scholarly journals Network-level connectivity is a critical feature distinguishing dystonic tremor and essential tremor

Brain ◽  
2019 ◽  
Vol 142 (6) ◽  
pp. 1644-1659 ◽  
Author(s):  
Jesse C DeSimone ◽  
Derek B Archer ◽  
David E Vaillancourt ◽  
Aparna Wagle Shukla
Keyword(s):  
Functional Connectivity ◽  
Essential Tremor ◽  
Clinical Features ◽  
Visual Feedback ◽  
Grip Force ◽  
Precision Grip ◽  
Critical Feature ◽  
Dystonic Tremor ◽  
Body Regions ◽  
Force Tremor

AbstractDystonia is a movement disorder characterized by involuntary muscle co-contractions that give rise to disabling movements and postures. A recent expert consensus labelled the incidence of tremor as a core feature of dystonia that can affect body regions both symptomatic and asymptomatic to dystonic features. We are only beginning to understand the neural network-level signatures that relate to clinical features of dystonic tremor. At the same time, clinical features of dystonic tremor can resemble that of essential tremor and present a diagnostic confound for clinicians. Here, we examined network-level functional activation and connectivity in patients with dystonic tremor and essential tremor. The dystonic tremor group included primarily cervical dystonia patients with dystonic head tremor and the majority had additional upper-limb tremor. The experimental paradigm included a precision grip-force task wherein online visual feedback related to force was manipulated across high and low spatial feedback levels. Prior work using this paradigm in essential tremor patients produced exacerbation of grip-force tremor and associated changes in functional activation. As such, we directly compared the effect of visual feedback on grip-force tremor and associated functional network-level activation and connectivity between dystonic tremor and essential tremor patient cohorts to better understand disease-specific mechanisms. Increased visual feedback similarly exacerbated force tremor during the grip-force task in dystonic tremor and essential tremor cohorts. Patients with dystonic tremor and essential tremor were characterized by distinct functional activation abnormalities in cortical regions but not in the cerebellum. We examined seed-based functional connectivity from the sensorimotor cortex, globus pallidus internus, ventral intermediate thalamic nucleus, and dentate nucleus, and observed abnormal functional connectivity networks in dystonic tremor and essential tremor groups relative to controls. However, the effects were far more widespread in the dystonic tremor group as changes in functional connectivity were revealed across cortical, subcortical, and cerebellar regions independent of the seed location. A unique pattern for dystonic tremor included widespread reductions in functional connectivity compared to essential tremor within higher-level cortical, basal ganglia, and cerebellar regions. Importantly, a receiver operating characteristic determined that functional connectivity z-scores were able to classify dystonic tremor and essential tremor with 89% area under the curve, whereas combining functional connectivity with force tremor yielded 94%. These findings point to network-level connectivity as an important feature that differs substantially between dystonic tremor and essential tremor and should be further explored in implementing appropriate diagnostic and therapeutic strategies.

Visual and Tactile Information About Object-Curvature Control Fingertip Forces and Grasp Kinematics in Human Dexterous Manipulation

2000 ◽  
Vol 84 (6) ◽  
pp. 2984-2997 ◽  
Author(s):  
Per Jenmalm ◽  
Seth Dahlstedt ◽  
Roland S. Johansson
Keyword(s):  
Visual Processing ◽  
Visual Cues ◽  
Grip Force ◽  
Center Of Mass ◽  
Precision Grip ◽  
Sensory Information ◽  
Afferent Input ◽  
Dependent Manner ◽  
Tactile Sensibility ◽  
Grasp Stability

Most objects that we manipulate have curved surfaces. We have analyzed how subjects during a prototypical manipulatory task use visual and tactile sensory information for adapting fingertip actions to changes in object curvature. Subjects grasped an elongated object at one end using a precision grip and lifted it while instructed to keep it level. The principal load of the grasp was tangential torque due to the location of the center of mass of the object in relation to the horizontal grip axis joining the centers of the opposing grasp surfaces. The curvature strongly influenced the grip forces required to prevent rotational slips. Likewise the curvature influenced the rotational yield of the grasp that developed under the tangential torque load due to the viscoelastic properties of the fingertip pulps. Subjects scaled the grip forces parametrically with object curvature for grasp stability. Moreover in a curvature-dependent manner, subjects twisted the grasp around the grip axis by a radial flexion of the wrist to keep the desired object orientation despite the rotational yield. To adapt these fingertip actions to object curvature, subjects could use both vision and tactile sensibility integrated with predictive control. During combined blindfolding and digital anesthesia, however, the motor output failed to predict the consequences of the prevailing curvature. Subjects used vision to identify the curvature for efficient feedforward retrieval of grip force requirements before executing the motor commands. Digital anesthesia caused little impairment of grip force control when subjects had vision available, but the adaptation of the twist became delayed. Visual cues about the form of the grasp surface obtained before contact was used to scale the grip force, whereas the scaling of the twist depended on visual cues related to object movement. Thus subjects apparently relied on different visuomotor mechanisms for adaptation of grip force and grasp kinematics. In contrast, blindfolded subjects used tactile cues about the prevailing curvature obtained after contact with the object for feedforward adaptation of both grip force and twist. We conclude that humans use both vision and tactile sensibility for feedforward parametric adaptation of grip forces and grasp kinematics to object curvature. Normal control of the twist action, however, requires digital afferent input, and different visuomotor mechanisms support the control of the grasp twist and the grip force. This differential use of vision may have a bearing to the two-stream model of human visual processing.

scholarly journals Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome

Symmetry ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1042
Author(s):  
Oscar J. Pellicer-Valero ◽  
José D. Martín-Guerrero ◽  
César Fernández-de-las-Peñas ◽  
Ana I. De-la-Llave-Rincón ◽  
Jorge Rodríguez-Jiménez ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Spectral Clustering ◽  
Grip Force ◽  
The Other ◽  
Pressure Pain ◽  
Thermal Pain ◽  
Pressure Pain Thresholds ◽  
Tunnel Syndrome

Identification of subgroups of patients with chronic pain provides meaningful insights into the characteristics of a specific population, helping to identify individuals at risk of chronification and to determine appropriate therapeutic strategies. This paper proposes the use of spectral clustering (SC) to distinguish subgroups (clusters) of individuals with carpal tunnel syndrome (CTS), making use of the obtained patient profiling to argue about potential management implications. SC is a powerful algorithm that builds a similarity graph among the data points (the patients), and tries to find the subsets of points that are strongly connected among themselves, but weakly connected to others. It was chosen due to its advantages with respect to other simpler clustering techniques, such as k-means, and the fact that it has been successfully applied to similar problems. Clinical (age, duration of symptoms, pain intensity, function, and symptom severity), psycho-physical (pressure pain thresholds—PPTs—over the three main nerve trunks of the upper extremity, cervical spine, carpal tunnel, and tibialis anterior), psychological (depressive levels), and motor (pinch tip grip force) variables were collected in 208 women with clinical/electromyographic diagnosis of CTS, whose symptoms usually started unilaterally but eventually evolved into bilateral symmetry. SC was used to identify clusters of patients without any previous assumptions, yielding three clusters. Patients in cluster 1 exhibited worse clinical features, higher widespread pressure pain hyperalgesia, higher depressive levels, and lower pinch tip grip force than the other two. Patients in cluster 2 showed higher generalized thermal pain hyperalgesia than the other two. Cluster 0 showed less hypersensitivity to pressure and thermal pain, less severe clinical features, and more normal motor output (tip grip force). The presence of subgroups of individuals with different altered nociceptive processing (one group being more sensitive to pressure pain and another group more sensitive to thermal pain) could lead to different therapeutic programs.

A new visual feedback-based system for the assessment of pinch force, endurance, accuracy and precision. A test-retest reliability study

Hand Therapy ◽  
2021 ◽  
pp. 175899832110025
Author(s):  
Alberto Dottor ◽  
Eleonora Camerone ◽  
Mirko Job ◽  
Diletta Barbiani ◽  
Elisa Frisaldi ◽  
...  
Keyword(s):  
Visual Feedback ◽  
Intraclass Correlation ◽  
Precision Grip ◽  
Voluntary Contraction ◽  
Good Reliability ◽  
Retest Reliability ◽  
Relative Reliability ◽  
Time Accuracy ◽  
In The Beginning ◽  
Test Retest Reliability

Introduction Given that pinch is a precision grip involved in sustained submaximal activities, a Sustained Contraction (SC) task could be associated to Maximal Voluntary Contraction (MVC). To better evaluate the thumb-index system, the test-retest reliability of pinch MVC and SC, measured by a visual feedback-based pinch gauge was assessed. Methods 26 healthy participants performed MVC and SC in two separate sessions. SC required to maintain 40%MVC as long as possible and it was evaluated in terms of time, accuracy (Mean Distance between force trace and target force, MD), precision (Coefficient of Variability of force trace, CV). MD and CV analyses were conducted dividing the SC task into three equivalent time stages (beginning, middle, exhaustion). Relative Reliability (RR) was measured by Intraclass Correlation Coefficient, and Absolute Reliability (AR) was measured by Standard Error of Measurement and by Bland-Altman plot. Results MVC and Time showed high RR and AR in both hands. RR of MD and CV in right hand was excellent in the beginning and middle stages, and fair in the exhaustion one, showing decreasing reliability as fatigue increases. In the left hand RR of MD and CV was generally lower. MD showed excellent reliability in the beginning stage and good reliability in the other stages. CV showed fair relative reliability at both beginning and middle stages, excellent in the last one. Conversely, it was observed high AR of MD and CV in all stages in both hands. Conclusions All indices are reliable to assess motor control of thumb-index pinch in both hands.

scholarly journals Intermittent Visuomotor Processing in the Human Cerebellum, Parietal Cortex, and Premotor Cortex

2006 ◽  
Vol 95 (2) ◽  
pp. 922-931 ◽  
Author(s):  
David E. Vaillancourt ◽  
Mary A. Mayka ◽  
Daniel M. Corcos
Keyword(s):  
Parietal Cortex ◽  
Visual Feedback ◽  
Visual Information ◽  
Grip Force ◽  
Premotor Cortex ◽  
Force Variability ◽  
Neural Activation ◽  
Control Force ◽  
Force Condition ◽  
Visuomotor Processing

The cerebellum, parietal cortex, and premotor cortex are integral to visuomotor processing. The parameters of visual information that modulate their role in visuomotor control are less clear. From motor psychophysics, the relation between the frequency of visual feedback and force variability has been identified as nonlinear. Thus we hypothesized that visual feedback frequency will differentially modulate the neural activation in the cerebellum, parietal cortex, and premotor cortex related to visuomotor processing. We used functional magnetic resonance imaging at 3 Tesla to examine visually guided grip force control under frequent and infrequent visual feedback conditions. Control conditions with intermittent visual feedback alone and a control force condition without visual feedback were examined. As expected, force variability was reduced in the frequent compared with the infrequent condition. Three novel findings were identified. First, infrequent (0.4 Hz) visual feedback did not result in visuomotor activation in lateral cerebellum (lobule VI/Crus I), whereas frequent (25 Hz) intermittent visual feedback did. This is in contrast to the anterior intermediate cerebellum (lobule V/VI), which was consistently active across all force conditions compared with rest. Second, confirming previous observations, the parietal and premotor cortices were active during grip force with frequent visual feedback. The novel finding was that the parietal and premotor cortex were also active during grip force with infrequent visual feedback. Third, right inferior parietal lobule, dorsal premotor cortex, and ventral premotor cortex had greater activation in the frequent compared with the infrequent grip force condition. These findings demonstrate that the frequency of visual information reduces motor error and differentially modulates the neural activation related to visuomotor processing in the cerebellum, parietal cortex, and premotor cortex.

Wrist Action Affects Precision Grip Force

1997 ◽  
Vol 78 (1) ◽  
pp. 271-280 ◽  
Author(s):  
Mary M. Werremeyer ◽  
Kelly J. Cole
Keyword(s):  
Grip Force ◽  
Precision Grip ◽  
Load Force ◽  
Myoelectric Activity ◽  
Resistive Load ◽  
Wrist Flexion ◽  
Wrist Extension ◽  
Hand Muscles ◽  
Force Pulse ◽  
Grasp Stability

Werremeyer, Mary M. and Kelly J. Cole. Wrist action affects precision grip force. J. Neurophysiol. 78: 271–280, 1997. When moving objects with a precision grip, fingertip forces normal to the object surface (grip force) change in parallel with forces tangential to the object (load force). We investigated whether voluntary wrist actions can affect grip force independent of load force, because the extrinsic finger muscles cross the wrist. Grip force increased with wrist angular speed during wrist motion in the horizontal plane, and was much larger than the increased tangential load at the fingertips or the reaction forces from linear acceleration of the test object. During wrist flexion the index finger muscles in the hand and forearm increased myoelectric activity; during wrist extension this myoelectric activity increased little, or decreased for some subjects. The grip force maxima coincided with wrist acceleration maxima, and grip force remained elevated when subjects held the wrist in extreme flexion or extension. Likewise, during isometric wrist actions the grip force increased even though the fingertip loads remained constant. A grip force “pulse” developed that increased with wrist force rate, followed by a static grip force while the wrist force was sustained. Subjects could not suppress the grip force pulse when provided visual feedback of their grip force. We conclude that the extrinsic hand muscles can be recruited to assist the intended wrist action, yielding higher grip-load ratios than those employed with the wrist at rest. This added drive to hand muscles overcame any loss in muscle force while the extrinsic finger flexors shortened during wrist flexion motion. During wrist extension motion grip force increases apparently occurred from eccentric contraction of the extrinsic finger flexors. The coactivation of hand closing muscles with other wrist muscles also may result in part from a general motor facilitation, because grip force increased during isometric knee extension. However, these increases were related weakly to the knee force. The observed muscle coactivation, from all sources, may contribute to grasp stability. For example, when transporting grasped objects, upper limb accelerations simultaneously produce inertial torques at the wrist that must be resisted, and inertial loads at the fingertips from the object that must be offset by increased grip force. The muscle coactivation described here would cause similarly timed pulses in the wrist force and grip force. However, grip-load coupling from this mechanism would not contribute much to grasp stability when small wrist forces are required, such as for slow movements or when the object's total resistive load is small.

scholarly journals Functional Connectivity Targeting for Deep Brain Stimulation in Essential Tremor

2011 ◽  
Vol 32 (10) ◽  
pp. 1963-1968 ◽  
Author(s):  
J.S. Anderson ◽  
H.S. Dhatt ◽  
M.A. Ferguson ◽  
M. Lopez-Larson ◽  
L.E. Schrock ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Functional Connectivity ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Deep Brain

scholarly journals Quantitative Assessment of Head Tremor in Patients with Essential Tremor and Cervical Dystonia by Using Inertial Sensors

Sensors ◽  
2019 ◽  
Vol 19 (19) ◽  
pp. 4246 ◽  
Author(s):  
Lazar Berbakov ◽  
Čarna Jovanović ◽  
Marina Svetel ◽  
Jelena Vasiljević ◽  
Goran Dimić ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Cervical Dystonia ◽  
Inertial Sensors ◽  
Signal Amplitude ◽  
Peak Frequency ◽  
Dystonic Tremor ◽  
Head Tremor ◽  
Different Types ◽  
The Mean ◽  
Remote Health

Tremor is most common among the movement disabilities that affect older people, having a prevalence rate of 4.6% in the population older than 65 years. Despite this, distinguishing different types of tremors is clinically challenging, often leading to misdiagnosis. However, due to advances in microelectronics and wireless communication, it is now possible to easily monitor tremor in hospitals and even in home environments. In this paper, we propose an architecture of a system for remote health-care and one possible implementation of such system focused on head tremor monitoring. In particular, the aim of the study presented here was to test new tools for differentiating essential tremor from dystonic tremor. To that aim, we propose a number of temporal and spectral features that are calculated from measured gyroscope signals, and identify those that provide optimal differentiation between two groups. The mean signal amplitude feature results in sensitivity = 0.8537 and specificity = 0.8039 in distinguishing patients having cervical dystonia with or without tremor. In addition, mean signal amplitude was shown to be significantly higher in patients with essential tremor than in patients with cervical dystonia, whereas the mean peak frequency is not different between two groups.

Precision grip force dynamics: a system identification approach

2000 ◽  
Vol 47 (10) ◽  
pp. 1366-1375 ◽  
Author(s):  
A. Fagergren ◽  
O. Ekeberg ◽  
H. Forssberg
Keyword(s):  
System Identification ◽  
Grip Force ◽  
Precision Grip ◽  
Force Dynamics ◽  
Identification Approach
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