PoleSat's Modelling a Reorganization of Vascular Catheterization Provision at the Territorial Hospital Grouping Level.

Since a French organization (2016) has defined "the territorial hospital groupings", public hospitals must share medical-economic knowledge and decision-makers expect prospective analyses. PoleSat aims, quick hospital-catchment area modellings, completed by population analyses. Modellings are based on "diagnostic and interventional vascular catheterizations" acts and Nouvelle-Aquitaine, and they are carried out 3 times, through the graphical user interface's main-setting values, coupled with 3 activity-scenarios. Scenario results cannot confirm the NA02-Atlantique's H0. The experts have approved PoleSat's method as a robust help-tool; therefore they project to repeat its usages.

Impaired anticipatory control of grasp during obstacle crossing in Parkinson's disease.

During self-paced walking, people with Parkinson's disease maintain anticipatory control during object grasping. However, common functional tasks often include carrying an object while changing step patterns mid-path and maneuvering over obstacles, increasing task complexity and attentional demands. Thus, the present study investigated the effect of Parkinson's disease on the modulation of grasping force changes as a function of gait-related inertial forces. Subjects with Parkinson's disease maintained the ability to scale and to couple over time their grip and inertial forces while walking at irregular step lengths, but were unable to maintain the temporal coupling of grasping forces compared to controls during obstacle crossing. We suggest that this deterioration in anticipatory control is associated with the increased demands of task complexity and attention during obstacle crossing.

Coordination of grasping and walking in Parkinson's disease.

Studies on grasp control underlying manual dexterity in people with Parkinson disease (PD) suggest that anticipatory grasp control is mainly unaffected during discrete tasks using simple two-digit grasp. Nevertheless, impaired hand function during daily activities is one of the most disabling symptoms of PD. As many daily grasping activities occur during functional movements involving the whole body, impairments in anticipatory grasp control might emerge during a continuous dynamic task such as object transport during walking. In this case, grasp control must be coordinated along with multiple body segments. The present study investigated the effect of PD on anticipatory grasp control and intersegmental coordination during walking with a hand-held object. Nine individuals with idiopathic PD (tested OFF and ON medication) and nine healthy age-matched controls carried a grip instrument between their right thumb and index finger during self-paced and fast walking. Although the amplitude of grip forces was higher in standing and walking for subjects with PD, both subjects with PD and control subjects coupled grip and inertial force changes in an anticipatory fashion while walking. However, gait-induced motions of the object relative to that of the trunk (i.e., dampening) was reduced in subjects with PD. Medication increased the dampening in all subjects with PD. We suggest that these differences are associated with impairments in intersegmental coordination.

Sensorimotor memory of object weight distribution during multidigit grasp.

We studied the ability to transfer three-digit force sharing patterns learned through consecutive lifts of an object with an asymmetric center of mass (CM). After several object lifts, we asked subjects to rotate and translate the object to the contralateral hand and perform one additional lift. This task was performed under two weight conditions (550 and 950 g) to determine the extent to which subjects would be able to transfer weight and CM information. Learning transfer was quantified by measuring the extent to which force sharing patterns and peak object roll on the first post-translation trial resembled those measured on the pre-translation trial with the same CM. We found that the overall gain of fingertip forces was transferred following object rotation, but that the scaling of individual digit forces was specific to the learned digit-object configuration, and thus was not transferred following rotation. As a result, on the first post-translation trial there was a significantly larger object roll following object lift-off than on the pre-translation trial. This suggests that sensorimotor memories for weight, requiring scaling of fingertip force gain, may differ from memories for mass distribution.

Countering postural posteffects following prolonged exposure to whole-body vibration: a sensorimotor treatment.

Postural stability of bulldozer operators after a day of work is investigated. When operators are no longer exposed to whole-body vibration (WBV) generated by their vehicle, their sensorimotor coordination and body representation remain altered. A sensorimotor treatment based on a set of customized voluntary movements is tested to counter and prevent potential post-work accidents due to prolonged exposure to WBV. This treatment includes muscle stretching, joint rotations, and plantar pressures, all known to minimize the deleterious effects of prolonged exposure to mechanical vibrations. The postural stability of participants (drivers; N = 12) was assessed via the area of an ellipse computed from the X and Y displacements of the center-of-pressure (CoP) in the horizontal plane when they executed a simple balance task before driving, after driving, and after driving and having performed the sensorimotor treatment. An ancillary experiment is also reported in which a group of non-driver participants (N = 12) performed the same postural task three times during the same day but without exposure to WBV or the sensorimotor treatment. Prolonged exposure to WBV significantly increased postural instability in bulldozer drivers after they operated their vehicle compared to prior to their day of work. The sensorimotor treatment allowed postural stability to return to a level that was not significantly different from that before driving. The results reveal that (1) the postural system remains perturbed after prolonged exposure to WBV due to operating a bulldozer and (2) treatment immediately after driving provides a "sensorimotor recalibration" and a significant decrease in WBV-induced postural instability. If confirmed in different contexts, the postural re-stabilizing effect of the sensorimotor treatment would constitute a simple, rapid, inexpensive, and efficient means to prevent post-work accidents due to balance-related issues.

Inducing any virtual two-dimensional movement in humans by applying muscle tendon vibration.

In humans, tendon vibration evokes illusory sensation of movement. We developed a model mimicking the muscle afferent patterns corresponding to any two-dimensional movement and checked its validity by inducing writing illusory movements through specific sets of muscle vibrators. Three kinds of illusory movements were compared. The first was induced by vibration patterns copying the responses of muscle spindle afferents previously recorded by microneurography during imposed ankle movements. The two others were generated by the model. Sixteen different vibratory patterns were applied to 20 motionless volunteers in the absence of vision. After each vibration sequence, the participants were asked to name the corresponding graphic symbol and then to reproduce the illusory movement perceived. Results showed that the afferent patterns generated by the model were very similar to those recorded microneurographically during actual ankle movements (r=0.82). The model was also very efficient for generating afferent response patterns at the wrist level, if the preferred sensory directions of the wrist muscle groups were first specified. Using recorded and modeled proprioceptive patterns to pilot sets of vibrators placed at the ankle or wrist levels evoked similar illusory movements, which were correctly identified by the participants in three quarters of the trials. Our proprioceptive model, based on neurosensory data recorded in behaving humans, should then be a useful tool in fields of research such as sensorimotor learning, rehabilitation, and virtual reality.

The Ia afferent feedback of a given movement evokes the illusion of the same movement when returned to the subject via muscle tendon vibration.

The aim of the present study was to further investigate the contribution of primary muscle spindle feedback to proprioception and higher brain functions, such as movement trajectory recognition. For this purpose, complex illusory movements were evoked in subjects by applying patterns of muscle tendon vibration mimicking the natural Ia afferent pattern. Ia afferent messages were previously recorded using microneurographic method from the six main muscle groups acting on the ankle joint during imposed "writing like" movements. The mean Ia afferent pattern was calculated for each muscle group and used as a template to pilot each vibrator. Eleven different vibratory patterns were applied to ten volunteers. Subjects were asked both to copy the perceived illusory movements by hand on a digitizing tablet and to recognize and name the corresponding graphic symbol. The results show that the Ia afferent feedback of a given movement evokes the illusion of the same movement when it is applied to the subject via the appropriate pattern of muscle tendon vibration. The geometry and the kinematic parameters of the imposed and illusory movements are very similar and the so-called "two-thirds power law" is present in the reproduction of the vibration-induced illusory movements. Vibrations within the "natural" frequency range of Ia fibres firing (around 30 Hz) produce clear illusions of movements in all the tested subjects. In addition, increasing the mean frequency of the vibration patterns resulted in a linear increase in the size of the illusory movements. Lastly, the subjects were able to recognize and name the symbols evoked by the vibration-induced primary muscle spindle afferent patterns in 83% of the trials. These findings suggest that the "proprioceptive signature" of a given movement is associated with the corresponding "perceptual signature". The neural mechanisms possibly underlying the sensory to perceptual transformation are discussed in the general framework of "the neuronal population vector model".

Proprioceptive feedback in humans expresses motor invariants during writing.

Proprioceptive feedback from populations of muscle spindle afferents feeds the brain with information relating to the instantaneous velocity and direction of ongoing movements. In this paper, we investigate whether the invariant relationship between the velocity and curvature of a trajectory, i.e. the two-thirds power law, is reflected in this muscle spindle feedback. Sixty unitary muscle spindle afferents from six ankle muscle groups were recorded using intraneural microelectrodes during imposed "writing-like" movements. The movements had kinematic parameters obeying the two-thirds power law and were imposed so that the tip of the foot followed trajectories forming four different letters and six numbers. The responses of the muscle spindle afferent populations were analysed using the population vector model. The results demonstrate that the neuronal trajectories attained from populations of muscle spindles clearly depict the path and kinematic parameters and express the movement invariants, i.e. the trajectory segmentation into units of action and the two-thirds power law. The central vs peripheral origin of such constraints involved in the motor system is discussed.

"Proprioceptive signature" of cursive writing in humans: a multi-population coding.

The goal of the present study was to investigate the firing behavior of populations of muscle spindle afferents in all the muscles acting on the ankle while this joint was being subjected to "writing-like" movements. First it was proposed to determine whether the ensemble of muscle spindles give rise to a unique, specific, and reproducible feedback information characterizing each letter, number or short word. Secondly, we analyzed how the proprioceptive feedback on the whole encodes the spatial and temporal characteristics of writing movements using the "vector population model". The unitary activity of 51 primary and secondary muscle spindle afferents was recorded in the tibial and common peroneal nerves at the level of the popliteal fossea, using the microneurographic method. The units recorded from belonged to the tibialis anterior, the extensor digitorum longus, the extensor hallucis longus, the peroneus lateralis, the gastrocnemius-soleus and the tibialis posterior muscles. The "writing-like" movements were randomly imposed at a "natural" velocity via a computer-controlled machine in a two-dimensional space. In general, muscle spindle afferents from any of the six muscles responded according to the tuning properties of the parent muscle, i.e. increasing their discharge rate during the phases where the direction of movement was within the preferred sensory sector of the parent muscle. The whole trajectory of the writing movements was coded in turn by the activity of Ia afferents arising from all the muscles acting on the joint. Both single afferent responses and population responses were found to be highly specific and reproducible with each graphic sign. The complex multi-muscle afferent pattern involved, with its timing and distribution in the muscle space, seems to constitute a true "proprioceptive signature" for each graphic symbol. The ensemble of muscle spindle afferents were therefore found to encode the instantaneous direction and velocity of writing movements remarkably accurately. It was concluded that the proprioceptive feedback from all the muscles with which the moving joint is equipped provides the CNS with highly specific information that might contribute to a graphic sign identification process.

Proprioceptive population coding of limb position in humans.

The present study investigates the coding of positions reached in a two-dimensional space by populations of muscle spindle afferents. The unitary activity of 35 primary muscle spindle afferents originating from the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus lateralis muscles were recorded from the common peroneal nerve by the microneurographic technique. The steady mean frequency of discharge was analyzed during 16 passively maintained positions of the tip of the foot. These positions were equally distant from and circularly arranged around the "neutral" position of the ankle. The results showed that a same position of the foot was differently coded depending on whether it was maintained for several seconds or whether it was attained after a movement. Muscle spindle activity was increased or decreased, respectively, when the previous movement lengthened or shortened the parent muscle; the magnitude of change in activity depended on the amount of lengthening or shortening in relation to movement direction. Each muscle surrounding the ankle joint was shown to encode the different spatial positions following a directional tuning curve. Data were analyzed by using the "neuronal population vector model". This model consists of calculating population vectors representing the mean contribution of each muscle population of afferents to the coding of a particular position, and by finally calculating a sum vector. The direction of the sum vector was shown to accurately describe the direction of a given maintained position compared to the initial position. We conclude that muscle spindle position coding is based on afferent information coming from the whole set of muscles crossing a given joint. A given spatial position is associated with a stable muscle afferent inflow where each muscle makes an oriented and weighted contribution to its coding.