Abstract: In the present report, we extend our previous observations on corticomotor facilitation associated with covert (action observed or imagined) and overt (action imitated) action execution in old adults (Leonard and Tremblay in Exp Brain Res 117:167-175, 2007) to investigate the impact of Parkinson's disease (PD). Participants consisted of 22 older adults (age range 58-76 years) of whom 11 were medicated patients diagnosed with PD (patient group) and 11 were age-matched healthy controls (healthy group). Corticomotor facilitation was assessed by monitoring the changes in the amplitude of motor evoked potentials (MEP) in muscles of the right hand (first dorsal interosseous: FDI; and abductor digiti minimi: ADM) in response to transcranial magnetic stimulation of the left motor cortex. In each group, corticomotor facilitation was assessed with participants seated in front of a computer screen under four testing conditions: (1) REST: eyes closed and instructions to relax for 10 s, (2) OBS: observe action, (3) IMAG: imagine action and (4) IMIT: imitate action. The action depicted in the video displayed the hand of a male subject cutting a piece of material with scissors. Comparison of variations in MEP amplitude revealed a significant interaction between groups and conditions. In the healthy group, the OBS and IMAG conditions were both associated with significant facilitation in the FDI and ADM, whereas the same conditions failed to produce facilitation in the PD group. In both groups, the IMIT condition produced the largest facilitation in hand muscles. Further planned comparisons revealed a significant difference between groups in the FDI for the OBS condition. From these findings, we conclude that, even when properly medicated, old adults with PD may experience major difficulties in engaging the motor system for covert actions, particularly when asked to observe another person's action. This failure of corticomotor facilitation for covert actions appears to be linked with the deficit in motor activation associated with basal ganglia dysfunction in PD and in line with the difficulty experienced in general by patients "to energize" the motor system in preparation for action.

Abstract: In the present report, we extent our previous findings (Clark et al. in Neuropsychologia 42:105-122, 2004) on corticomotor facilitation associated with covert (observation and imagery) and overt execution (action imitation) of hand actions to better delineate the selectivity of the effect in the context of an object-oriented action. A second aim was to examine whether the pattern of facilitation would be affected by age. Corticomotor facilitation was determined in two groups of participants (young n = 21, 24 +/- 2 years; old n = 19, 62 +/- 6 years) by monitoring changes in the amplitude and latency of motor evoked potentials (MEPs) elicited in hand muscles by transcranial magnetic stimulation. MEP responses were measured from both the first dorsal interosseous (FDI, task selective muscle) and the abductor digiti minimi (ADM) of the right hand while participants attended to four different video presentations. Each of four videos provided specific instructions for participants to either: (1) close their eyes and relax (REST), (2) observe the action attentively (OBS), (3) close their eyes and mentally simulate the action (IMAG), or (4) imitate the action (IMIT). The action depicted in the videos represented a male subject cutting a piece of material with scissors. In the young group, the pattern of results revealed selective facilitation in the FDI in conditions involving either covert (OBS and IMAG) or overt action execution (IMIT). In the ADM, only overt execution with action imitation was associated with significant MEP facilitation. In the old group, a similar pattern of results was observed, although the modulation was less selective than that seen in the young group. In fact, older individuals often exhibited concomitant facilitation in both the FDI and ADM during either covert (OBS and IMAG conditions) or overt action execution (IMIT condition). Taken together, these results further corroborate the notion that the corticomotor system is selectively active when actions are covertly executed through internal simulation triggered by observation or by motor imagery, as proposed by Jeannerod (Neuroimage 14:S103-S109, 2001). With aging, the ability to produce corticomotor facilitation in association with covert action execution appears to be largely preserved, although there seems to be a loss in selectivity. This lack of selectivity may, in turn, reflect age-related alterations in the function of the corticospinal system, which may impair the ability to individuate finger movements either in the covert or overt stage of action execution.

Abstract: The ability to navigate without vision towards a previously seen target has been extensively studied, but its reliability over time has yet to be established. Our aims were to determine distance and direction errors made during blind navigation across four different directions involving three different gait patterns (stepping forward, stepping sideway, and stepping backward), and to establish the test-retest reproducibility of these errors. Twenty young healthy adults participated in two testing sessions separated by 7 days. They were shown targets located, respectively, 8 m ahead, 8 m behind, and 8 m to their right and left. With vision occluded by opaque goggles, they walked forward (target ahead), backward (target behind), and sideway (right and left targets) until they perceived to be on the target. Subjects were not provided with feedback about their performance. Walked distance, angular deviation, and body rotation were measured. The mean estimated distance error was similar across the four walking directions and ranged from 16 to 80 cm with respect to the 8 m target. In contrast, direction errors were significantly larger during sideway navigation (walking in the frontal plane: leftward, 10 degrees +/- 15 degrees deviation; rightward, 18 degrees +/- 13 degrees) than during forward and backward navigation (walking in the sagittal plane). In general, distance and direction errors were only moderately reproducible between the two sessions [intraclass correlation coefficients (ICCs) ranging from 0.682 to 0.705]. Among the four directions, rightward navigation showed the best reproducibility with ICCs ranging from 0.607 to 0.726, and backward navigation had the worst reliability with ICCs ranging from 0.094 to 0.554. These findings indicate that errors associated with blind navigation across different walking directions and involving different gait patterns are only moderately to poorly reproducible on repeated testing, especially for walking backward. The biomechanical constraints and increased cognitive loading imposed by changing the walking pattern to backward stepping may underlie the poor performance in this direction.

Abstract: In the present report, we investigated changes in corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament (ACL) injury. Ten participants, each with a previous history of unilateral ACL injury (median time post-injury 22 months) and eight healthy controls underwent transcranial magnetic stimulation (TMS) to assess excitability of the lower limb motor representation. Resting motor thresholds (RMTs) and stimulus response curves were measured at rest, while amplitude of motor evoked potentials and silent period duration were measured during active contraction. Correlations between these indices of excitability and three clinical measures of knee function were identified. Paired comparisons of indices by hemisphere revealed an asymmetry only in RMTs, which were significantly reduced on the side of injury in the ACL group. Correlations with clinical measures showed that the extent of quadriceps motor representation, as reflected by the steepness of SR curves, was strongly associated with quadriceps strength (r 2=0.71) on the injured side. The RMT asymmetry reported here in the context of ACL injury is consistent with other recent reports describing enhanced excitability of corticomotor projections targeting muscles adjacent to an immobilized or a painful joint. In such conditions, alterations in the quantity and quality of sensory feedback from the affected limb may underlie the rise in cortical excitability.

Abstract: Young (21-26 years, n=20) and old (55-86 years, n=25) participants were tested for their ability to recognize raised letters (6-mm high, 1-mm relief) by touch. Spatial resolution thresholds were also measured with grating domes to derive an index of the degree of afferent innervation at the fingertip. Letter recognition in the young group was very consistent and highly accurate (mean, 86% correct), contrasting with the performance of the old group, which was more variable and comparatively low in accuracy (mean, 53% correct). In both groups, spatial resolution thresholds accounted for a substantial portion of the variance in the performance, suggesting a strong link between age-dependent variations in tactile innervation and recognition accuracy. The patterns of errors in the old group showed that an inability to encode internal elements specific to certain letters was at the source of most confusion among letters. Whether this inability reflected only deficient peripheral encoding mechanisms or some other alterations at the central level is discussed.

Abstract: In the present report, we extend our previous observations on the effect of age on postural stabilization from fingertip contact (Exp Brain Res 157 (2004) 275) to examine the possible influence of sensory thresholds measured at the fingertip on the magnitude of contact forces. Participants (young, n=25, 19-32 years; old, n=35, 60-86 years) underwent psychophysical testing of the right index finger to determine thresholds for spatial acuity, pressure sensitivity and kinesthetic acuity. Spatial acuity was determined from the ability to detect gaps of different widths, while Semmes-Weinstein monofilaments were used for pressure sensitivity. Kinesthetic acuity was determined by asking participants to discriminate plates of different thicknesses using a thumb-index precision grip. These tests were selected on the basis that each reflected different sensory coding mechanisms (resolution of spatial stimuli, detection of mechanical forces and integration of multi-sensory inputs for hand conformation) and thus provided specific information about the integrity and function of mechanoreceptive afferents innervating the hand. After log transformation, thresholds were first examined to determine the influence of age (young and old) and gender (male, female) on tactile acuity. Sensory thresholds were then entered into multiple linear regression models to examine their ability to predict fingertip contact forces (normal and tangential) applied to a smooth surface when subjects stood with eyes closed on either a firm or a compliant support surface. As expected, age exerted a significant effect (p<0.01) on all three thresholds, but its impact was greater on spatial acuity than on pressure sensitivity or kinesthetic acuity. Gender had a marginal impact on pressure sensitivity thresholds only. The regression analyses revealed that tactile thresholds determined at the index fingertip accounted for a substantial proportion of the variance (up to 30%) seen in the contact forces deployed on the touch-plate, especially those exerted in the normal direction. The same analyses further revealed that much of the variance explained by the models arose from inter-individual differences in tactile spatial acuity and not from differences in pressure sensitivity or in kinesthetic acuity. Thus, of all three tests, the spatial acuity task was the most sensitive at detecting differences in hand sensibility both within and between age groups and, accordingly, was also better at predicting the magnitude of fingertip forces deployed for postural stabilization. Since spatial acuity is critically dependent upon innervation density, we conclude that the degree of functional innervation at the fingertip was likely an important factor in determining the capacity of older participants to use contact cues for stability purposes, forcing the most affected individuals to exert unusually high pressures in order to achieve stabilization in the presence of reduced tactile inputs arising from contact with the touched surface.

Abstract: OBJECTIVE: To determine whether the ability to discriminate weights remained accurate after anterior cruciate ligament (ACL) injury. DESIGN: Descriptive case series. SETTING: Outpatient physical therapy. PARTICIPANTS: Convenience sample of 10 participants with unilateral ACL injuries (age, 27.1+/-8.2 y) and 8 healthy controls (age, 22.6+/-2.8 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Weber fractions, expressed as percentage differences from the standard weight (3.00 kg) that could be reliably detected (75% correct level), were derived from each leg to provide an index of proprioceptive acuity for weight discrimination. Subjective ratings of knee function (Activities of Daily Living Scale of the Knee Outcome Survey) and measurements of quadriceps strength (peak isometric torque). RESULTS: The ACL group exhibited a reduced acuity to detect differences in weight on the injured, as compared with the uninjured, side as reflected in the increase in Weber fractions (mean, 6.7%+/-2.3% vs 4.8%+/-1.1%, respectively; P = .043). No such difference in acuity between legs was detected in healthy controls (mean right and left, 5.4%+/-1.4% vs 5.7%+/-1.3%, respectively, P = .99). CONCLUSIONS: Proprioceptive acuity for weight discrimination was significantly reduced after an ACL injury, possibly reflecting deficits in the ability to properly calibrate force signals generated while muscles are actively contracting, as a result of a loss in ligamentous sensory innervation.

Abstract: In this study, we attempted to better delineate the changes in corticospinal excitability that accompany perceptual to motor transformations when people are asked to observe, image or imitate actions. Motor evoked potentials (MEP) from transcranial magnetic stimulation were recorded in the first dorsal interosseous (FDI) muscle of the dominant hand (15 right, 4 left) in five different conditions: (1) passive observation; (2) observation to imitate; (3) imagery; (4) imitation; and (5) counting backwards mentally. MEPs were also recorded at rest at the beginning and at the end of the session to establish baseline (BL) values. For the observation conditions, participants (n=19, 18-38 years) watched video sequences (5s) of hand actions performed by a model with the right arm (passive observation: scissors; observation to imitate: OK sign). Active imitation produced the greatest MEP facilitation compared to baseline, followed by the two observation conditions and the imagery conditions, which all produced similar levels of facilitation (post hoc comparisons). Mental counting produced some facilitation, but this effect was inconsistent. Baseline MEPs remained stable at the end of the session. A further comparison between right-handers (n=15) and left-handers (n=4) revealed no difference in the pattern of modulation across conditions. The similarity found between observation and imagery of hand actions in terms of corticospinal facilitation is interpreted in the light of the motor-simulation theory of Jeannerod [Neuroimage 14 (2001)], which proposes that perceiving actions involves neural simulation of the same action by the observer, thereby explaining the parallel between actions observed and actions imaged at the representational level.

Abstract: In this study, we compared the ability of young (n=10, 19-32 years) and older subjects (n=35, 60-86 years) to use fingertip contact as a balance aid during quiet stance under various conditions to determine whether aging would influence contact strategies. Experimental trials (duration, 60 s) included two visual conditions (vision; no vision), three fingertip contact conditions (no touch; smooth touch; rough touch) and two support surface conditions (firm; foam). In trials with contact, participants were required to maintain a light contact with their right index fingertip on an instrumented touch-plate. Subjects were not constrained to exert minimal contact force, although they were aware that the touch-plate was not designed for physical support. From displacements of the centre of foot pressure (COP), mean sway amplitude (MSA) was computed in the anterior-posterior (COP(AP)) and medio-lateral (COP(ML)) directions. Subjective estimates of stability were also obtained by asking participants to rate perceived stability on a visual analog scale in each condition. Mean normal force (FN) and mean resultant tangential force (F(TAN)) were computed from contact force data applied on the touch plate. In both age groups, touch conditions had a substantial effect on MSA in the AP direction under both support surface conditions, with reductions averaging between 40-55% when touch was allowed. Reductions in the ML direction, though less important (8-12% on average), were nevertheless highly significant, especially in the older subjects when standing on the foam. In the two groups, vision and texture had only marginal impact on MSA computed on both support surfaces. Contrasting with sway measurements, stability ratings were highly influenced by visual conditions in both age groups. Only in conditions of deficient support (foam surface) and absent vision did the perceived effect of touch exceed that of vision. Age had a major impact, however, on contact forces deployed during trials with touch. While individuals in the young group typically produced forces of <1 N (mean FN, 0.32+/-0.15 N) to achieve postural stabilization, older subjects tended to use higher, though not too excessive, contact forces (mean FN, 1.21+/-0.75 N) under the same conditions. From these findings, we conclude that the ability to use contact cues from the fingertip as a source of sensory information to improve postural stability is largely preserved in healthy older adults. The increase in contact force deployed by older individuals to achieve postural stabilization is interpreted as a compensatory strategy to help overcome age-related loss in tactile sensation, an issue that will be further addressed in a companion paper.

Abstract: In this study, we sought to better define the limit of spatial resolution at the fingertips of elderly participants (n = 30, age 60-95 years) using an extended set of JVP grating domes, incorporating four new grating dimensions (2.5-, 3.5-, 4.0- and 4.5-mm width). A secondary aim was to examine whether deficits in tactile acuity could be related to hand dysfunction in older adults. Spatial resolution thresholds were determined by the finest grating whose orientation (dominant index finger) could be reported reliably. Manual dexterity was assessed with the Grooved Pegboard Test (GPT). The extended set of domes improved threshold measurements in a majority of participants (21/30). Still, accurate threshold estimates could not be obtained in one third of the participants, mostly in the older age group (8/9, 74-95 years). Grating resolution thresholds at the index finger were strongly correlated (r = 0.66, p<0.01) with dexterity scores derived from the GPT. From these results, we conclude that the 2.5- and 3.5-mm grating domes are suitable additions when assessing spatial acuity at the fingertips of older subjects between 60 and 70 years of age (mean threshold, 2.7+/-0.6 mm). For the older ones, the 4.0- and 4.5-mm domes can improve threshold measurements but interpretation of values can be complicated by the presence of undiagnosed pathologies (e.g., diffuse polyneuropathy) as people advance in age. The strong relationship between grating resolution thresholds and dexterity scores indicates that an impaired spatial acuity at the fingertips may translate into great difficulties in tasks requiring fine manipulations. These findings have important implications for the assessment of hand function in older adults.

Abstract: OBJECTIVE: To compare indices of cortico-motor excitability derived from transcranial magnetic stimulation (TMS) of the lower limb motor representation in patients with Parkinson's diseases (PD) and healthy controls. METHODS: The cortico-motor excitability of the lower limb motor area was studied both at rest (motor threshold, amplitude of motor evoked potentials (MEPs)) and during active contraction of the quadriceps (Quad) muscle (MEPs facilitation and silent period) in 10 PD patients (11 legs) and 11 healthy controls using single pulse TMS. RESULTS: At rest, the motor threshold was found to be significantly lower and the amplitude of MEPs larger in patients than in controls. During active knee contraction, patients produced lower levels of MEP facilitation with respect to baseline values and the silent period was lengthened in comparison to controls. CONCLUSIONS: The present results provide further evidence from the lower limb motor area that enhanced cortico-spinal excitability is an important feature in the pathophysiology of PD.

Abstract: Recent studies suggest that sensory input generated during highly repetitive tasks can degrade the sensory representation of the hand and eventually lead to sensory and motor problems. In this study, we investigated whether early changes in tactile perception and manual dexterity could be detected in persons exposed to computer tasks. Performance in tests designed to assess tactile perception (grating orientation task for spatial acuity and roughness discrimination) and manual dexterity (grooved pegboard test) was compared between two groups of healthy individuals, matched for age, gender, and experience, who differed in terms of computer habits. One group consisted of frequent users (FU, > 2 h/day, n = 36) and the other of non or occasional users (OU, < 2 h/day, n = 28). Comparison of performance between groups with subjects sorted by gender revealed significant differences (t-test, p < 0.05) in female, but not male, participants. Grating resolution thresholds at the tip on the second and fifth digits were, on average, 40% higher in female FU (n = 13) than in female OU (n = 10) and performance scores on the dexterity test were significantly higher for the left hand. The results of this study indicate that early signs of deterioration in hand function can be present in persons constantly exposed to computer tasks and that these signs are more readily apparent in women than in men. The loss of tactile spatial acuity found in female FU possibly reflect an early consequence of the degraded sensory representation of the hand resulting from constant repetitions of fine motor tasks.

Abstract: In this study, we investigated corticospinal excitability during mental simulation of a leg extension movement with the technique of transcranial magnetic stimulation. Motor evoked potentials were recorded in both knee extensors (quadriceps) and flexors (biceps femoris) in 19 trained participants (healthy volunteers). The amplitude and latency of motor evoked potentials were compared in three conditions: (1) at rest, (2) during motor imagery, and (3) at rest, immediately after motor imagery. The results showed a significant effect (p < 0.001) of conditions on motor evoked potentials amplitude in the quadriceps but not in the biceps femoris. During motor imagery, the size of motor evoked potentials in the quadriceps increased significantly (p < 0.001) compared with rest and post-imagery conditions. Changes in motor evoked potentials latency across conditions were not significant, however. These results are consistent with previous studies in the upper limb and suggest that corticospinal excitability can be enhanced during motor imagery to facilitate responses in specific lower limb muscles.

Abstract: OBJECTIVE: To test the influence of cooling on proprioceptive acuity as reflected in the ability to discriminate weights. DESIGN AND SETTING: Participants were trained to perform a weight-discrimination task. Their ability to correctly report small increments in weight was compared before and after local cooling (a 20-minute application of a crushed-ice pack) of the quadriceps muscle group. Data were collected at a university research laboratory. SUBJECTS: Twenty young, physically active adults (undergraduate students; 14 men, 6 women; mean age, 22.1 +/- 2.6 years). MEASUREMENTS: We calculated overall performance in the weight-discrimination task (percentage of discrimination correct) for each participant to estimate the differential threshold (ie, minimal increment in weight that yields a probability of 75% correct responses). RESULTS: Before local cooling, participants discriminated increments in the order of 4% to 10% from the standard weight (mean threshold, 0.17 +/- 0.06 kg). After local cooling, the discriminative performance remained, on average, very similar to that seen before cooling (mean threshold, 0.17 +/- 0.08 kg; paired t test: t = 0.24, P =.81). Only a small group of participants (n = 5) showed evidence of a decreased ability to discriminate weight after cooling. CONCLUSIONS: The perception of force signals required for weight discrimination does not appear to be affected by local cooling of the quadriceps muscle group. This finding provides additional evidence for the relative safety of cold applications and their effect on proprioceptive perceptual abilities.