Action-outcome Regularity Perceptual Sensitivity in Children with Developmental Coordination Disorder.

PURPOSE: An internal model deficit is considered to underlie developmental coordination disorder (DCD); thus, children with DCD have an altered sense of agency (SoA), which is associated with depressive symptoms. Furthermore, the perception of action-outcome regularity is present in early development, is involved in the generation of SoA, and has roles in adaptive motor learning and coordinated motor skills. However, perceptual sensitivity to action-outcome regularity has not been examined in children with DCD. METHODS: We investigated perceptual sensitivity to action-outcome regularity in 6-15-year-old children with DCD and age- and sex-matched typically developing (TD) children. Both groups were assessed for coordinated motor skills with the Movement Assessment Battery for Children-2nd Edition, while the DCD group was assessed with the DCD Questionnaire, Social Communication Questionnaire, Attention-Deficit/Hyperactivity Disorder-Rating Scale, and Depression Self- Rating Scale for Children. RESULTS: Perceptual sensitivity to action-outcome regularity was significantly reduced in children with DCD. However, there was a significant correlation between perceptual sensitivity to action-outcome regularity and age in DCD and TD children. Perceptual sensitivity to action-outcome regularity was significantly lower in younger children with DCD than in younger and older TD children, but there were no significant differences between older children with DCD and younger and older TD children. CONCLUSION: The current results suggest that children with DCD have significantly reduced perceptual sensitivity to action-outcome regularity at younger ages, which may alter SoA and inhibit internal model development, thereby reducing motor skill coordination.

Influence of vibrotactile random noise on the smoothness of the grasp movement in patients with chemotherapy-induced peripheral neuropathy.

Patients with chemotherapy-induced peripheral neuropathy (CIPN) often suffer from sensorimotor dysfunction of the distal portion of the extremities (e.g., loss of somatosensory sensation, numbness/tingling, difficulty typing on a keyboard, or difficulty buttoning/unbuttoning a shirt). The present study aimed to reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor dysfunction in CIPN patients without exacerbating symptoms. Twenty-five patients with CIPN and 28 age-matched healthy adults participated in this study. To reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor function, participants were asked to perform a tactile detection task and a grasp movement task during random noise stimulation delivered to the volar and dorsal wrist. We set three intensity conditions of the vibrotactile random noise: 0, 60, and 120% of the sensory threshold (Noise 0%, Noise 60%, and Noise 120% conditions). In the tactile detection task, a Semmes-Weinstein monofilament was applied to the volar surface of the tip of the index finger using standard testing measures. In the grasp movement task, the distance between the thumb and index finger was recorded while the participant attempted to grasp a target object, and the smoothness of the grasp movement was quantified by calculating normalized jerk in each experimental condition. The experimental data were compared using two-way repeated-measures analyses of variance with two factors: experimental condition (Noise 0, 60, 120%) × group (Healthy controls, CIPN patients). The tactile detection threshold and the smoothness of the grasp movement were only improved in the Noise 60% condition without exacerbating numbness/tingling in CIPN patients and healthy controls. The current study suggested that the development of treatment devices using stochastic resonance can improve sensorimotor function for CIPN patients.

Developmental changes in action-outcome regularity perceptual sensitivity and its relationship to hand motor function in 5-16-year-old children.

Along with the comparator model, the perception of action-outcome regularity is involved in the generation of sense of agency. In addition, the perception of action-outcome regularity is related to motor performance. However, no studies have examined the developmental changes in the perception of action-outcome regularity. The current study measured perceptual sensitivity to action-outcome regularity and manual dexterity in 200 children aged between 5 and 16 years. The results showed that perceptual sensitivity to action-outcome regularity was significantly lower in 5-6-year-old children than in 9-16-year-old children, and that it was significantly lower in children with low manual dexterity than in children with medium to high manual dexterity. Correlation analyses revealed significant correlations of age and perceptual sensitivity to action-outcome regularity, but no significant correlation of manual dexterity and perceptual sensitivity to action-outcome regularity, either overall or in any age band. The present study suggests that perceptual sensitivity to action-outcome regularity is immature at 5-6 years of age and that it may be impaired in 5-16-year-old children with poor manual dexterity.

Spatial Instability during Precision Grip-Lift in Children with Poor Manual Dexterity.

Although children with developmental coordination disorder (DCD) show impaired precision grip control due to a sensory-motor integration deficit, their spatial instability (such as changes in force direction and object roll during a precision grip task) is unclear. Herein, we investigated the spatial instability in the precision grip force control of children with poor manual dexterity. We divided 66 school-aged children who performed a precision gripping and lifting of heavy- or lightweight objects into those with low manual dexterity (n = 11) and those with high manual dexterity (n = 55) as revealed by the Movement Assessment Battery for Children (2nd edition). The group and weight effects were then determined. The results revealed that the total trajectory lengths of the center of pressure (COP) were longer in the lightweight object data of the children in the low-manual-dexterity group and were related to the children's grip force. The low-manual-dexterity group also showed a shifted COP position from the center of the object in the medial-lateral direction and in the object roll regardless of the object's weight; these were closely related in both weights' tests. These results demonstrated that children with poor manual dexterity show spatial instability and different adaptations to the weight of objects during a precision grip task. Further studies are needed to determine whether these findings would be replicated in children with a diagnosis of DCD.

Pain quality of thermal grill illusion is similar to that of central neuropathic pain rather than peripheral neuropathic pain.

OBJECTIVES: Application of spatially interlaced innocuous warm and cool stimuli to the skin elicits illusory pain, known as the thermal grill illusion (TGI). This study aimed to discriminate the underlying mechanisms of central and peripheral neuropathic pain focusing on pain quality, which is considered to indicate the underlying mechanism(s) of pain. We compared pain qualities in central and peripheral neuropathic pain with reference to pain qualities of TGI-induced pain. METHODS: Experiment 1:137 healthy participants placed their hand on eight custom-built copper bars for 60 s and their pain quality was assessed by the McGill Pain Questionnaire. Experiment 2: Pain quality was evaluated in patients suffering from central and peripheral neuropathic pain (42 patients with spinal cord injury, 31 patients with stroke, 83 patients with trigeminal neuralgia and 131 patients with postherpetic neuralgia). RESULTS: Experiment 1: Two components of TGI-induced pain were found using principal component analysis: component 1 included aching, throbbing, heavy and burning pain, component 2 included itching, electrical-shock, numbness, and cold-freezing. Experiment 2: Multiple correspondence analysis (MCA) and cross tabulation analysis revealed specific pain qualities including aching, hot-burning, heavy, cold-freezing, numbness, and electrical-shock pain were associated with central neuropathic pain rather than peripheral neuropathic pain. CONCLUSIONS: We found similar qualities between TGI-induced pain in healthy participants and central neuropathic pain rather than peripheral neuropathic pain. The mechanism of TGI is more similar to the mechanism of central neuropathic pain than that of neuropathic pain.

Effect of Painful Electrical Stimuli on Readiness Potential in the Human Brain.

The readiness potential (RP), which is a slow negative electrical brain potential that occurs before voluntary movement, can be interpreted as a measure of intrinsic brain activity originating from self-regulating mechanisms. Early and late components of the RP may indicate clinical-neurophysiological features such as motivation, preparation, intention, and initiation of voluntary movements. In the present study, we hypothesized that electrical pain stimuli modulate the preparatory brain activity for movement. The grand average evoked potentials were measured at sensory motor regions with EEG during an experimental protocol consisting of painful and nonpainful stimuli. Our results demonstrated that painful stimuli were preceded by an enhanced RP when compared to non-painful stimuli at the Cz channel (p < 0.05). Furthermore, the mean amplitude of the RP at the early phase was significantly higher for the painful stimuli when compared to the non-painful stimuli (p < 0.05). Our results indicate that electrical painful stimuli, which can be considered as an unpleasant and stressful condition, modulate the motor preparation at sensory motor regions to a different extent when compared to non-painful electrical stimuli. Since early component of the RP represents cortical activation due to anticipation of the stimuli and the allocation of attentional resources, our results suggest that painful stimuli may affect the motor preparation processes and the prediction of the movement at the cortical level.

Fear of movement-related pain disturbs cortical preparatory activity after becoming aware of motor intention.

Fear of movement-related pain is known to disturb the process of motor preparation in patients with chronic pain. In the present study, we aimed to clarify the neural mechanisms underlying the influence of fear movement-related pain on motor preparatory brain activity using Libet's clock and electroencephalography (EEG). Healthy participants were asked to press a button while watching a rotating Libet's clock-hand, and report the number on the clock ("W time") when they made the "decision" to press the button with their right index finger. Immediately after pressing the button, a painful electrical stimulus was delivered to the dorsum of the left hand, causing participants to feel fear of movement (button press-related pain). We found that fear of movement-related pain caused the W time to be early, and that the amplitudes of readiness potentials (RPs) increased after awareness of motor intention emerged. In addition, fear of movement-related pain caused over-activation of the medial frontal cortex, supplementary motor area, cingulate motor area, and primary motor cortex after participants became aware of their motor intention. Such over-activation might result from conflict between the unrealized desire to escape from a painful experience and motivation to perform a required motor task.

Influence of Stochastic Resonance on Manual Dexterity in Children With Developmental Coordination Disorder: A Double-Blind Interventional Study.

Background: There is increasing evidence that the stochastic resonance (SR) phenomenon provided by subthreshold mechanical noise stimulation improves the sensory-motor system. However, the effect of SR on children with developmental coordination disorder (DCD) is unclear. The purpose of this study was to assess whether SR activated by subthreshold vibrotactile noise stimulation of the wrist influences manual dexterity in children with DCD. Methods: A double-blind interventional study was conducted. Participants were 30 children (age: 9.3 ± 1.44 years, range 6-11 years; 27 male, three female; 25 right-handed, five left-handed) meeting DCD diagnostic criteria in DSM-5. The manual dexterity test was administered the day before SR intervention (baseline-data). SR was elicited using subthreshold vibrotactile noise stimulation at 60% of the vibrotactile threshold measured at the wrist. SR was delivered two times and the manual dexterity test was administered during each SR stimulation block (SR-on condition) and after each SR stimulation block (SR-off), for a total of four measurements. Target outcomes were the component score, the standard score, and the percentile score of the manual dexterity test. Results: The manual dexterity test scores in the SR-on condition were significantly improved compared to scores at the baseline and in the SR-off condition (p < 0.001). Conclusions: The present study showed that subthreshold noise stimulation eliciting SR significantly improved manual dexterity outcomes in children with DCD during stimulation but not after stimulation. Future studies will need to investigate the carry-over effects of SR stimulation.

Goal sharing with others modulates the sense of agency and motor accuracy in social contexts.

Sense of agency (SoA), the feeling of control over one's own actions and their effects, is fundamental to goal-directed actions at the individual level and may constitute a cornerstone of everyday life, including cooperative behavior (i.e., goal sharing). Previous studies have demonstrated that goal sharing can activate the motor prediction of both agent's action and partner's action in joint-action tasks. Moreover, given that from an SoA perspective, predictive processes are an essential basis, there is a possibility that goal sharing may modulate SoA. However, the possibility for goal sharing to modulate SoA remains unclear. This study aimed to investigate whether goal sharing modulates the intentional binding (IB) effect (a method that can quantitatively measure SoA) of self-generated and observed partner's actions and improves motor accuracy. Participants were required to stop a circular horizontal moving object by pressing a key when the object reaches the center of a target in a social situation. This task measured IB by having participants estimate the time interval between action and effect in several 100 milliseconds, with shorter time interval estimations indicating enhancement of SoA. Participants were randomly divided into 13 Cooperative groups (goal sharing) and 13 Independent groups (non-goal sharing). Cooperative groups were instructed to perform the task together, while Independent groups did so individually. Participants estimated the time interval between them by pressing the key and hearing the corresponding sound (Self-generated action) and the other person pressing the key and hearing the sound (Observed action). Our results indicated that goal sharing improved motor accuracy and enhanced both the IB of Self-generated and Observed actions compared to non-goal sharing. We suggest that SoA can be modulated by goal sharing in specific social contexts.

The Effects of Transcranial Direct Current Stimulation Combined with Aerobic Exercise on Pain Thresholds and Electroencephalography in Healthy Adults.

OBJECTIVES: We examined whether transcranial direct current stimulation (tDCS) combined with aerobic exercise (AE) modulated the pressure pain threshold (PPT) and peak alpha frequency (PAF) measured via resting electroencephalography. DESIGN: Single-blind experimental study with a cross-over design. SETTING: Neuro Rehabilitation Research Center, Kio University. SUBJECTS: Ten healthy controls participated in this study. METHODS: Three types of sessions--(i) tDCS, (ii) Sham tDCS/AE, and (iii) tDCS/AE--were tested in this investigation. Anodal stimulation (2 mA, 20 minutes) was applied over the left primary motor cortex. Each session was 20 minutes long. We used the PPT and short-form Profile of Mood States-Brief, as well as PAF measured via resting-electroencephalography, to investigate the effects of tDCS and AE. Heart rate and scores on the Borg scale were used to confirm exercise intensity. PAF was calculated in four regions of interest: frontal, central, parietal, and occipital areas. RESULTS: The change ratio of PPT increased during each session. The maximum change ratio of PPT were tDCS: 40.7%, Sham tDCS/AE: 51.5%, and tDCS/AE: 83.4%. change ratio of PPT was earlier and higher in the tDCS/AE trials compared with the other sessions. Negative mood was improved after session completion. Significant differences in PAF were found in the occipital area in the Sham tDCS/AE and tDCS/AE sessions. CONCLUSIONS: The combined tDCS and AE intervention induced significant changes in PPT in a single session, with a PAF that was earlier and higher than those produced during the Sham tDCS/AE and tDCS sessions.

Increased visual bias in children with developmental coordination disorder: Evidence from a visual-tactile temporal order judgment task.

BACKGROUND: Previous studies have suggested that children with developmental coordination disorder (DCD) rely heavily on vision to perform movements, which may contribute to their clumsy movements. However, few studies have objectively and quantitatively investigated the perceptual biases of children with DCD. METHODS: A visual-tactile temporal order judgment (TOJ) task was used to measure and compare the perceptual biases of 19 children with DCD and 19 age- and sex-matched typically developing children. The point of subjective equality, which demonstrates when "visual first" and "tactile first" judgment probabilities are equal (50%), obtained by analyzing the results of the visual-tactile TOJ task, was used as an indicator of perceptual biases. Further, variables (age and manual dexterity in all participants; motor function, autism spectrum disorder and attention-deficit hyperactivity disorder traits, and depressive symptoms in children with DCD) associated with perceptual biases were examined with correlation analysis. RESULTS: Children with DCD had significantly stronger visual bias than typically developing children. Overall correlation analysis showed that increased visual bias was significantly correlated with poor manual dexterity. CONCLUSION: Children with DCD had a strong visual bias, which was associated with poor manual dexterity.

Effects of Tool Novelty and Action Demands on Gaze Searching During Tool Observation.

Technical reasoning refers to making inferences about how to use tools. The degree of technical reasoning is indicated by the bias of the gaze (fixation) on the functional part of the tool when in use. Few studies have examined whether technical reasoning differs between familiar and unfamiliar novel tools. In addition, what effect the intention to use the tool has on technical reasoning has not been determined. This study examined gaze shifts in relation to familiar or unfamiliar tools, under three conditions (free viewing, lift, and use), among 14 healthy adults (mean age ± standard deviation, 29.4 ± 3.9 years). The cumulative fixation time on the functional part of the tool served as a quantitative indicator of the degree of technical reasoning. The two-way analysis of variance for tools (familiar and unfamiliar) and conditions (free viewing, lift, and use) revealed that the cumulative fixation time significantly increased under free viewing and use conditions, compared to lift conditions. Relative to the free viewing condition, cumulative fixation time for unfamiliar tools significantly decreased in the lift condition and significantly increased in the use condition. Importantly, the results showed that technical reasoning was performed in both the use and the free viewing conditions. However, technical reasoning in the free viewing condition was not as strong as in the use condition. The difference between technical reasoning in free viewing and use conditions may indicate the difference between automatic and intentional technical reasoning.

Self-Rated Depressive Symptoms in Children and Youth with and without Cerebral Palsy: A Pilot Study.

Children with cerebral palsy (CP) often exhibit mental health problems, such as depressive symptoms. The purpose of this study was to describe the self-rated depressive symptoms in children with and without CP and to investigate the associated predictors. Participants included 24 children with CP and 33 typically developing (TD) children. Depressive symptoms were assessed using the Birleson Depression Self-Rating Scale for Children. Parents of the participants completed the Strengths and Difficulties Questionnaire. Severity of self-rated depressive symptoms was higher in children with CP than that in TD children. Particularly, decline in activities and enjoyment was identified as a contributor to the increased severity of depressive symptoms. Hierarchical multiple regression analysis revealed that the greater severity of depressive symptoms in children with CP was mediated by hyperactivity/inattention and peer problems. Our study suggests that it is imperative to provide opportunities to participate in social activities from an early age.

Altered sense of agency in children with developmental coordination disorder.

BACKGROUND: There is increasing evidence that children with developmental coordination disorder (DCD) have deficits in sensory-motor integration, but it is unclear whether the sense of agency (SoA) generated by sensory-motor integration is altered. AIMS: To investigate whether there is a difference in the time window for SoA between children with DCD and typically developing (TD) children. METHODS AND PROCEDURES: An agency attribution task was used to quantitatively measure and compare the time window for SoA in 15 children with DCD and 46 children in the TD group. Variables that correlated with the time window for SoA were also examined in both groups of children. OUTCOMES AND RESULTS: The time window for SoA was significantly extended in children with DCD compared to TD children. The time window for SoA in TD children was significantly associated with manual dexterity, whereas the time window for SoA in children with DCD was significantly associated with depressive tendency. CONCLUSIONS AND IMPLICATIONS: The time window for SoA is altered in children with DCD. The present results suggest that there may be a bidirectional relationship between an internal model deficit and depressive tendency and SoA in children with DCD.

Manual Dexterity is not Related to Media Viewing but is Related to Perceptual Bias in School-Age Children.

Although the media can have both negative and positive effects on children's cognitive and motor functions, its influence on their perceptual bias and manual dexterity is unclear. Thus, we investigated the association between media viewing time, media preference level, perceptual bias, and manual dexterity in 100 school-aged children. Questionnaires completed by children and their parents were used to ascertain media viewing time and preference levels. Perceptual bias and manual dexterity were measured using the visual-tactile temporal order judgment task and Movement Assessment Battery for Children-2nd edition, respectively. There were significant positive correlations between age and media viewing time and between media viewing time and media preference level. There was also a significant negative correlation between visual bias and manual dexterity. Hierarchical multiple regression analysis revealed that increasing visual bias was a significant predictor of decreasing manual dexterity. Further, children with low manual dexterity showed significant visual bias compared to those with high manual dexterity, when matched for age and gender. The present results demonstrated that, in school-aged children, although viewing media was not associated with perceptual bias and manual dexterity, there was a significant association between perceptual bias and manual dexterity.

Avoidance Behavioral Difference in Acquisition and Extinction of Pain-Related Fear.

Fear of movement-related pain leads to two types of avoidance behavior: excessive avoidance and pain-inhibited movement. Excessive avoidance is an absence of movement by fear, and pain-inhibited movements involve a change in motor behavior for the purpose of protecting the painful part. Here, we sought to clarify the acquisition process and adaptation of fear for each avoidance behavior. Thirty-one female and 13 male (age 20.9 ± 2.1 years) subjects could decide persistent behaviors: approach with an intense pain stimulus, pain-inhibited movement with weak pain stimulus, or excessive avoidance with no pain in acquisition and test phases. In the subsequent extinction phase, the pain stimulus was omitted. Subjects were divided into an approach group (n = 24), a pain-inhibited movement group (n = 10), and an excessive avoidance group (n = 10) by cluster analysis. The response latencies in approach and pain-inhibited movement groups were not affected by conditioned pain. The subjects in the excessive avoidance group exhibited delayed response latencies, and their high-fear responses remained in the acquisition, test, and extinction phases. In addition, the excessive avoidance group showed high harm avoidance and high trait anxiety. This study demonstrated that differences in pain-related avoidance behaviors are affected by psychological traits. Pain-related excessive avoidance behavior indicated a maladaptive fear, but pain-inhibited movement did not.

Subthreshold Vibrotactile Noise Stimulation Immediately Improves Manual Dexterity in a Child With Developmental Coordination Disorder: A Single-Case Study.

Developmental coordination disorder (DCD) is the most common childhood movement disorder. It is characterized by clumsiness of fine and gross motor skills in developing children. Children with DCD have low ability to effectively use tactile information for movements, instead relying on visual information. In addition, children with DCD have deficits in visuo-motor temporal integration, which is important in motor control. These traits subsequently lead to clumsiness of movements. Conversely, however, imperceptible vibrotactile noise stimulation (at 60%-intensity of the sensory threshold) to the wrist provides stochastic resonance (SR) phenomenon to the body, improving the sensory and motor systems. However, the effects of SR have not yet been validated in children with DCD. Thus, we conducted a single case study of a 10-year-old boy with a diagnosis of DCD to investigate the effect of SR on visual dependence, visuo-motor temporal integration, and manual dexterity. SR was provided by vibrotactile noise stimulation (at an intensity of 60% of the sensory threshold) to the wrist. Changes in manual dexterity (during the SR on- and off-conditions) were measured using the manual dexterity test of the Movement Assessment Battery for Children-2nd edition. The point of subjective equality measured by visual or tactile temporal order judgment task served as a quantitative indicator reflecting specific sensory dependence. The delay detection threshold and steepness of delay detection probability curve, which were measured using the delayed visual feedback detection task, were used as quantitative indicators of visuo-motor temporal integration. The results demonstrated alleviated visual dependence and improved visuo-motor temporal integration during the SR on-conditions rather than the SR off-conditions. Most importantly, manual dexterity during the SR on-conditions was significantly improved compared to that during the SR off-conditions. Thus, the present results highlighted that SR could contribute to improving poor movement in children with DCD. However, since this was a single case study, a future interventional study with a large sample size is needed to determine the effectiveness of SR for children with DCD.

The relationship and difference between delay detection ability and judgment of sense of agency.

Judgment of agency involves the comparison of motor intention and proprioceptive/visual feedback, in addition to a range of cognitive factors. However, few studies have experimentally examined the differences or correlations between delay detection ability and judgment of agency. Thus, the present study investigated the relationship between delay detection ability and agency judgment using the delay detection task and the agency attribution task. Fifty-eight participants performed the delay detection and agency attribution tasks, and the time windows of each measure were analyzed using logistic curve fitting. The results revealed that the time window of judgment of agency was significantly longer than that of delay detection, and there was a slight correlation between the time windows in each task. The results supported a two-step model of agency, suggesting that judgment of agency involved not only comparison of multisensory information but also several cognitive factors. The study firstly revealed the model in psychophysical experiments.

Motor-imagery ability and function of hemiplegic upper limb in stroke patients.

Objectives: We quantitatively examined the motor-imagery ability in stroke patients using a bimanual circle-line coordination task (BCT) and clarified the relationship between motor-imagery ability and motor function of hemiplegic upper limbs and the level of use of paralyzed limbs. Methods: We enrolled 31 stroke patients. Tasks included unimanual-line (U-L)-drawing straight lines on the nonparalyzed side; bimanual circle-line (B-CL)-drawing straight lines with the nonparalyzed limb while drawing circles with the paralyzed limb; and imagery circle-line (I-CL)-drawing straight lines on the nonparalyzed side during imagery drawing on the paralyzed side, using a tablet personal computer. We calculated the ovalization index (OI) and motor-imagery ability (image OI). We used the Fugl-Meyer motor assessment (FMA), amount of use (AOU), and quality of motion (QOM) of the motor activity log (MAL) as the three variables for cluster analysis and performed mediation analysis. Results: Clusters 1 (FMA <26 points) and 2 (FMA ≥26 points) were formed. In cluster 2, we found significant associations between image OI and FMA, AOU, and QOM. When AOU and QOM were mediated between image OI and FMA, we observed no significant direct association between image OI and FMA, and a significant indirect effect of AOU and QOM. Interpretation: In stroke patients with moderate-to-mild movement disorder, image OI directly affects AOU of hemiplegic upper limbs and their QOM in daily life and indirectly influences the motor functions via those parameters.

Changes in intentional binding effect during a novel perceptual-motor task.

Perceptual-motor learning describes the process of improving the smoothness and accuracy of movements. Intentional binding (IB) is a phenomenon whereby the length of time between performing a voluntary action and the production of a sensory outcome during perceptual-motor control is perceived as being shorter than the reality. How IB may change over the course of perceptual-motor learning, however, has not been explicitly investigated. Here, we developed a set of IB tasks during perceptual-motor learning. Participants were instructed to stop a circular moving object by key press when it reached the center of a target circle on the display screen. The distance between the center of the target circle and the center of the moving object was measured, and the error was used to approximate the perceptual-motor performance index. This task also included an additional exercise that was unrelated to the perceptual-motor task: after pressing the key, a sound was presented after a randomly chosen delay of 200, 500, or 700 ms and the participant had to estimate the delay interval. The difference between the estimated and actual delay was used as the IB value. A cluster analysis was then performed using the error values from the first and last task to group the participants based on their perceptual-motor performance. Participants showing a very small change in error value, and thus demonstrating a small effect of perceptual-motor learning, were classified into cluster 1. Those who exhibited a large decrease in error value from the first to the last set, and thus demonstrated a strong improvement in perceptual-motor performance, were classified into cluster 2. Those who exhibited perceptual-motor learning also showed improvements in the IB value. Our data suggest that IB is elevated when perceptual-motor learning occurs.