Human Foot Force Informs Balance Control Strategies when Standing on a Narrow Beam.

Despite the abundance of studies on the control of standing balance, insights about the roles of biomechanics and neural control have been limited. Previous work introduced an analysis combining the direction and orientation of foot-ground forces. The "intersection point" of the lines of actions of these forces exhibited a consistent pattern across healthy, young subjects when computed for different frequency components of the center of pressure signal. To investigate the control strategy of quiet stance, we applied this intersection point analysis to experimental data of 15 healthy, young subjects balancing in tandem stance on a narrow beam and on the ground. Data from the sagittal and frontal planes were analyzed separately. The task was modeled as a double-inverted pendulum controlled by an optimal controller with torque-actuated ankle and hip joints and additive white noise. To test our prediction that the controller that minimized overall joint effort would yield the best fit across the tested conditions and planes of analyses, experimental results were compared to simulation outcomes. The controller that minimized overall effort produced the best fit in both balance conditions and planes of analyses. For some conditions, the relative penalty on the hip and ankle joints varied in a way relevant to the balance condition or to the plane of analysis. These results suggest that unimpaired quiet balance in a challenging environment can be best described by a controller that maintains minimal effort through the adjustment of relative ankle and hip joint torques.

Inferring control objectives in a virtual balancing task in humans and monkeys.

Natural behaviors have redundancy, which implies that humans and animals can achieve their goals with different strategies. Given only observations of behavior, is it possible to infer the control objective that the subject is employing? This challenge is particularly acute in animal behavior because we cannot ask or instruct the subject to use a particular strategy. This study presents a three-pronged approach to infer an animal's control objective from behavior. First, both humans and monkeys performed a virtual balancing task for which different control strategies could be utilized. Under matched experimental conditions, corresponding behaviors were observed in humans and monkeys. Second, a generative model was developed that represented two main control objectives to achieve the task goal. Model simulations were used to identify aspects of behavior that could distinguish which control objective was being used. Third, these behavioral signatures allowed us to infer the control objective used by human subjects who had been instructed to use one control objective or the other. Based on this validation, we could then infer objectives from animal subjects. Being able to positively identify a subject's control objective from observed behavior can provide a powerful tool to neurophysiologists as they seek the neural mechanisms of sensorimotor coordination.

Dynamic primitives in constrained action: systematic changes in the zero-force trajectory.

Humans substantially outperform robotic systems in tasks that require physical interaction, despite seemingly inferior muscle bandwidth and slow neural information transmission. The control strategies that enable this performance remain poorly understood. To bridge that gap, this study examined kinematically constrained motion as an intermediate step between the widely studied unconstrained motions and sparsely studied physical interactions. Subjects turned a horizontal planar crank in two directions (clockwise and counterclockwise) at three constant target speeds (fast, medium, and very slow) as instructed via visual display. With the hand constrained to move in a circle, nonzero forces against the constraint were measured. This experiment exposed two observations that could not result from mechanics alone but may be attributed to neural control composed of dynamic primitives. A plausible mathematical model of interactive dynamics (mechanical impedance) was assumed and used to "subtract" peripheral neuromechanics. This method revealed a summary of the underlying neural control in terms of motion, a zero-force trajectory. The estimated zero-force trajectories were approximately elliptical and their orientation differed significantly with turning direction; that is consistent with control using oscillations to generate an elliptical zero-force trajectory. However, for periods longer than 2-5 s, motion can no longer be perceived or executed as periodic. Instead, it decomposes into a sequence of submovements, manifesting as increased variability. These quantifiable performance limitations support the hypothesis that humans simplify this constrained-motion task by exploiting at least three primitive dynamic actions: oscillations, submovements, and mechanical impedance.NEW & NOTEWORTHY Control using primitive dynamic actions may explain why human performance is superior to robots despite seemingly inferior "wetware"; however, this also implies limitations. For a crank-turning task, this work quantified two such informative limitations. Force was exerted even though it produced no mechanical work, the underlying zero-force trajectory was roughly elliptical, and its orientation differed with turning direction, evidence of oscillatory control. At slow speeds, speed variability increased substantially, indicating intermittent control via submovements.

Learning to manipulate a whip with simple primitive actions - A simulation study.

This simulation study investigated whether a 4-degrees-of-freedom (DOF) arm could strike a target with a 50-DOF whip using a motion profile similar to discrete human movements. The interactive dynamics of the multi-joint arm was modeled as a constant joint-space mechanical impedance, with values derived from experimental measurement. Targets at various locations could be hit with a single maximally smooth motion in joint-space coordinates. The arm movements that hit the targets were identified with fewer than 250 iterations. The optimal actions were essentially planar arm motions in extrinsic task-space coordinates, predominantly oriented along the most compliant direction of both task-space and joint-space mechanical impedances. Of the optimal movement parameters, striking a target was most sensitive to movement duration. This result suggests that the elementary actions observed in human motor behavior may support efficient motor control in interaction with a dynamically complex object.

Inferring control objectives in a virtual balancing task in humans and monkeys.

Natural behaviors have redundancy, which implies that humans and animals can achieve their goals with different control objectives. Given only observations of behavior, is it possible to infer the control strategy that the subject is employing? This challenge is particularly acute in animal behavior because we cannot ask or instruct the subject to use a particular control strategy. This study presents a threepronged approach to infer an animal's control strategy from behavior. First, both humans and monkeys performed a virtual balancing task for which different control objectives could be utilized. Under matched experimental conditions, corresponding behaviors were observed in humans and monkeys. Second, a generative model was developed that represented two main control strategies to achieve the task goal. Model simulations were used to identify aspects of behavior that could distinguish which control objective was being used. Third, these behavioral signatures allowed us to infer the control objective used by human subjects who had been instructed to use one control objective or the other. Based on this validation, we could then infer strategies from animal subjects. Being able to positively identify a subject's control objective from behavior can provide a powerful tool to neurophysiologists as they seek the neural mechanisms of sensorimotor coordination.

Body Mechanics, Optimality, and Sensory Feedback in the Human Control of Complex Objects.

Humans are adept at a wide variety of motor skills, including the handling of complex objects and using tools. Advances to understand the control of voluntary goal-directed movements have focused on simple behaviors such as reaching, uncoupled to any additional object dynamics. Under these simplified conditions, basic elements of motor control, such as the roles of body mechanics, objective functions, and sensory feedback, have been characterized. However, these elements have mostly been examined in isolation, and the interactions between these elements have received less attention. This study examined a task with internal dynamics, inspired by the daily skill of transporting a cup of coffee, with additional expected or unexpected perturbations to probe the structure of the controller. Using optimal feedback control (OFC) as the basis, it proved necessary to endow the model of the body with mechanical impedance to generate the kinematic features observed in the human experimental data. The addition of mechanical impedance revealed that simulated movements were no longer sensitively dependent on the objective function, a highly debated cornerstone of optimal control. Further, feedforward replay of the control inputs was similarly successful in coping with perturbations as when feedback, or sensory information, was included. These findings suggest that when the control model incorporates a representation of the mechanical properties of the limb, that is, embodies its dynamics, the specific objective function and sensory feedback become less critical, and complex interactions with dynamic objects can be successfully managed.

Developmental change in predictive motor abilities.

Prediction is critical for successful interactions with a dynamic environment. To test the development of predictive processes over the life span, we designed a suite of interceptive tasks implemented as interactive video games. Four tasks involving interactions with a flying ball with titrated challenge quantified spatiotemporal aspects of prediction. For comparison, reaction time was assessed in a matching task. The experiments were conducted in a museum, where over 400 visitors across all ages participated, and in a laboratory with a focused age group. Results consistently showed that predictive ability improved with age to reach adult level by age 12. In contrast, reaction time continued to decrease into late adolescence. Inter-task correlations revealed that the tasks tested different aspects of predictive processes. This developmental progression complements recent findings on cerebellar and cortical maturation. Additionally, these results can serve as normative data to study predictive processes in individuals with neurodevelopmental conditions.

A Systematic Review and Meta-analysis of the Effect of Active Video Games on Postural Balance.

OBJECTIVE: To conduct a comprehensive systematic review and meta-analysis of the effects of active video game (AVG) interventions on postural balance across all ages in populations with and without neurologic impairments, using all types of platforms. DATA SOURCE: Six databases (PubMed, PsycINFO, Sport Discus, MEDLINE, Web of Science, and Google Scholar) were reviewed by December 31, 2020. STUDY SELECTION: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, a study must be original, published in English peer-reviewed venues and employed AVGs as the sole or primary intervention to enhance, maintain, or regain postural balance. At least 2 within- or between-subjects conditions must be included with ≥10 participants per condition. DATA EXTRACTION: Three reviewers independently performed data extraction and assessed the risk of bias. DATA SYNTHESIS: 129 studies were identified, with 102 eligible for meta-analysis. The total number of tested participants was 6407 (60.0% women, Mage=55.1 years, range=3-99 years, SD=22.6). The average intervention duration was 35.6 min/session with 3.1 sessions/week for 7.6 weeks. The overall effect favored AVG interventions (Hedges' g=0.469; 95% confidence interval [CI]=0.407-0.531). Although the overall study quality was relatively low, the analysis expectedly indicated significantly larger effects (P<.001) for AVG-interventions over passive controls (Hedges' g=0.627; 95% CI=0.466-0.788), but importantly also favored AVG-interventions over conventional treatment (Hedges' g=0.389; 95% CI=0.311-0.468). All clinical populations responded positively, although with different effect sizes (P=.023). Children experienced larger treatment effects (Hedges' g=0.550; 95% CI=0.336-0.764), closely followed by seniors (Hedges' g=0.529; 95% CI=0.402-0.656). The largest intervention effect on balance improvements was seen in healthy people without a medical condition (Hedges' g=0.609; 95% CI=0.465-0.753). CONCLUSIONS: AVGs can produce postural balance improvements and better postural maintenance. All populations could benefit from AVG interventions.

Novel Platform for Quantitative Assessment of Functional Object Interactions After Stroke.

Many persons with stroke exhibit upper extremity motor impairments. These impairments often lead to dysfunction and affect performance in activities of daily living, where successful manipulation of objects is essential. Hence, understanding how upper extremity motor deficits manifest in functional interactions with objects is critical for rehabilitation. However, quantifying skill in these tasks has been a challenge. Traditional rehabilitation assessments require highly trained clinicians, are time-consuming, and yield subjective scores. This paper introduces a custom-designed device, the "MAGIC Table", that can record real-time kinematics of persons with stroke during interaction with objects, specifically a 'cup of coffee'. The task and its quantitative assessments were derived from previous basic-science studies. Six participants after stroke and six able-bodied participants moved a 3D-printed cup with a rolling ball inside, representing sloshing coffee, with 3 levels of difficulty. Movements were captured via a high-resolution camera above the table. Conventional kinematic metrics (movement time and smoothness) and novel kinematic metrics accounting for object interaction (risk and predictability) evaluated performance. Expectedly, persons with stroke moved more slowly and less smoothly than able-bodied participants, in both simple reaches and during transport of the cup-and-ball system. However, the more sensitive metric was mutual information, which captured the predictability of interactions, essential in cup transport as shown in previous theoretical research. Predictability sensitively measured differences in performance with increasing levels of difficulty. It also showed the best intraclass consistency, promising sensitive differentiation between different levels of impairment. This study highlights the feasibility of this new device and indicates that examining dynamic object interaction may provide valuable insights into upper extremity function after stroke useful for assessment and rehabilitation.

Motor control beyond reach-how humans hit a target with a whip.

Humans are strikingly adept at manipulating complex objects, from tying shoelaces to cracking a bullwhip. These motor skills have highly nonlinear interactive dynamics that defy reduction into parts. Yet, despite advances in data recording and processing, experiments in motor neuroscience still prioritize experimental reduction over realistic complexity. This study embraced the fully unconstrained behaviour of hitting a target with a 1.6-m bullwhip, both in rhythmic and discrete fashion. Adopting an object-centered approach to test the hypothesis that skilled movement simplifies the whip dynamics, the whip's evolution was characterized in relation to performance error and hand speed. Despite widely differing individual strategies, both discrete and rhythmic styles featured a cascade-like unfolding of the whip. Whip extension and orientation at peak hand speed predicted performance error, at least in the rhythmic style, suggesting that humans accomplished the task by setting initial conditions. These insights may inform further studies on human and robot control of complex objects.

Mechanical effects of canes on standing posture: beyond perceptual information.

BACKGROUND: Numerous studies showed that postural balance improves through light touch on a stable surface highlighting the importance of haptic information, seemingly downplaying the mechanical contributions of the support. The present study examined the mechanical effects of canes for assisting balance in healthy individuals challenged by standing on a beam. METHODS: Sixteen participants supported themselves with two canes, one in each hand, and applied minimal, preferred, or maximum force onto the canes. They positioned the canes in the frontal plane or in a tripod configuration. Statistical analysis used a linear mixed model to evaluate the effects on the center of pressure and the center of mass. RESULTS: The canes significantly reduced the variability of the center of pressure and the center of mass to the same level as when standing on the ground. Increasing the exerted force beyond the preferred level yielded no further benefits, although in the preferred force condition, participants exploited the altered mechanics by resting their arms on the canes. The tripod configuration allowed for larger variability of the center of pressure in the task-irrelevant anterior-posterior dimension. High forces had a destabilizing effect on the canes: the displacement of the hand on the cane handle increased with the force. CONCLUSIONS: Given this static instability, these results show that using canes can provide not only mechanical benefits but also challenges. From a control perspective, effort can be reduced by resting the arms on the canes and by channeling noise in the task-irrelevant dimensions. However, larger forces exerted onto the canes can also have destabilizing effects and the instability of the canes needs to be counteracted, possibly by arm and shoulder stiffness. Insights into the variety of mechanical effects is important for the design of canes and the instructions of how to use them.

Dynamic Primitives Limit Human Force Regulation during Motion.

Humans excel at physical interaction despite long feedback delays and low-bandwidth actuators. Yet little is known about how humans manage physical interaction. A quantitative understanding of how they do is critical for designing machines that can safely and effectively interact with humans, e.g. amputation prostheses, assistive exoskeletons, therapeutic rehabilitation robots, and physical human-robot collaboration. To facilitate applications, this understanding should be in the form of a simple mathematical model that not only describes humans' capabilities but also their limitations. In robotics, hybrid control allows simultaneous, independent control of both motion and force and it is often assumed that humans can modulate force independent of motion as well. This paper experimentally tested that assumption. Participants were asked to apply a constant 5N force on a robot manipulandum that moved along an elliptical path. After initial improvement, force errors quickly plateaued, despite practice and visual feedback. Within-trial analyses revealed that force errors varied with position on the ellipse, rejecting the hypothesis that humans have independent control of force and motion. The findings are consistent with a feed-forward motion command composed of two primitive oscillations acting through mechanical impedance to evoke force.

Ambulatory Voice Biofeedback: Acquisition and Retention of Modified Daily Voice Use in Patients With Phonotraumatic Vocal Hyperfunction.

PURPOSE: Voice ambulatory biofeedback (VAB) has potential to improve carryover of therapeutic voice use into daily life. Previous work in vocally healthy participants demonstrated that motor learning inspired variations to VAB produced expected differences in acquisition and retention of modified daily voice use. This proof-of-concept study was designed to evaluate whether these VAB variations have the same desired effects on acquisition and retention in patients with phonotraumatic vocal hyperfunction (PVH). METHOD: Seventeen female patients with PVH wore an ambulatory voice monitor for 6 days: three baseline days, one biofeedback day, one short-term retention day, and one long-term retention day. Short- and long-term retention were 1- and 7-days postbiofeedback, respectively. Patients were block-randomized to receive one of three types of VAB: 100%, 25%, and Summary. Performance was measured in terms of adherence time below a subject-specific vocal intensity threshold. RESULTS: All three types of VAB produced a biofeedback effect with 13 out of 17 patients displaying an increase in adherence time compared to baseline days. Additionally, multiple patients from each VAB group increased their adherence time during short- and/or long-term retention monitoring compared to baseline. CONCLUSIONS: These findings show that VAB can be associated with acquisition and retention of desired voice use in patients with PVH. Specifically, all three feedback types improved multiple patients' performance and retention for up to 1 week after biofeedback removal. Future work can investigate the impact of incorporating VAB into voice therapy.

Preparing to move: Setting initial conditions to simplify interactions with complex objects.

Humans dexterously interact with a variety of objects, including those with complex internal dynamics. Even in the simple action of carrying a cup of coffee, the hand not only applies a force to the cup, but also indirectly to the liquid, which elicits complex reaction forces back on the hand. Due to underactuation and nonlinearity, the object's dynamic response to an action sensitively depends on its initial state and can display unpredictable, even chaotic behavior. With the overarching hypothesis that subjects strive for predictable object-hand interactions, this study examined how subjects explored and prepared the dynamics of an object for subsequent execution of the target task. We specifically hypothesized that subjects find initial conditions that shorten the transients prior to reaching a stable and predictable steady state. Reaching a predictable steady state is desirable as it may reduce the need for online error corrections and facilitate feed forward control. Alternative hypotheses were that subjects seek to reduce effort, increase smoothness, and reduce risk of failure. Motivated by the task of 'carrying a cup of coffee', a simplified cup-and-ball model was implemented in a virtual environment. Human subjects interacted with this virtual object via a robotic manipulandum that provided force feedback. Subjects were encouraged to first explore and prepare the cup-and-ball before initiating a rhythmic movement at a specified frequency between two targets without losing the ball. Consistent with the hypotheses, subjects increased the predictability of interaction forces between hand and object and converged to a set of initial conditions followed by significantly decreased transients. The three alternative hypotheses were not supported. Surprisingly, the subjects' strategy was more effortful and less smooth, unlike the observed behavior in simple reaching movements. Inverse dynamics of the cup-and-ball system and forward simulations with an impedance controller successfully described subjects' behavior. The initial conditions chosen by the subjects in the experiment matched those that produced the most predictable interactions in simulation. These results present first support for the hypothesis that humans prepare the object to minimize transients and increase stability and, overall, the predictability of hand-object interactions.

Central nervous system physiology.

This is the second chapter of the series on the use of clinical neurophysiology for the study of movement disorders. It focusses on methods that can be used to probe neural circuits in brain and spinal cord. These include use of spinal and supraspinal reflexes to probe the integrity of transmission in specific pathways; transcranial methods of brain stimulation such as transcranial magnetic stimulation and transcranial direct current stimulation, which activate or modulate (respectively) the activity of populations of central neurones; EEG methods, both in conjunction with brain stimulation or with behavioural measures that record the activity of populations of central neurones; and pure behavioural measures that allow us to build conceptual models of motor control. The methods are discussed mainly in relation to work on healthy individuals. Later chapters will focus specifically on changes caused by pathology.

Frequency-dependent force direction elucidates neural control of balance.

BACKGROUND: Maintaining upright posture is an unstable task that requires sophisticated neuro-muscular control. Humans use foot-ground interaction forces, characterized by point of application, magnitude, and direction to manage body accelerations. When analyzing the directions of the ground reaction forces of standing humans in the frequency domain, previous work found a consistent pattern in different frequency bands. To test whether this frequency-dependent behavior provided a distinctive signature of neural control or was a necessary consequence of biomechanics, this study simulated quiet standing and compared the results with human subject data. METHODS: Aiming to develop the simplest competent and neuromechanically justifiable dynamic model that could account for the pattern observed across multiple subjects, we first explored the minimum number of degrees of freedom required for the model. Then, we applied a well-established optimal control method that was parameterized to maximize physiologically-relevant insight to stabilize the balancing model. RESULTS: If a standing human was modeled as a single inverted pendulum, no controller could reproduce the experimentally observed pattern. The simplest competent model that approximated a standing human was a double inverted pendulum with torque-actuated ankle and hip joints. A range of controller parameters could stabilize this model and reproduce the general trend observed in experimental data; this result seems to indicate a biomechanical constraint and not a consequence of control. However, details of the frequency-dependent pattern varied substantially across tested control parameter values. The set of parameters that best reproduced the human experimental results suggests that the control strategy employed by human subjects to maintain quiet standing was best described by minimal control effort with an emphasis on ankle torque. CONCLUSIONS: The findings suggest that the frequency-dependent pattern of ground reaction forces observed in quiet standing conveys quantitative information about human control strategies. This study's method might be extended to investigate human neural control strategies in different contexts of balance, such as with an assistive device or in neurologically impaired subjects.

The effects of continuous oromotor activity on speech motor learning: speech biomechanics and neurophysiologic correlates.

Sustained limb motor activity has been used as a therapeutic tool for improving rehabilitation outcomes and is thought to be mediated by neuroplastic changes associated with activity-induced cortical excitability. Although prior research has reported enhancing effects of continuous chewing and swallowing activity on learning, the potential beneficial effects of sustained oromotor activity on speech improvements is not well-documented. This exploratory study was designed to examine the effects of continuous oromotor activity on subsequent speech learning. Twenty neurologically healthy young adults engaged in periods of continuous chewing and speech after which they completed a novel speech motor learning task. The motor learning task was designed to elicit improvements in accuracy and efficiency of speech performance across repetitions of eight-syllable nonwords. In addition, transcranial magnetic stimulation was used to measure the cortical silent period (cSP) of the lip motor cortex before and after the periods of continuous oromotor behaviors. All repetitions of the nonword task were recorded acoustically and kinematically using a three-dimensional motion capture system. Productions were analyzed for accuracy and duration, as well as lip movement distance and speed. A control condition estimated baseline improvement rates in speech performance. Results revealed improved speech performance following 10 min of chewing. In contrast, speech performance following 10 min of continuous speech was degraded. There was no change in the cSP as a result of either oromotor activity. The clinical implications of these findings are discussed in the context of speech rehabilitation and neuromodulation.

Predicting apneic events in preterm infants using cardio-respiratory and movement features.

BACKGROUND AND OBJECTIVE: Preterm neonates are prone to episodes of apnea, bradycardia and hypoxia (ABH) that can lead to neurological morbidities or even death. There is broad interest in developing methods for real-time prediction of ABH events to inform interventions that prevent or reduce their incidence and severity. Using advances in machine learning methods, this study develops an algorithm to predict ABH events. METHODS: Following previous studies showing that respiratory instabilities are closely associated with bouts of movement, we present a modeling framework that can predict ABH events using both movement and cardio-respiratory features derived from routine clinical recordings. In 10 preterm infants, movement onsets and durations were estimated with a wavelet-based algorithm that quantified artifactual distortions of the photoplethysmogram signal. For prediction, cardio-respiratory features were created from time-delayed correlations of inter-beat and inter-breath intervals with past values; movement features were derived from time-delayed correlations with inter-breath intervals. Gaussian Mixture Models and Logistic Regression were used to develop predictive models of apneic events. Performance of the models was evaluated with ROC curves. RESULTS: Performance of the prediction framework (mean AUC) was 0.77 ± 0.04 for 66 ABH events on training data from 7 infants. When grouped by the severity of the associated bradycardia during the ABH event, the framework was able to predict 83% and 75% of the most severe episodes in the 7-infant training set and 3-infant test set, respectively. Notably, inclusion of movement features significantly improved the predictions compared with modeling with only cardio-respiratory signals. CONCLUSIONS: Our findings suggest that recordings of movement provide important information for predicting ABH events in preterm infants, and can inform preemptive interventions designed to reduce the incidence and severity of ABH events.

Hand pose selection in a bimanual fine-manipulation task.

Many daily tasks involve the collaboration of both hands. Humans dexterously adjust hand poses and modulate the forces exerted by fingers in response to task demands. Hand pose selection has been intensively studied in unimanual tasks, but little work has investigated bimanual tasks. This work examines hand poses selection in a bimanual high-precision-screwing task taken from watchmaking. Twenty right-handed subjects dismounted a screw on the watch face with a screwdriver in two conditions. Results showed that although subjects used similar hand poses across steps within the same experimental conditions, the hand poses differed significantly in the two conditions. In the free-base condition, subjects needed to stabilize the watch face on the table. The role distribution across hands was strongly influenced by hand dominance: the dominant hand manipulated the tool, whereas the nondominant hand controlled the additional degrees of freedom that might impair performance. In contrast, in the fixed-base condition, the watch face was stationary. Subjects used both hands even though single hand would have been sufficient. Importantly, hand poses decoupled the control of task-demanded force and torque across hands through virtual fingers that grouped multiple fingers into functional units. This preference for bimanual over unimanual control strategy could be an effort to reduce variability caused by mechanical couplings and to alleviate intrinsic sensorimotor processing burdens. To afford analysis of this variety of observations, a novel graphical matrix-based representation of the distribution of hand pose combinations was developed. Atypical hand poses that are not documented in extant hand taxonomies are also included.NEW & NOTEWORTHY We study hand poses selection in bimanual fine motor skills. To understand how roles and control variables are distributed across the hands and fingers, we compared two conditions when unscrewing a screw from a watch face. When the watch face needed positioning, role distribution was strongly influenced by hand dominance; when the watch face was stationary, a variety of hand pose combinations emerged. Control of independent task demands is distributed either across hands or across distinct groups of fingers.

Effect of spontaneous movement on respiration in preterm infants.

NEW FINDINGS: What is the central question of this study? The respiratory centres in the brainstem that control respiration receive inputs from various sources, including proprioceptors in muscles and joints and suprapontine centres, which all affect limb movements. What is the effect of spontaneous movement on respiration in preterm infants? What is the main finding and its importance? Apnoeic events tend to be preceded by movements. These activity bursts can cause respiratory instability that leads to an apnoeic event. These findings show promise that infant movements might serve as potential predictors of life-threatening apnoeic episodes, but more research is required. ABSTRACT: A common condition in preterm infants (<37 weeks' gestational age) is apnoea resulting from immaturity and instability of the respiratory system. As apnoeas are implicated in several acute and long-term complications, prediction of apnoeas may preempt their onset and subsequent complications. This study tests the hypothesis that infant movements are a predictive marker for apnoeic episodes and examines the relation between movement and respiration. Movement was detected using a wavelet algorithm applied to the photoplethysmographic signal. Respiratory activity was measured in nine infants using respiratory inductance plethysmography; in an additional eight infants, respiration and partial pressure of airway carbon dioxide ( PCO2 ) were measured by a nasal cannula with side-stream capnometry. In the first cohort, the distribution of movements before and after the onset of 370 apnoeic events was compared. Results showed that apnoeic events were associated with longer movement duration occurring before apnoea onsets compared to after. In the second cohort, respiration was analysed in relation to movement, comparing standard deviation of inter-breath intervals (IBI) before and after apnoeas. Poincaré maps of the respiratory activity quantified variability of airway PCO2 in phase space. Movement significantly increased the variability of IBI and PCO2 . Moreover, destabilization of respiration was dependent on the duration of movement. These findings support that bodily movements of the infants precede respiratory instability. Further research is warranted to explore the predictive value of movement for life-threatening events, useful for clinical management and risk stratification.