Kinematic markers dissociate error correction from sensorimotor realignment during prism adaptation.

This study investigated the motor control mechanisms that enable healthy individuals to adapt their pointing movements during prism exposure to a rightward optical shift. In the prism adaptation literature, two processes are typically distinguished. Strategic motor adjustments are thought to drive the pattern of rapid endpoint error correction typically observed during the early stage of prism exposure. This is distinguished from so-called 'true sensorimotor realignment', normally measured with a different pointing task, at the end of prism exposure, which reveals a compensatory leftward 'prism after-effect'. Here, we tested whether each mode of motor compensation - strategic adjustments versus 'true sensorimotor realignment' - could be distinguished, by analyzing patterns of kinematic change during prism exposure. We hypothesized that fast feedforward versus slower feedback error corrective processes would map onto two distinct phases of the reach trajectory. Specifically, we predicted that feedforward adjustments would drive rapid compensation of the initial (acceleration) phase of the reach, resulting in the rapid reduction of endpoint errors typically observed early during prism exposure. By contrast, we expected visual-proprioceptive realignment to unfold more slowly and to reflect feedback influences during the terminal (deceleration) phase of the reach. The results confirmed these hypotheses. Rapid error reduction during the early stage of prism exposure was achieved by trial-by-trial adjustments of the motor plan, which were proportional to the endpoint error feedback from the previous trial. By contrast, compensation of the terminal reach phase unfolded slowly across the duration of prism exposure. Even after 100 trials of pointing through prisms, adaptation was incomplete, with participants continuing to exhibit a small rightward shift in both the reach endpoints and in the terminal phase of reach trajectories. Individual differences in the degree of adaptation of the terminal reach phase predicted the magnitude of prism after-effects. In summary, this study identifies distinct kinematic signatures of fast strategic versus slow sensorimotor realignment processes, which combine to adjust motor performance to compensate for a prismatic shift.

Factitious torsion dystonia in rehabilitation: a singular new case and literature review.

We report a case of a 29-year-old woman suffering from chronic factitious disorder (FD) with torsion dystonia. For nearly five years, she traveled widely over the country, going from one hospital to another, taking serious medical risk in order to prolong her illness. After several admissions to Rehabilitation Units and multiple explorations, we find convincing evidence for factitious origin and the diagnosis of Munchausen syndrome was evoked. Such a clinical presentation is infrequent in Munchausen's syndrome. Indeed, most often the clinical picture is characterized by acute abdominal pain, fainting, hemoptysis, precordialgia, hematemesis or dermatological lesions. Physicians should be aware of this rare and potentially critical form of FD. Awareness in identifying these patients may lead to prevent unnecessary medical and/or surgical interventions.