organs. This required the assumption that both tactile and visual feedback are too slow to explain the measured adaptations in face of unpredictable force perturbations. Although this assumption was shown to hold using model simulations, so far no experimental data is available to validate it. Here we applied a systematic approach using continuous perturbations and engineering analyses to provide experimental evidence for the hypothesis that motor control adaptation in force control tasks can be achieved using proprioceptive feedback only. Varying task instruction resulted in substantial adaptations in neuromuscular behavior, which persisted after eliminating visual and/or tactile feedback by a nerve block of the nervus plantaris medialis. It is concluded that proprioception adapts dynamic human ankle motor control even in the absence of visual and tactile feedback.

Fenestrations in the jaws of laparoscopic graspers.

Laparoscopic graspers used for manipulating delicate tissue generally possess jaws with fenestrations (windows). The fenestrations should enhance the grip on the tissue; however, fenestrations reduce the contact area between jaws and tissue, leading to higher local pressures and possibly tissue damage. Experiments were performed to determine the effect of a fenestration on the pinch force needed to prevent slip of tissue and on the pinch force leading to tissue damage. In addition, the size and position of the fenestration were determined. Fenestrated jaws resulted in increased tissue damage, without affecting the pinch force needed to prevent slip. These negative effects increased with increasing fenestration size and when the fenestration was located toward the tip of the jaws. Therefore, fenestrated jaws had a smaller safe working range than the jaws without fenestrations.

Targeted brain activation using an MR-compatible wrist torque measurement device and isometric motor tasks during functional magnetic resonance imaging

Dedicated pairs of isometric wrist flexion tasks, with and without visual feedback of the exerted torque, were designed to target activation of the CBL and BG in healthy subjects during functional magnetic resonance imaging (fMRI). Selective activation of the cerebellum (CBL) and basal ganglia (BG), often implicated in movement disorders such as tremor and dystonia, may help identify pathological changes and expedite diagnosis. A prototyped MR-compatible wrist torque measurement device, free of magnetic and conductive materials, allowed safe execution of tasks during fMRI without causing artifacts. A significant increase of activity in CBL and BG was found in healthy volunteers during a constant torque task with visual feedback compared to a constant torque task without visual feedback. This study shows that specific pairs of motor tasks using MR-compatible equipment at the wrist allow for targeted activation of CBL and BG, paving a new way for research into the pathophysiology of movement disorders.