Identifying fine motor difficulties in children with acute lymphoblastic leukemia: a scoping review.

PURPOSE: Survival rates for children diagnosed with acute lymphoblastic leukemia (ALL) have increased significantly over recent decades, and thus attention shifted toward understanding the adverse effects of cancer treatment. Chemotherapy has side effects that could affect muscle state and diminish motor performance. This scoping review was conducted to map the breadth of evidence for different tools used in fine motor skills assessment, the extent of upper extremity strength, and fine motor performance, highlighting the potential risk factors that may influence these skills. METHODS: In March 2023, full-text studies that examined fine motor performance and/or upper extremity strength were identified via searches in PubMed, Science Direct, Scopus, Web of Science, and PEDro databases. The titles and abstracts of selected studies were screened according to the inclusion and exclusion criteria. RESULTS: The search yielded initial 418 citations and 26 peer-reviewed articles were finally included in the review. Considerable heterogeneity was observed regarding the methods of evaluating fine motor skills. The results of this review indicate that children and adolescents with ALL experienced fine motor limitations and upper extremity weakness either during or after cessation of treatment. CONCLUSION: This scoping review presents a broad overview of the literature addressing fine motor difficulties in the pediatric population with ALL. Results accentuate the need to incorporate strengthening and occupational therapy training to preserve muscle strength and minimize future fine motor problems along the course of chemotherapeutic treatment. Little evidence was reported regarding the risk factors that may impair muscle strength and motor performance.

Relationships between moderate vigorous physical activity, motor- and health-related fitness and motor skills in children.

BACKGROUND:  Childhood is an important transitional period for the development of healthy physical activity (PA) behaviours, so it is important to understand its impact on a healthy lifestyle. AIM:  This study aimed to determine the influences of sex, socioeconomic status (SES) and body composition (BC) on the relationships between PA, motor skills, motor- and health-related physical fitness in 5-8-year-olds. SETTING:  Participants were a subsample consisting of 299 children (150 boys, 149 girls, mean age 6.83 ± 0.96 years) from the Exercise, Arterial Modulation and Nutrition in Youth South Africa study (ExAMIN Youth SA). METHODS:  Anthropometric measures, health-related physical fitness (HRPF), motor-related physical fitness (MRPF), objectively measured PA and demographic information were determined. RESULTS:  Only 66% achieved the recommended 60 min of daily moderate vigorous physical activity (MVPA) with 19% classified as having unhealthy body composition (11% overweight, 8% obese). Fat-free mass and SES revealed small-to-moderate influences on the relationship between MVPA, standing broad jump (SBJ; r = 0.32), predicted VO2max (r = 0.28) and beep levels (r = 0.22). For MRPF, the quality of running (r = 0.12) and balancing were associated with MVPA. Adjusting for sex, BC and SES in the relationship between PA with HRPF and MRPF, reductions in most correlations were observed. CONCLUSION:  Moderate vigorous physical activity levels were positively associated with HRPF, MRPF and some motor skills in 5-8-year-olds. Socioeconomic status (lower parental income, employment and education negatively influenced the association between MVPA and fitness [beeps, SBJ, O2max]).Contribution: This study provides knowledge with regard to the use of accelerometer for baseline data for PA, MRPF, HRPF as well as motor skills in South African children.

Long-term outcomes of visual motor integration and motor development children with retinopathy of prematurity.

Premature infants have a risk of neurodevelopmental deficits. Little is known, however, about how retinopathy of prematurity (ROP) affects visual motor integration (VMI), which is necessary for both fine motor skills and further school abilities. Due to the systemic escape of bevacizumab in the treatment of ROP, concerns regarding the long-term neurodevelopmental effect of the drug have arisen. The aim is to evaluate VMI and motor development long-term outcomes after intravitreal bevacizumab (IVB) injection and laser treatment for ROP. Two groups of premature children were included: Bevacizumab group - 16 premature children who received IVB treatment and laser group - 23 premature children who underwent laser photocoagulation treatment in this single center cross-sectional study. At 2-6 years of age, VMI (Beery-Buktenica Developmental Test), motor development (Peabody Developmental Motor Scales-2), visual acuity, and refractive status were assessed. The incidence of abnormal visual function was significantly higher in bevacizumab group than in laser group (p = 0.022). The incidence of abnormal VMI skill was significantly higher in bevacizumab group than in laser group (p = 0.024). Incidences of abnormal gross, fine, and total motor skills were significantly higher in bevacizumab group compared to laser group (p < 0.05). Premature children who received bevacizumab for ROP demonstrated significantly lower VMI and motor development features than those with laser treatment at preschool age. Although our results suggest the relevance of bevacizumab injection in impaired VMI and motor development outcomes, general level of sickness rather than treatment might be the cause of delayed motor development.

ASSESSMENT OF SIMULATED SURGICAL DEXTERITY AFTER MODIFIABLE EXTERNAL EXPOSURES AMONG NOVICE VERSUS EXPERIENCED VITREORETINAL SURGEONS.

PURPOSE: To evaluate novice and senior vitreoretinal surgeons after various exposures. Multiple comparisons ranked the importance of these exposures for surgical dexterity based on experience. METHODS: This prospective cohort study included 15 novice and 11 senior vitreoretinal surgeons (<2 and >10 years' practice, respectively). Eyesi-simulator tasks were performed after each exposure. Day 1, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine; day 2, placebo, 0.2 mg/kg propranolol, and 0.6 mg/kg propranolol; day 3, baseline simulation, breathalyzer readings of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentrations; day 4, baseline simulation, push-up sets with 50% and 85% repetitions maximum; and day 5, 3-hour sleep deprivation. Eyesi-generated score (0-700, worst-best), out-of-tolerance tremor (0-100, best-worst), task completion time (minutes), and intraocular pathway (in millimeters) were measured. RESULTS: Novice surgeons performed worse after caffeine (-29.53, 95% confidence interval [CI]: -57.80 to -1.27, P = 0.041) and alcohol (-51.33, 95% CI: -80.49 to -22.16, P = 0.001) consumption. Alcohol caused longer intraocular instrument movement pathways (212.84 mm, 95% CI: 34.03-391.65 mm, P = 0.02) and greater tremor (7.72, 95% CI: 0.74-14.70, P = 0.003) among novices. Sleep deprivation negatively affected novice performance time (2.57 minutes, 95% CI: 1.09-4.05 minutes, P = 0.001) and tremor (8.62, 95% CI: 0.80-16.45, P = 0.03); however, their speed increased after propranolol (-1.43 minutes, 95% CI: -2.71 to -0.15 minutes, P = 0.029). Senior surgeons' scores deteriorated only following alcohol consumption (-47.36, 95% CI: -80.37 to -14.36, P = 0.005). CONCLUSION: Alcohol compromised all participants despite their expertise level. Experience negated the effects of caffeine, propranolol, exercise, and sleep deprivation on surgical skills.

O efeito de 12 semanas de aulas de ballet sobre a potência de bailarinas amadoras / The effect of 12 weeks of ballet classes on the power of amateur dancers

RESUMO Os grandes saltos são passos que exigem potência muscular e coordenação motora. Visto que há uma escassez na literatura sobre o aprendizado e treinamento destes passos, o objetivo deste estudo foi verificar o efeito de doze semanas de aulas de ballet clássico com o exercício de grand allegro sobre a potência de membros inferiores em bailarinas amadoras. Participaram sete bailarinas, com 11,33±1,02 anos de idade, que cursavam o Grade 3 da Royal Academy of Dance. Foram realizados cálculos de Pico de Velocidade de Crescimento, testes de salto vertical e avaliação técnica do grand allegro em quatro momentos durante doze semanas. Os planos de aula, Percepção Subjetiva de Esforço e Qualidade Total de Recuperação de cada aula foram analisadas. Os principais resultados apontam bailarinas pré-púberes, cuja potência muscular e técnica do exercício de grand allegro apresentaram melhora (p<0,05). A carga semanal e quantidade de saltos e de exercícios executados variaram durante o período, enquanto que a Qualidade Total de Recuperação se mostrou estável. Os dados obtidos apontam para as variações da carga de trabalho nas aulas de ballet somadas à fase sensível do desenvolvimento e coordenação motora como os responsáveis pela evolução na potência muscular e na qualidade técnica.

ABSTRACT The big jumps are steps that require muscular power and motor coordination. Since there is a lack in the literature on the learning and training of these steps, the aim of this study was to verify the effect of 12 weeks of classical ballet classes with the grand allegro exercise on lower limb power in amateur ballerinas. Seven dancers, aged 11.33±1.02 years, who were studying Grade 3 of Royal Academy of Dance, participated Height Growth Speed Peak calculations, vertical jump tests, and technical evaluation of the grand allegro exercise were performed at four moments over the 12-week study period. Lesson plans, the Rating of Perceived Exertion, and the Total Recovery Quality for each class were collected to analyze load and recovery. The main results indicate that the dancers were prepubertal and lower limb muscular power and the technique of the grand allegro exercise improved (p<0.05). Weekly load and the quantity of jumps and exercises performed varied during the period, while Total Recovery Quality remained stable. The obtained data point to variations in the workload during ballet classes, combined with the sensitive phase of development and motor coordination, as responsible for the improvement in muscular power and technical quality.

Exposure to an incompatible virtual surgery impacts the null space components of the muscle patterns after re-adaptation but not the task performance.

Under the synergy hypothesis, novel muscle synergies may be required for motor skill learning. We have developed a "virtual surgery" experimental paradigm that alters the mapping of muscle activations onto virtual cursor motion during an isometric reaching task using myoelectric control. By creating virtual surgeries that are "incompatible" with the original synergies, we can investigate learning new muscle synergies in controlled experimental conditions. We have previously shown that participants are able to improve their task performance after an incompatible virtual surgery, using novel muscle patterns to overcome the perturbation. In this work, we investigated whether the activation of novel muscle patterns, that are required after an incompatible virtual surgery, affects task performance or the muscle patterns after re-adaptation to the unperturbed baseline mapping. We found that experiencing an incompatible virtual surgery did not affect the task performance during the baseline mapping. However, the adaptation to the incompatible virtual surgery resulted in changes in the null space components of the muscle patterns used in the unperturbed task.

Anodal cerebellar t-DCS impacts skill learning and transfer on a robotic surgery training task.

The cerebellum has demonstrated a critical role during adaptation in motor learning. However, the extent to which it can contribute to the skill acquisition of complex real-world tasks remains unclear. One particularly challenging application in terms of motor activities is robotic surgery, which requires surgeons to complete complex multidimensional visuomotor tasks through a remotely operated robot. Given the need for high skill proficiency and the lack of haptic feedback, there is a pressing need for understanding and improving skill development. We investigated the effect of cerebellar transcranial direct current stimulation applied during the execution of a robotic surgery training task. Study participants received either real or sham stimulation while performing a needle driving task in a virtual (simulated) and a real-world (actual surgical robot) setting. We found that cerebellar stimulation significantly improved performance compared to sham stimulation at fast (more demanding) execution speeds in both virtual and real-world training settings. Furthermore, participants that received cerebellar stimulation more effectively transferred the skills they acquired during virtual training to the real world. Our findings underline the potential of non-invasive brain stimulation to enhance skill learning and transfer in real-world relevant tasks and, more broadly, its potential for improving complex motor learning.

Persistent changes in motor adaptation strategies after perturbations that require exploration of novel muscle activation patterns.

Motor skill learning requires the acquisition of novel muscle patterns and a new control policy-a process that requires time. In contrast, motor adaptation often requires only the adjustment of existing muscle patterns-a fast process. By altering the mapping of muscle activations onto cursor movements in a myoelectrically controlled virtual environment, we are able to create perturbations that require either the recombination of existing muscle synergies (compatible virtual surgery) or the learning of novel muscle patterns (incompatible virtual surgery). We investigated whether adaptation to a compatible surgery is affected by prior exposure to an incompatible surgery, i.e., a motor skill learning task. We found that adaptation to a compatible surgery was characterized by a decrease in the quality of muscle pattern reconstructions using the original synergies and an increase in reaction times only after exposure to an incompatible surgery. In contrast, prior exposure to a compatible surgery did not affect the learning process required to overcome an incompatible surgery. The fact that exposure to an incompatible surgery had a profound effect on the muscle patterns during the adaptation to a subsequent compatible surgery and not vice versa suggests that null space exploration, possibly combined with an explicit exploration strategy, is engaged during exposure to an incompatible surgery and remains enhanced during a new adaptation episode. We conclude that motor skill learning, requiring novel muscle activation patterns, leads to changes in the exploration strategy employed during a subsequent perturbation.NEW & NOTEWORTHY Motor skill learning requires the acquisition of novel muscle patterns, whereas motor adaptation requires adjusting existing ones. We wondered whether training a new motor skill affects motor adaptation strategies. We show that learning an incompatible perturbation, a complex skill requiring new muscle synergies, affects the muscle patterns observed during adaption to a compatible perturbation, which requires adjusting the existing synergies. Our results suggest that motor skill learning results in persistent changes in the exploration strategy.

[Effectiveness of robotic technology and virtual reality for the rehabilitation of motor function in cerebral palsy. Systematic review]. / Efectividad de la tecnología robótica y la realidad virtual para la rehabilitación de la función motora en la parálisis cerebral. Revisión sistemática.

INTRODUCTION: Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification. RESULTS: Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual-perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.

The plyometric activity as a conditioning to enhance strength and precision of the finger movements in pianists.

Stability of timing and force production in repetitive movements characterizes skillful motor behaviors such as surgery and playing musical instruments. However, even trained individuals such as musicians undergo further extensive training for the improvement of these skills. Previous studies that investigated the lower extremity movements such as jumping and sprinting demonstrated enhancement of the maximum force and rate of force development immediately after the plyometric exercises. However, it remains unknown whether the plyometric exercises enhance the stability of timing and force production of the dexterous finger movements in trained individuals. Here we address this issue by examining the effects of plyometric exercise specialized for finger movements on piano performance. We compared the training-related changes in the piano-key motion and several physiological features of the finger muscles (e.g., electromyography, rate of force development, and muscle temperature) by well-trained pianists. The conditioning demonstrated a decrease of the variation in timing and velocity of successive keystrokes, along with a concomitant increase in the rate of force development of the four fingers, but not the thumb, although there was no change in the finger muscular activities through the activity. By contrast, such a conditioning effect was not evident following a conventional repetitive piano practice. In addition, a significant increase in the forearm muscle temperature was observed specifically through performing the plyometric exercise with the fingers, implying its association with improved performance. These results indicate effectiveness of the plyometric exercises for improvement of strength, precision, and physiological efficiency of the finger movements even in expert pianists, which implicates that ways of practicing play a key role in enhancing experts' expertise.

Effects of functional training on proprioception in sport athletes / Efeitos do treinamento funcional na propriocepção física de atletas esportivos / Efectos del entrenamiento funcional en la propiocepción física de los deportistas

ABSTRACT Introduction Physical training is a well-known training method in competitive sports. However, in the majority of the physical training classes, the focus is still on the traditional exercises of physical conditioning as strength, speed, resistance, etc., directed for young athletes that are in the growth and development phase, without a literary base to assure actual effectiveness in the load increases for the athletic performance facing the risks in the athletes' physical proprioception. Objective Explores the effect of functional training on the physical sensibility of sports athletes. Methods The data collection method is used in the daily training of six notable athletes in a district sports school: judo, martial arts, wrestling, tennis team, swimming team, and table tennis team, adding the functional training protocol in body movement. Results The average performance of the groups before and after the experiment was collected and confronted, the difference test was performed, and the test result found P>0.05. The athletes in the experimental group not only improved the footwork speed and physical coordination, the movement speed of the footwork and the speed of the connection between movements increased significantly in the sixth week, reflecting more excellent stability and motor coordination in the movements. Proprioception is one of the essential sports qualities of the human body; it is directly related to physical qualities such as speed and strength and is also closely related to the different neural pathways. Conclusion Functional training can improve athletes' physical flexibility and motor coordination; it can also stimulate body proprioceptors, increase athletes' confidence, and make training more efficient and effective. Evidence level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução O treinamento físico é um método de treinamento bastante conhecido em esportes competitivos. Porém, na maioria das aulas de treinamento físico, o foco ainda está nos exercícios tradicionais de condicionamento físico como força, velocidade, resistência, etc., voltados para jovens atletas que estão em fase de crescimento e desenvolvimento, sem embasamento literário para assegurar uma real eficácia nos aumentos de carga para o desempenho atlético frente aos riscos na propriocepção física dos atletas. Objetivo Explorar o efeito do treinamento funcional na sensibilidade física de atletas esportivos. Métodos O método de coleta de dados é utilizado no treinamento diário de seis diferentes atletas especiais em uma escola de esportes distrital: judô, artes marciais, luta livre, equipe de tênis, equipe de natação e equipe de tênis de mesa, agregando o protocolo de treino funcional em movimento corporal. Resultados O desempenho médio dos grupos antes e depois do experimento foram coletados e confrontados, o teste de diferença foi realizado, sendo o resultado do teste encontrado P>0,05. Os atletas do grupo experimental não apenas melhoraram a velocidade de trabalho com os pés e a coordenação física, a velocidade do movimento do trabalho com os pés e a velocidade da conexão entre os movimentos aumentaram significativamente na sexta semana, refletindo maior estabilidade e coordenação motora nos movimentos. A propriocepção é uma das qualidades esportivas essenciais do corpo humano, não está apenas diretamente relacionada às qualidades físicas, como velocidade e força, mas também está intimamente relacionada as diferentes vias neurais. Conclusão O treinamento funcional pode melhorar a flexibilidade física e a coordenação motora dos atletas; também pode estimular os proprioceptores corporais, aumentar a confiança dos atletas e tornar o treinamento mais eficiente e eficaz. Nível de evidência II; Estudos terapêuticos - Investigação de resultados.

RESUMEN Introducción El entrenamiento físico es un método de entrenamiento muy conocido en los deportes de competición. Sin embargo, en la mayoría de las clases de entrenamiento físico, el enfoque sigue siendo los ejercicios tradicionales de acondicionamiento físico como fuerza, velocidad, resistencia, etc., dirigidos para jóvenes atletas que están en fase de crecimiento y desarrollo, sin base literaria para asegurar una eficacia real en los aumentos de carga para el rendimiento atlético frente a los riesgos en la propiocepción física de los atletas. Objetivo Explorar el efecto del entrenamiento funcional en la sensibilidad física de los deportistas. Métodos El método de recogida de datos se utiliza en el entrenamiento diario de seis atletas especiales diferentes en una escuela deportiva distrital: judo, artes marciales, lucha, equipo de tenis, equipo de natación y equipo de tenis de mesa, añadiendo el protocolo de entrenamiento funcional en el movimiento corporal. Resultados Se recogió el rendimiento medio de los grupos antes y después del experimento y se confrontó, se realizó la prueba de la diferencia y el resultado de la prueba fue P>0,05. Los atletas del grupo experimental no sólo mejoraron la velocidad del trabajo de pies y la coordinación física, sino que la velocidad del movimiento de pies y la velocidad de la conexión entre los movimientos aumentaron significativamente en la sexta semana, lo que refleja una mayor estabilidad y coordinación motora en los movimientos. La propiocepción es una de las cualidades deportivas esenciales del cuerpo humano, no sólo está directamente relacionada con cualidades físicas como la velocidad y la fuerza, sino que también está estrechamente relacionada con las diferentes vías neuronales. Conclusión El entrenamiento funcional puede mejorar la flexibilidad física y la coordinación motora de los atletas; también puede estimular los propioceptores corporales, aumentar la confianza de los atletas y hacer que el entrenamiento sea más eficiente y eficaz. Nivel de evidencia II;Estudios terapéuticos - Investigación de resultados.

Inflûencia da gravidade motora no desempenho de autocuidado de crianças e adolescentes com paralisia cerebral / Influencia de la gravedad motriz en el rendimiento del cuidado personal de niños y adolescentes con parálisis cerebral / Influence of motor gravity on the performance of self-care of children and adolescents with cerebral palsy

Objetivo: Esta pesquisa teve como objetivo analisar a correlação entre nível de funcionalidade e autocuidado de crianças com Paralisia Cerebral (PC) por meio das habilidades motoras e o desempenho nas atividades de vida diária. Metodologia: De modo remoto, foi realizada uma busca por crianças e adolescente com PC em serviços de reabilitação infantil e 30 participantes foram considerados elegíveis. Os responsáveis responderam ao formulário para caracterização da amostra e um instrumento que mede a capacidade funcional nas atividades de vida diária (CHAQ). Os profissionais dos serviços responderam as avaliações acerca da topografia dos participantes e a classificação das funções motoras através de um sistema de classificação ordinal da função motora grossa (GMFCS E&R) e um sistema de classificação da função manual (MACS). Resultados: Foi possível verificar que a maioria dos participantes era do sexo masculino, com idade média de 6 anos. Quanto ao quadro motor, a maioria era bilateral espástico, classificados nível V do GMFCS e no nível I do MACS. Conclusão: Foi possível observar a influência da função motora grossa e da função manual no desempenho do autocuidado, a correlação entre o CHAQ com as atividades de autocuidado e a capacidade de uma atividade influenciar o desempenho da outra. Assim, os resultados demonstram que a gravidade motora influencia o desempenho de autocuidado de crianças com PC.

Objetivo: Esta investigación tuvo como objetivo analizar la correlación entre el nivel de funcionalidad y el autocuidado de niños con Parálisis Cerebral (PC) a través de la motricidad y el desempeño en las actividades de vida diaria. Metodología: De manera remota, se realizó una búsqueda de niños y adolescentes con parálisis cerebral en servicios de rehabilitación infantil y se consideraron elegibles 30 participantes. Los padres respondieron el formulario de caracterización de la muestra y un instrumento que mide la capacidad funcional en las actividades de la vida diaria (CHAQ). Los profesionales de los servicios de rehabilitación respondieron a las evaluaciones sobre la topografía del niño o adolescente y a la clasificación de las funciones motoras mediante un sistema de clasificación ordinal de la función motora gruesa (GMFCS E&R) y un sistema de clasificación de funciones manual (MACS). Resultados: Se pudo constatar que la mayoría de los niños y adolescentes eran del sexo masculino, con una edad promedio de 6 años. En cuanto a la condición motora, la mayoría fueron espásticos bilaterales, clasificados como nivel V del GMFCS y I del MACS. Conclusión: Se pudo observar la influencia de la función motora gruesa y la función manual en el desempeño de autocuidado, la correlación entre el CHAQ y las actividades de cuidados personales y la capacidad de una actividad influir en el desempeño de otra. Así, los resultados demuestran que la severidad motora influye en el desempeño de autocuidado de los niños con PC.

Aim: This research aimed to analyze the correlation between level of functionality and self-care in children with Cerebral Palsy (CP) through motor skills and performance in activities of daily living. Methodology: A recruiting process was made remotely, searching for children and adolescents with CP in child rehabilitation services, 30 participants were considered eligible. Data collection started by telephone, parents answered the form for sample-characterizing and an instrument that measures the functional capacity in the activities of daily living (CHAQ). Professionals of the rehabilitation services answered the evaluations about the topography of the participants and the classification of motor functions, through an ordinal classification system of gross motor function (GMFCS E&R) and a manual function classification system (MACS). Results: It was possible to verify that most children and adolescents were male, with an average age of 6 years. As for the motor condition, most were bilateral spastic, classified as level V of the GMFCS and level I of the MACS. Conclusion: It was possible to observe that there is an influence of gross motor function and manual function on performance of self-care; there is a correlation between CHAQ and the activities self-care; and one activity can influence the performance of the other. Thus, the results demonstrate that a motor severity influences the self-care performance of children with CP.

Task space exploration improves adaptation after incompatible virtual surgeries.

Humans have a remarkable capacity to learn new motor skills, a process that requires novel muscle activity patterns. Muscle synergies may simplify the generation of muscle patterns through the selection of a small number of synergy combinations. Learning of new motor skills may then be achieved by acquiring novel muscle synergies. In a previous study, we used myoelectric control to construct virtual surgeries that altered the mapping from muscle activity to cursor movements. After compatible virtual surgeries, which could be compensated by recombining subject-specific muscle synergies, participants adapted quickly. In contrast, after incompatible virtual surgeries, which could not be compensated by recombining existing synergies, participants explored new muscle patterns but failed to adapt. Here, we tested whether task space exploration can promote learning of novel muscle synergies required to overcome an incompatible surgery. Participants performed the same reaching task as in our previous study but with more time to complete each trial, thus allowing for exploration. We found an improvement in trial success after incompatible virtual surgeries. Remarkably, improvements in movement direction accuracy after incompatible surgeries occurred faster for corrective movements than for the initial movement, suggesting that learning of new synergies is more effective when used for feedback control. Moreover, reaction time was significantly higher after incompatible than compatible virtual surgeries, suggesting an increased use of an explicit adaptive strategy to overcome incompatible surgeries. Taken together, these results indicate that exploration is important for skill learning and suggest that human participants, with sufficient time, can learn new muscle synergies.NEW & NOTEWORTHY Motor skill learning requires the acquisition of novel muscle patterns, a slow adaptive process. Here we show that learning to control a cursor after an incompatible virtual surgery, a complex skill requiring new muscle synergies, is possible when enough time for task space exploration is provided. Our results suggest that learning new synergies is related to the exceptional human capacity to acquire a wide variety of novel motor skills with practice.

Adaptation to university studies affects on functional state of freshmen

According to different researches, 30% of university graduates have a low level of health, and studying at university is one of the factors of its deterioration, besides the first year is considered critical. The purpose of research is to study the dynamics of physical development, physical fitness and functional state of young men during the first year of university studies. For the survey we used standard measurements and index calculations for 11 indicators of physical development, 9 indicators of physical fitness and 15 indicators of functional status. We calculated the arithmetic mean (M), the standard error of the mean (m), then evaluated differences by the Student criterion (t) for independent samples and considered them as reliable atр < 0.05. It is shown that during the first year of studies, young men have an increase in the Erismann index, the corpulence (Rohrer's) index, the body mass index and a decrease in the Pignet index. There is also an increase in the coefficient of endurance, adaptive capacity and diastolic pressure, while vital capacity of the lungs, the vital index, time of hanging on the bar and the speed of running 1000 m decrease. The dynamics of physical development is expressed in a change in mass-growth indices and indicates an increase in body weight. The dynamics of physical fitness is expressed in a decrease of the time of hanging on the bar and the speed of running 1000 m. The dynamics of the functional state is expressed in a decrease of vital capacity of the lungs, vital index, increase in the coefficient of endurance, adaptive capacity and diastolic blood pressure.

Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury.

AIM: To assess the relationship between neonatal brain development and injury with early motor outcomes in infants with critical congenital heart disease (CCHD). METHOD: Neonatal brain magnetic resonance imaging was performed after open-heart surgery with cardiopulmonary bypass. Cortical grey matter (CGM), unmyelinated white matter, and cerebellar volumes, as well as white matter motor tract fractional anisotropy and mean diffusivity were assessed. White matter injury (WMI) and arterial ischaemic stroke (AIS) with corticospinal tract (CST) involvement were scored. Associations with motor outcomes at 3, 9, and 18 months were corrected for repeated cardiac surgery. RESULTS: Fifty-one infants (31 males, 20 females) were included prospectively. Median age at neonatal surgery and postoperative brain magnetic resonance imaging was 7 days (interquartile range [IQR] 5-11d) and 15 days (IQR 12-21d) respectively. Smaller CGM and cerebellar volumes were associated with lower fine motor scores at 9 months (CGM regression coefficient=0.51, 95% confidence interval [CI]=0.15-0.86; cerebellum regression coefficient=3.08, 95% CI=1.07-5.09) and 18 months (cerebellum regression coefficient=2.08, 95% CI=0.47-5.12). The fractional anisotropy and mean diffusivity of white matter motor tracts were not related with motor scores. WMI was related to lower gross motor scores at 9 months (mean difference -0.8SD, 95% CI=-1.5 to -0.2). AIS with CST involvement increased the risk of gross motor problems and muscle tone abnormalities. Cerebral palsy (n=3) was preceded by severe ischaemic brain injury. INTERPRETATION: Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.

Neuronal activation of cerebellum functional circuits in motor and non-motor functions in mice.

The cerebellum is involved in the control of balance, movement and the acquisition of motor skills. Scientific and technological advances have shown that the cerebellum also participates in non-motor functions, such as emotional control, memory and language. However, which cerebellar areas and functional circuits are predominantly activated in these different functions is not known. The current study analyzed the neuronal activation of cerebellar areas and other brain structures (e.g., hippocampus, amygdala, prelimbic cortex and infralimbic cortex) after exposure to rotarod and inhibitory avoidance behavioral models to establish possible neuronal circuits for motor and non-motor functions. Naïve male Swiss albino mice weighing 25 to 35 g were used. The animals were subjected to three conditions for behavioral evaluation: inhibitory avoidance, which is a model used to infer emotional memory; rotarod, which assesses motor performance and motor learning; and housing box/control. The mice remained in their housing box in Condition 1. Mice in Condition 2 were exposed to the inhibitory avoidance box for 2 days, and mice in Condition 3 were exposed to the rotarod for 3 days. The animals were euthanized after the last exposure to the apparatus then perfused with paraformaldehyde. Brains were extracted and sectioned for immunofluorescence analysis of c-Fos protein in pre-established structures. Images of the brain structures were obtained, and neuronal activation was analyzed microscopically. One-way analysis of variance was used, followed by Tukey's post-hoc test. There was no significant difference in c-Fos expression in lobe VI of the cerebellum between the different conditions. Differences in c-Fos expression were observed in the basolateral amygdala, infralimbic cortex and prelimbic cortex, which are relevant to emotional processes, after exposure to the evaluation apparatuses. Pearson's r correlation coefficient test showed a positive correlation between the variables of structures related to emotional processes. We concluded that there was no significant difference in c-Fos expression in lobe VI of the cerebellum after exposure of the animals to the evaluation apparatus. However, there was a difference in c-Fos expression in other brain structures related to emotional processes after exposure of animals to the apparatus.

The influence of the quality in daycare environments on children's motor development between six to 15 months old / Influência da qualidade do ambiente das creches no desenvolvimento motor de crianças entre seis e 15 meses

Abstract Objectives: to analyze the influence of the quality in the environment on children's motor development between six to 15 months old attending early childhood education centers. Methods: a cross-sectional and analytical study addressing children's motor development between six to 15 months old, both sexes, enrolled in nursery (0-12 months) and preschoolers (12-24 months). The Affordances in the Home Environment for Motor Development-Infant Scale and Alberta Infant Motor Scale were used in the Brazilian versions Results: the sample was comprised of 104 children and 30 early childhood education centers: presenting a mean age of 9.15 months, 88% attended full-time and 12% part-time schooling (mornings or afternoons). One center was classified with a low Affordances, 26 were considered Sufficient, and three were Adequate. Of the participating children, 40% presented typical motor development. The higher levels of Affordances suggest better motor development, and lower levels of suspected delayed motor development. Conclusion: the environments of early childhood education centers influence children's motor performance, especially daily activities and the use of toys. The lower the Affordances level, more likely children are suspected of delayed motor development.

Resumo Objetivos: analisar a influência da qualidade do ambiente no desenvolvimento motor de crianças na faixa etária entre seis e 15 meses que frequentam centros de educação infantil. Métodos estudo de delineamento transversal e analítico sobre o desenvolvimento motor de crianças entre seis e 15 meses de idade, de ambos os sexos, matriculadas em turmas de berçário (0-12 meses) e maternal I (12-24 meses), com utilização das escalas validadas Affordances in the Home Environment for Motor Development-Infant Scale e Alberta Infant Motor Scale. Resultados: a amostra de 104 crianças e 30 centros de educação infantil apresentou idade média de 9,15 meses, 88% permanecia em período integral e 12% meio período (manhã ou tarde), um centro foi classificado como Affordance Fraca, 26 Suficiente e três Adequada. Das crianças participantes, 40% apresentaram desenvolvimento motor normal. Os maiores níveis de Affordance indicam melhor desenvolvimento motor e níveis menores de Affordance sinalizam suspeita de atraso motor. Conclusão: o ambiente de centros de educação infantil em que a criança está inserida exerce influência no desempenho motor, principalmente ligado às atividades diárias e uso de brinquedos. Quanto menor o nível de Affordance mais possibilidades de suspeita de atraso motor infantil.

Antenatal low-intensity pulsed ultrasound reduces neurobehavioral deficits and brain injury following dexamethasone-induced intrauterine growth restriction.

Intrauterine growth restriction (IUGR) is a leading cause of perinatal mortality and morbidity, and IUGR survivors are at increased risk of neurodevelopmental deficits. No effective interventions are currently available to improve the structure and function of the IUGR brain before birth. This study investigated the protective effects of low-intensity pulsed ultrasound (LIPUS) on postnatal neurodevelopmental outcomes and brain injury using a rat model of IUGR induced by maternal exposure to dexamethasone (DEX). Pregnant rats were treated with DEX (200 µg/kg, s.c.) and LIPUS daily from gestational day (GD) 14 to 19. Behavioral assessments were performed on the IUGR offspring to examine neurological function. Neuropathology, levels of neurotrophic factors, and CaMKII-Akt-related molecules were assessed in the IUGR brain, and expression of glucose and amino acid transporters and neurotrophic factors were examined in the placenta. Maternal LIPUS treatment increased fetal weight, fetal liver weight, and placental weight following IUGR. LIPUS treatment also increased neuronal number and myelin protein expression in the IUGR brain, and attenuated neurodevelopmental deficits at postnatal day (PND) 18. However, the number of oligodendrocytes or microglia was not affected. These changes were associated with the upregulation of brain-derived neurotrophic factor (BDNF) and placental growth factor (PlGF) protein expression, and enhancement of neuronal CaMKII and Akt activation in the IUGR brain at PND 1. Additionally, LIPUS treatment promoted glucose transporter (GLUT) 1 production and BDNF expression in the placenta, but had no effects on GLUT3 or amino acid transporter expression. Our findings suggest that antenatal LIPUS treatment may reduce IUGR-induced brain injury via enhancing cerebral BDNF/CaMKII/Akt signaling. These data provide new evidence that LIPUS stimulation could be considered for antenatal neuroprotective therapy in IUGR.

Distinct Functional and Structural Connectivity of the Human Hand-Knob Supported by Intraoperative Findings.

Fine motor skills rely on the control of hand muscles exerted by a region of primary motor cortex (M1) that has been extensively investigated in monkeys. Although neuroimaging enables the exploration of this system also in humans, indirect measurements of brain activity prevent causal definitions of hand motor representations, which can be achieved using data obtained during brain mapping in tumor patients. High-frequency direct electrical stimulation delivered at rest (HF-DES-Rest) on the hand-knob region of the precentral gyrus has identified two sectors showing differences in cortical excitability. Using quantitative analysis of motor output elicited with HF DES-Rest, we characterized two sectors based on their excitability, higher in the posterior and lower in the anterior sector. We studied whether the different cortical excitability of these two regions reflected differences in functional connectivity (FC) and structural connectivity (SC). Using healthy adults from the Human Connectome Project (HCP), we computed FC and SC of the anterior and the posterior hand-knob sectors identified within a large cohort of patients. The comparison of FC of the two seeds showed that the anterior hand-knob, relative to the posterior hand-knob, showed stronger functional connections with a bilateral set of parietofrontal areas responsible for integrating perceptual and cognitive hand-related sensorimotor processes necessary for goal-related actions. This was reflected in different patterns of SC between the two sectors. Our results suggest that the human hand-knob is a functionally and structurally heterogeneous region organized along a motor-cognitive gradient.SIGNIFICANCE STATEMENT The capability to perform complex manipulative tasks is one of the major characteristics of primates and relies on the fine control of hand muscles exerted by a highly specialized region of the precentral gyrus, often termed the "hand-knob" sector. Using intraoperative brain mapping, we identify two hand-knob sectors (posterior and anterior) characterized by differences in cortical excitability. Based on resting-state functional connectivity (FC) and tractography in healthy subjects, we show that posterior and anterior hand-knob sectors differ in their functional connectivity (FC) and structural connectivity (SC) with frontoparietal regions. Thus, anteroposterior differences in cortical excitability are paralleled by differences in FC and SC that likely reflect a motor (posterior) to cognitive (anterior) organization of this cortical region.

Immediate effects of hemodialysis on upper extremity and cognitive function.

BACKGROUND: Subjects undergoing hemodialysis often describe feeling "weak" and "fatigued" after dialysis. This has not previously been quantified. We sought to evaluate upper extremity and cognitive function before and after hemodialysis to see if differences existed and how long recovery takes. METHODS: Subjects undergoing hemodialysis in an inpatient hospital dialysis unit were recruited. Subjects underwent assessment of upper extremity strength (grip (GS) and pinch (PS)), dexterity (pegboard assembly (PA)), finger sensation (monofilaments), and cognitive function (mini-mental status exam (MMS)) immediately pre- and post-dialysis, 3 h post-dialysis, and the following morning. Both the dialysis (index) and non-dialysis extremities were evaluated. Results were also stratified for fistulas vs. central venous catheters. Patients were dialyzed at the same flow rate and duration. RESULTS: 21 subjects were evaluated, 13 (62%), male, mean age 56 ± 17 years, 15 (71%) diabetic, 15 (71%) fistulas, 6 (29%) central venous catheters. Overall, there were no significant changes in GS, PS, PA, immediately or 3 h after dialysis. MMS was non-significantly reduced 3 h after dialysis (22.8 ± 10.3 vs 27.0 ± 3.5, p = 0.06). PA was significantly improved the following morning (6.4 ± 4.8 assembled units vs 7.5 ± 5.1, p = 0.049). Patients dialyzing through catheters had reduced grip strength 3 h after dialysis compared to fistulas (-4.6 ± 2.7 N from baseline vs 1.4 ± 4.3 N from baseline, p = 0.018) that was resolved by the next day. CONCLUSIONS: Hemodialysis in hospitalized inpatients does not cause acute objective deficits in upper extremity or cognitive function, with a significant improvement in hand dexterity the day after dialysis.