Cortical facilitation of somatosensory inputs using gravity-related tactile information in humans with vestibular hypofunction.

A few years after their bilateral vestibular loss, patients usually show a motor repertoire that is almost back to normal. This recovery is thought to involve an upregulation of the visual and proprioceptive information that compensates for the lack of vestibular information. Here, we investigated whether plantar tactile inputs, which provide body information relative to the ground and to the Earth vertical, contribute to this compensation. More specifically, we tested the hypothesis that somatosensory cortex response to electric stimulation of the plantar sole in standing adults will be greater in humans (n = 10) with bilateral vestibular hypofunction (VH) than in an age-matched healthy group (n = 10). Showing significantly greater somatosensory evoked potentials (i.e., P1N1) in VH than in control subjects, the electroencephalographic recordings supported this hypothesis. Furthermore, we found evidence that increasing the differential pressure between both feet, by adding a 1-kg mass at each pendant wrist, enhanced the internal representation of body orientation and motion relative to a gravitational reference frame. The large decrease in alpha power in the right posterior parietal cortex (and not in the left) is in line with this assumption. Finally, behavioral analyses showed that trunk oscillations were smaller than head oscillations in VH and showed a reverse pattern for healthy participants. These findings are consistent with a tactile-based postural control strategy in the absence of vestibular input and a vestibular-based control strategy in healthy participants where the head serves as a reference for balance control.NEW & NOTEWORTHY Somatosensory cortex excitability is greater in participants with bilateral vestibular hypofunction than in age-matched healthy humans. To control balance, healthy humans "locked" the head whereas participants with vestibular hypofunction "locked" their pelvis. For participants with vestibular hypofunction, increasing loading/unloading of the feet enhances the internal representation of body state in the posterior parietal cortex.

The influence of experimental low back pain on neural networks involved in the control of lumbar erector spinae muscles.

Low back pain (LBP) often modifies spine motor control, but the neural origin of these motor control changes remains largely unexplored. This study aimed to determine the impact of experimental low back pain on the excitability of cortical, subcortical, and spinal networks involved in the control of back muscles. Thirty healthy subjects were recruited and allocated to pain (capsaicin and heat) or control (heat) groups. Corticospinal excitability (motor-evoked potential; MEP) and intracortical networks were assessed by single- and paired-pulse transcranial magnetic stimulation, respectively. Electrical vestibular stimulation was applied to assess vestibulospinal excitability (vestibular MEP; VMEP) and the stretch reflex for excitability of the spinal or supraspinal loop (R1 and R2, respectively). Evoked back motor responses were measured before, during, and after pain induction. Nonparametric rank-based ANOVA determined if pain modulated motor neural networks. A decrease of R1 amplitude was present after the pain disappearance (P = 0.01) whereas an increase was observed in the control group (P = 0.03) compared with the R1 amplitude measured at prepain and preheat period, respectively (group × time interaction, P < 0.001). No difference in MEP and VMEP amplitude was present during and after pain (P > 0.05). During experimental LBP, no change in cortical, subcortical, or spinal networks was observed. After pain disappearance, the reduction of the R1 amplitude without modification of MEP and VMEP amplitude suggests a reduction in spinal excitability potentially combined with an increase in descending drives. The absence of effect during pain needs to be further explored.NEW & NOTEWORTHY In the presence of experimental low back pain, spinal, subcortical, and cortical motor networks involved in the control of back muscles were not modified. However, once the pain disappeared, a reduction in motoneuronal excitability was observed without change in corticospinal and vestibulospinal excitability, suggesting a reduction in descending drive. Experimental low back pain may elicit long-term plasticity even after pain extinction.

Less Vibrotactile Feedback Is Effective to Improve Human Balance Control during Sensory Cues Alteration.

For individuals with altered sensory cues, vibrotactile feedback improves their balance control. However, should vibrotactile feedback be provided every time balance control is compromised, or only one-third of the time their balance is compromised? We hypothesized that vibrotactile feedback would improve balance control more when provided every time their balance is compromised. Healthy young adults were randomly assigned to two groups: group 33% feedback (6 males and 6 females) and group 100% feedback (6 males and 6 females). Vibrotactile feedbacks related to the body's sway angle amplitude and direction were provided, while participants stood upright on a foam surface with their eyes closed. Then, we assessed if balance control improvement lasted when the vibrotactile feedback was removed (i.e., post-vibration condition). Finally, we verified whether or not vibrotactile feedback unrelated to the body's sway angle and direction (sham condition) altered balance control. The results revealed no significant group difference in balance control improvement during vibrotactile feedback. Immediately following vibrotactile feedback, both groups reduced their balance control commands; body sway velocity and the ground reaction forces variability decreased. For both groups, unrelated vibrotactile feedback worsened balance control. These results confirmed that participants processed and implemented vibrotactile feedback to control their body sways. Less vibrotactile feedback was effective in improving balance control.

A Comprehensive Review of Pain Interference on Postural Control: From Experimental to Chronic Pain.

Motor control, movement impairment, and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized in the lower back or in the leg induced postural control alteration. Although proprioceptive and cortical excitability seem modified with pain, spinal modulation assessment might provide a new understanding of the pain phenomenon related to postural control. The literature highlights that the motor control of trunk muscles in patient presenting with lower back pain could be dichotomized in two populations, where the first over-activates the trunk muscles, and the second under-activates the trunk muscles; both generate an increase in tissue loading. Taking all these findings into account will help clinician to provide adapted treatment for managing both pain and postural control.

Comparison of Spinal Cord Stimulation vs. Dorsal Root Ganglion Stimulation vs. Association of Both in Patients with Refractory Chronic Back and/or Lower Limb Neuropathic Pain: An International, Prospective, Randomized, Double-Blinded, Crossover Trial (BOOST-DRG Study).

While spinal cord stimulation (SCS) is a well-established therapy to address refractory persistent spinal pain syndrome after spinal surgery (PSPS-T2), its lack of spatial selectivity and reported discomfort due to positional effects can be considered as significant limitations. As alternatives, new waveforms, such as burst stimulation and different spatial neural targets, such as dorsal root ganglion stimulation (DRGS), have shown promising results. Comparisons between DRGS and standard SCS, or their combination, have never been studied on the same patients. "BOOST DRG" is the first prospective, randomized, double-blinded, crossover study to compare SCS vs. DRGS vs. SCS+DRGS. Sixty-six PSPS-T2 patients will be recruited internationally in three centers. Before crossing over, patients will receive each stimulation modality for 1 month, using tonic conventional stimulation. After 3 months, stimulation will consist in switching to burst for 1 month, and patients will choose which modality/waveform they receive and will then be reassessed at 6 and 12 months. In addition to our primary outcome based on pain rating, this study is designed to assess quality of life, functional disability, psychological distress, pain surface coverage, global impression of change, medication quantification, adverse events, brain functional imaging and electroencephalography, with the objective being to provide a multidimensional insight based on composite pain assessment.

Standing Balance Performance and Knee Extensors' Strength in Diabetic Patients with Neuropathy.

Diabetes peripheral neuropathy (DPN) leads to balance impairment among diabetes mellitus (DM). The aims of this study were to (1) distinguish between DM patients who have/do not have DPN and to (2) compare quadriceps' strength and balance performance of DM, DPN, and healthy groups. Fifteen healthy females and 33 females with type 2 diabetic patients participated. The electrodiagnostic method was used to classify diabetic patients into DM and DPN. A dynamometer was used to measure quadriceps' strength. Single-leg standing on a force plate was also used to quantify participants' balance. Smaller conduction velocity and amplitude and greater distal latency of all nerves were observed in the DPN compared with the DM in particular for sensory nerve. In DPN, conduction velocity was asymmetrical. The quadriceps' strength of both legs in DPN and the right leg in DM was smaller than in the control group. The root mean square of the center of pressure was similar between DM and DPN. But it was larger in DPN than in the control group. DPN is associated with asymmetrical conduction velocity, smaller quadriceps' strength, and weaker balance performance that is suggestive of higher risk of falling. Balance training is recommended for the DPN group during their rehabilitation to reduce their falling risk.

Assessment of sensorimotor control in adults with surgical correction for idiopathic scoliosis.

PURPOSE: This study aims at verifying if impaired sensorimotor control observed in adolescents and young adults with scoliosis is also present in adult patients who underwent surgery to reduce their spine deformation. METHODS: The study included ten healthy adults and ten adults with idiopathic scoliosis who underwent surgery to reduce their spine deformation. Galvanic vestibular stimulation was delivered to assess sensorimotor control. Vertical forces under each foot and horizontal displacement of the upper body were measured before, during and after stimulation. Balance control was assessed by calculating the root mean square values of kinematic and kinetic variables. RESULTS: The amplitude of the vestibular-evoked postural response was 3.4 % (0.8-6.0 %) and 4.5 % (-0.4 to 9.5 %) of the maximal range of motion. Therefore, spine surgery did not limit the postural response. Patients with idiopathic scoliosis exhibited larger body sway than the healthy controls during and immediately after vestibular stimulation. The maximal normalized lateral displacement of the body was 0.85 and 0.40 cm/m and maximal normalized vertical force was 0.78 vs. 0.39 N/kg, for idiopathic scoliosis and healthy groups, respectively. CONCLUSIONS: This result suggests that dysfunctional sensorimotor integration is still present even in adult idiopathic scoliosis that underwent spine deformation correction.

Sensorimotor Control Impairment in Young Adults With Idiopathic Scoliosis Compared With Healthy Controls.

OBJECTIVE: It has been hypothesized that the impaired sensorimotor control observed in adolescents with idiopathic scoliosis (IS) may be related more to the onset of scoliosis than to the maturation of sensory systems or sensorimotor control mechanisms. The objective of this study was to assess sensorimotor control in adults diagnosed with IS in adolescence versus healthy controls. METHODS: The study included 20 young adults 20 to 24 years of age (10 healthy controls and 10 diagnosed with adolescent IS but not treated for it). Binaural bipolar galvanic vestibular stimulation (GVS) was delivered to assess sensorimotor control. Vertical forces under each foot and upper body kinematics along the frontal plane were measured before GVS (2-second window), during GVS (2-second window), immediately after the cessation of GVS (1-second window), and during the following 2 seconds. Balance control was assessed by calculating the root mean square values of vertical forces and upper body kinematics. RESULTS: Compared with healthy controls, the IS group showed greater body sway upon GVS; the amplitude of this sway was even greater immediately after the cessation of GVS-an outcome requiring sensorimotor control. CONCLUSION: Compared with normal controls, adults who had been diagnosed with IS in adolescence showed altered balance control immediately following GVS. This finding suggests that dysfunctional sensorimotor control may be related to the onset of scoliosis rather than to a transient suboptimal development of the sensory systems or sensorimotor control mechanisms.

Facilitation of cutaneous inputs during the planning phase of gait initiation.

It has been shown that during the planning of a voluntary movement the transmission of cutaneous afferent inputs to the somatosensory cortex is attenuated shortly before the motor output as well as during movement execution. However, it is not known whether the sensory suppression observed during the planning phase (i.e., before any movement execution) is a systemic phenomenon or whether it is dependent on movement context. For example, movements such as step initiation are controlled based on information received from cutaneous receptors in the feet. Because afferent information emerging from these receptors is critical for movement initiation, we hypothesized that suppression of these inputs may not occur during the planning phase prior to gait initiation. To examine this hypothesis we measured the cortical response to somatosensory stimulation during the planning phase of step initiation and during movement execution. Sensitivity to cutaneous stimulation was assessed by measuring the amplitude of the cortical somatosensory-evoked potential (SEP, over the Cz electrode) following electrical stimulations of the plantar sole of one foot. Two stimulations were provided during the planning phase of a step movement and two stimulations during movement execution. It was found that the P50-N80 SEP was facilitated in the early planning phase (-700 ms before motor execution) compared with when participants remained still (control standing task). This mechanism might contribute to an enhanced perception of cutaneous input leading to a more accurate setting of the forces to be exerted onto the ground to shift the body's weight toward the supporting side prior to foot-off.

Postural dependence of human locomotion during gait initiation.

The initiation of human walking involves postural motor actions for body orientation and balance stabilization that must be effectively integrated with locomotion to allow safe and efficient transport. Our ability to coordinately adapt these functions to environmental or bodily changes through error-based motor learning is essential to effective performance. Predictive compensations for postural perturbations through anticipatory postural adjustments (APAs) that stabilize mediolateral (ML) standing balance normally precede and accompany stepping. The temporal sequencing between these events may involve neural processes that suppress stepping until the expected stability conditions are achieved. If so, then an unexpected perturbation that disrupts the ML APAs should delay locomotion. This study investigated how the central nervous system (CNS) adapts posture and locomotion to perturbations of ML standing balance. Healthy human adults initiated locomotion while a resistance force was applied at the pelvis to perturb posture. In experiment 1, using random perturbations, step onset timing was delayed relative to the APA onset indicating that locomotion was withheld until expected stability conditions occurred. Furthermore, stepping parameters were adapted with the APAs indicating that motor prediction of the consequences of the postural changes likely modified the step motor command. In experiment 2, repetitive postural perturbations induced sustained locomotor aftereffects in some parameters (i.e., step height), immediate but rapidly readapted aftereffects in others, or had no aftereffects. These results indicated both rapid but transient reactive adaptations in the posture and gait assembly and more durable practice-dependent changes suggesting feedforward adaptation of locomotion in response to the prevailing postural conditions.

Quantifying forearm and wrist joint power during unconstrained movements in healthy individuals.

BACKGROUND: Wrist movement-related injuries account for a large number of repetitive motion injuries. Remarkably little, if any, empirical data exist to quantify the impact of neuromuscular disorders affecting the wrist or to validate the effectiveness of rehabilitation training programs on wrist functions. The aim of this project was to develop a biomechanical model for quantifying wrist and forearm kinetics during unconstrained movements, to assess its reliability and to determine its sensitivity. METHODS: Twenty healthy subjects with no history of upper arm and wrist pain volunteered for the experiment. To evaluate the reliability of the data, we quantified their forearm and wrist kinetics on two different days (minimum and maximum number of days between experimental sessions were 1 and 4 days respectively). To measure forearm and wrist kinetics, an apparatus was built to offer rotational inertia during forearm and wrist movements. An inertial measurement unit was located near the top of the device measuring its angular position along the frontal and sagittal planes. We used a mathematical model to infer forearm and wrist torque. Thereafter, we calculated the product of torque and angular velocity to determine forearm and wrist power. RESULTS: Results revealed that for 75% of the power and torque measurements the ICC was greater than 0.75 (range: 0.77 - 0.83). Torque and power measurements for adduction movements, however, were less reliable (i.e., ICC of 0.60 and 0.47, respectively) across testing sessions. The biomechanical model was robust to small measurement errors, and the power peaks between the first and second testing session were not different indicating that there was no systematic bias (i.e., motor performance improvement) between testing sessions. CONCLUSIONS: The biomechanical model can be used to assess the effectiveness of rehabilitation programs, document the progression of athletes or conduct research-oriented testing of maximum forearm and wrist kinetic capacities. Nonetheless, caution should be taken when assessing forearm and wrist power adduction movements. Future studies should aim at defining a set of normative values, for various age groups, for forearm and wrist joint torque and power in healthy individuals.

Visuotactile integration in individuals with fibromyalgia.

Our brain constantly integrates afferent information, such as visual and tactile information, to perceive the world around us. According to the maximum-likelihood estimation (MLE) model, imprecise information will be weighted less than precise, making the multisensory percept as precise as possible. Individuals with fibromyalgia (FM), a chronic pain syndrome, show alterations in the integration of tactile information. This could lead to a decrease in their weight in a multisensory percept or a general disruption of multisensory integration, making it less beneficial. To assess multisensory integration, 15 participants with FM and 18 pain-free controls performed a temporal-order judgment task in which they received pairs of sequential visual, tactile (unisensory conditions), or visuotactile (multisensory condition) stimulations on the index and the thumb of the non-dominant hand and had to determine which finger was stimulated first. The task enabled us to measure the precision and accuracy of the percept in each condition. Results indicate an increase in precision in the visuotactile condition compared to the unimodal conditions in controls only, although we found no intergroup differences. The observed visuotactile precision was correlated to the precision predicted by the MLE model in both groups, suggesting an optimal integration. Finally, the weights of the sensory information were not different between the groups; however, in the group with FM, higher pain intensity was associated with smaller tactile weight. This study shows no alterations of the visuotactile integration in individuals with FM, though pain may influence tactile weight in these participants.

ANKLE TORQUE VARIANCE IS A BETTER INDICATOR OF BALANCE CONTROL PERFORMANCE THAN PLANTAR PERCEPTUAL SENSITIVITY THRESHOLD.

We explored whether ankle torque variability or plantar perceptual threshold explains human balance control more effectively. We hypothesized that ankle torque variance is a better indicator of center of pressure (COP) velocity variance than plantar perceptual sensitivity. Two conditions were tested: loaded (23 kg vest added) and unloaded, as loading should diminish plantar sensitivity and increase COP velocity variability. We created a linear feedback model to assess the noise change in the sensorimotor loop induced by loading. Plantar sensitivity was quantified using a psychophysical approach while participants stood barefoot. A linear motor applied a force impulse on the participant's heel. A 'yes-no' method of limits was selected to identify plantar sole sensory thresholds in both conditions. We observed reduced plantar sensitivity in loaded compared to unloaded conditions. In the loaded condition, participants exhibited greater COP velocity variance, with significant positive Pearson's correlations confirming a substantial association between ankle torque and COP velocity variances for both loaded (variance accounted for (VAR): r2 = 44.56%, p = 0.018) and unloaded conditions (VAF: r2 = 58.83 %, p = 0.004). No significant correlation existed between COP velocity variance and plantar sensitivity threshold for both loaded (VAF: r2 = 0.002 %, p = 0.99) and unloaded conditions (VAF: r2 = 21.81%, p = 0.35). The model confirmed a ~88% rise in sensorimotor loop noise in the loaded condition. Ankle torque variance assesses the precision of non-perceptual and perceptual detection mechanisms in evaluating whole-body motions and the accuracy in converting sensory cues into ankle torque.

Preserved tactile distance estimation despite body representation distortions in individuals with fibromyalgia.

Our mental representation of our body depends on integrating various sensory modalities, such as tactile information. In tactile distance estimation (TDE) tasks, participants must estimate the distance between two tactile tips applied to their skin. This measure of tactile perception has been linked to body representation assessments. Studies in individuals with fibromyalgia (FM), a chronic widespread pain syndrome, suggest the presence of body representation distortions and tactile alterations, but TDE has never been examined in this population. Twenty participants with FM and 24 pain-free controls performed a TDE task on three Body regions (upper limb, trunk, lower limb), in which they manually estimated the interstimuli distance on a tablet. TDE error, the absolute difference between the estimation and the interstimuli distance, was not different between the Groups, on any Body region. Drawings of their body as they felt it revealed clear and frequent distortions of body representation in the group with FM, compared to negligible perturbations in controls. This contrast between distorted body drawings and unaltered TDE suggests a preserved integration of tactile information but an altered integration of this information with other sensory modalities to generate a precise and accurate body representation. Future research should investigate the relative contribution of each sensory information and prior knowledge about the body in body representation in individuals with FM to shed light on the observed distortions.

Effects of underestimating the kinematics of trunk rotation on simultaneous reaching movements: predictions of a biomechanical model.

BACKGROUND: Rotation of the torso while reaching produces torques (e.g., Coriolis torque) that deviate the arm from its planned trajectory. To ensure an accurate reaching movement, the brain may take these perturbing torques into account during movement planning or, alternatively, it may correct hand trajectory during movement execution. Irrespective of the process selected, it is expected that an underestimation of trunk rotation would likely induce inaccurate shoulder and elbow torques, resulting in hand deviation. Nonetheless, it is still undetermined to what extent a small error in the perception of trunk rotations, translating into an inappropriate selection of motor commands, would affect reaching accuracy. METHODS: To investigate, we adapted a biomechanical model (J Neurophysiol 89: 276-289, 2003) to predict the consequences of underestimating trunk rotations on right hand reaching movements performed during either clockwise or counter clockwise torso rotations. RESULTS: The results revealed that regardless of the degree to which the torso rotation was underestimated, the amplitude of hand deviation was much larger for counter clockwise rotations than for clockwise rotations. This was attributed to the fact that the Coriolis and centripetal joint torques were acting in the same direction during counter clockwise rotation yet in opposite directions during clockwise rotations, effectively cancelling each other out. CONCLUSIONS: These findings suggest that in order to anticipate and compensate for the interaction torques generated during torso rotation while reaching, the brain must have an accurate prediction of torso rotation kinematics. The present study proposes that when designing upper limb prostheses controllers, adding a sensor to monitor trunk kinematics may improve prostheses control and performance.

Pain and Parkinson's disease: Current mechanism and management updates.

The aim of this comprehensive review was to provide an overview of pain in Parkinson's disease (PD) by identifying different clinical features and potential mechanisms, and presenting some data on the evaluation and management of pain in PD. PD is a multifocal degenerative and progressive disease, which could affect the pain process at multiple levels. Pain in PD has a multifactorial aetiology, with a dynamic process based on pain intensity, complexity of symptoms, pain pathophysiology and presence of comorbidities. In fact, pain in PD responds to the concept of multimorphic pain, which can evolve, in relation to the different factors, whether they are linked to disease and its management. Understanding the underlying mechanisms will help in guiding of treatment choices. Providing scientific support useful for clinicians and health professionals involved in management of PD, the aim of this review was to bringing practical suggestions and clinical perspectives on the development of a multimodal approach guided by a multidisciplinary clinical intervention through a combination of pharmacological and rehabilitative approaches, to manage pain to improve the quality of life on individuals with PD.

Seeing our hand or a tool during visually-guided actions: Different effects on the somatosensory and visual cortices.

The processing of proprioceptive information in the context of a conflict between visual and somatosensory feedbacks deteriorates motor performance. Previous studies have shown that seeing one's hand increases the weighting assigned to arm somatosensory inputs. In this light, we hypothesized that the sensory conflict, when tracing the contour of a shape with mirror-reversed vision, will be greater for participants who trace with a stylus seen in their hand (Hand group, n = 17) than for participants who trace with the tip of rod without seen their hand (Tool group, n = 15). Based on this hypothesis, we predicted that the tracing performance with mirror vision will be more deteriorated for the Hand group than for the Tool group, and we predicted a greater gating of somatosensory information for the Hand group to reduce the sensory conflict. The participants of both groups followed the outline of a shape in two visual conditions. Direct vision: the participants saw the hand or portion of a light 40 cm rod directly. Mirror Vision: the hand or the rod was seen through a mirror. We measured tracing performance using a digitizing tablet and the cortical activity with electroencephalography. Behavioral analyses revealed that the tracing performance of both groups was similarly impaired by mirror vision. However, contrasting the spectral content of the cortical oscillatory activity between the Mirror and Direct conditions, we observed that tracing with mirror vision resulted in significantly larger alpha (8-12 Hz) and beta (15-25 Hz) powers in the somatosensory cortex for participants of the Hand group. The somatosensory alpha and beta powers did not significantly differ between Mirror and Direct vision conditions for the Tool group. For both groups, tracing with mirror vision altered the activity of the visual cortex: decreased alpha power for the Hand group, decreased alpha and beta power for the Tool group. Overall, these results suggest that seeing the hand enhanced the sensory conflict when tracing with mirror vision and that the increase of alpha and beta powers in the somatosensory cortex served to reduce the weight assigned to somatosensory information. The increased activity of the visual cortex observed for both groups in the mirror vision condition suggests greater visual processing with increased task difficulty. Finally, the fact that the participants of the Tool group did not show better tracing performance than those of the Hand group suggests that tracing deterioration resulted from a sensorimotor conflict (as opposed to a visuo-proprioceptive conflict).

Behavioral and Electrocortical Response to a Sensorimotor Conflict in Individuals with Fibromyalgia.

People with fibromyalgia have been shown to experience more somatosensory disturbances than pain-free controls during sensorimotor conflicts (i.e., incongruence between visual and somatosensory feedback). Sensorimotor conflicts are known to disturb the integration of sensory information. This study aimed to assess the cerebral response and motor performance during a sensorimotor conflict in people with fibromyalgia. Twenty participants with fibromyalgia and twenty-three pain-free controls performed a drawing task including visual feedback that was either congruent with actual movement (and thus with somatosensory information) or incongruent with actual movement (i.e., conflict). Motor performance was measured according to tracing error, and electrocortical activity was recorded using electroencephalography. Motor performance was degraded during conflict for all participants but did not differ between groups. Time-frequency analysis showed that the conflict was associated with an increase in theta power (4-8 Hz) at conflict onset over the left posterior parietal cortex in participants with fibromyalgia but not in controls. This increase in theta suggests a stronger detection of conflict in participants with fibromyalgia, which was not accompanied by differences in motor performance in comparison to controls. This points to dissociation in individuals with fibromyalgia between an altered perception of action and a seemingly unaltered control of action.

Active training and driving-specific feedback improve older drivers' visual search prior to lane changes.

BACKGROUND: Driving retraining classes may offer an opportunity to attenuate some effects of aging that may alter driving skills. Unfortunately, there is evidence that classroom programs (driving refresher courses) do not improve the driving performance of older drivers. The aim of the current study was to evaluate if simulator training sessions with video-based feedback can modify visual search behaviors of older drivers while changing lanes in urban driving. METHODS: In order to evaluate the effectiveness of the video-based feedback training, 10 older drivers who received a driving refresher course and feedback about their driving performance were tested with an on-road standardized evaluation before and after participating to a simulator training program (Feedback group). Their results were compared to a Control group (12 older drivers) who received the same refresher course and in-simulator active practice as the Feedback group without receiving driving-specific feedback. RESULTS: After attending the training program, the Control group showed no increase in the frequency of the visual inspection of three regions of interests (rear view and left side mirrors, and blind spot). In contrast, for the Feedback group, combining active training and driving-specific feedbacks increased the frequency of blind spot inspection by 100% (32.3 to 64.9% of verification before changing lanes). CONCLUSIONS: These results suggest that simulator training combined with driving-specific feedbacks helped older drivers to improve their visual inspection strategies, and that in-simulator training transferred positively to on-road driving. In order to be effective, it is claimed that driving programs should include active practice sessions with driving-specific feedbacks. Simulators offer a unique environment for developing such programs adapted to older drivers' needs.

On the Dynamics of Spatial Updating.

Most of our knowledge on the human neural bases of spatial updating comes from functional magnetic resonance imaging (fMRI) studies in which recumbent participants moved in virtual environments. As a result, little is known about the dynamic of spatial updating during real body motion. Here, we exploited the high temporal resolution of electroencephalography (EEG) to investigate the dynamics of cortical activation in a spatial updating task where participants had to remember their initial orientation while they were passively rotated about their vertical axis in the dark. After the rotations, the participants pointed toward their initial orientation. We contrasted the EEG signals with those recorded in a control condition in which participants had no cognitive task to perform during body rotations. We found that the amplitude of the P1N1 complex of the rotation-evoked potential (RotEPs) (recorded over the vertex) was significantly greater in the Updating task. The analyses of the cortical current in the source space revealed that the main significant task-related cortical activities started during the N1P2 interval (136-303 ms after rotation onset). They were essentially localized in the temporal and frontal (supplementary motor complex, dorsolateral prefrontal cortex, anterior prefrontal cortex) regions. During this time-window, the right superior posterior parietal cortex (PPC) also showed significant task-related activities. The increased activation of the PPC became bilateral over the P2N2 component (303-470 ms after rotation onset). In this late interval, the cuneus and precuneus started to show significant task-related activities. Together, the present results are consistent with the general scheme that the first task-related cortical activities during spatial updating are related to the encoding of spatial goals and to the storing of spatial information in working memory. These activities would precede those involved in higher order processes also relevant for updating body orientation during rotations linked to the egocentric and visual representations of the environment.