Sex differences in the neural underpinnings of unimanual and bimanual control in adults.

While many of the movements we make throughout our day involve just one upper limb, most daily movements require a certain degree of coordination between both upper limbs. Historically, sex differences in eye-hand coordination have been observed. As well, there are demonstrated sex-specific differences in hemisphere symmetry, interhemispheric connectivity, and motor cortex organization. While it has been suggested that these anatomical differences may underlie sex-related differences in performance, sex differences in the functional neural correlate underlying bimanual performance have not been explicitly investigated. In the current study we tested the hypothesis that the functional connectivity underlying bimanual movement control differed depending on the sex of an individual. Participants underwent MRI scanning to acquire anatomical and functional brain images. During the functional runs, participants performed unimanual and bimanual coordination tasks using two button boxes. The tasks included pressing the buttons in time to an auditory cue with either their left or their right hand individually (unimanual), or with both hands simultaneously (bimanual). The bimanual task was further divided into either an in-phase (mirror/symmetrical) or anti-phase (parallel/asymmetrical) condition. Participants were provided with extensive training to ensure task comprehension, and performance error rates were found to be equivalent between men and women. A generalized psychophysiological interaction (gPPI) analysis was implemented to examine how functional connectivity in each condition was modulated by sex. In support of our hypothesis, women and men demonstrated differences in the neural correlates underlying unimanual and bimanual movements. In line with previous literature, functional connectivity patterns showed sex-related differences for right- vs left-hand movements. Sex-specific functional connectivity during bimanual movements was not a sum of the functional connectivity underlying right- and left-hand unimanual movements. Further, women generally showed greater interhemispheric functional connectivity across all conditions compared to men and had greater connectivity between task-related cortical areas, while men had greater connectivity involving the cerebellum. Sex differences in brain connectivity were associated with both unimanual and bimanual movement control. Not only do these findings provide novel insight into the fundamentals of how the brain controls bimanual movements in both women and men, they also present potential clinical implications on how bimanual movement training used in rehabilitation can best be tailored to the needs of individuals.

Cortical and cerebellar structural correlates of cognitive-motor integration performance in females with and without persistent concussion symptoms.

INTRODUCTION: Fifteen percent of individuals who sustain a concussion develop persistent concussion symptoms (PCS). Recent literature has demonstrated atrophy of the frontal, parietal, and cerebellar regions following acute concussive injury. The frontoparietal-cerebellar network is essential for the performance of visuomotor transformation tasks requiring cognitive-motor integration (CMI), important for daily function. PURPOSE: We investigated cortical and subcortical structural differences and how these differences are associated with CMI performance in those with PCS versus healthy controls. METHODS: Twenty-six age-matched  female participants (13 PCS, 13 healthy) completed four visuomotor tasks.  Additionally, MR-images were analyzed for cortical thickness and volume, and cerebellar lobule volume. RESULTS: No statistically significant group differences were found in CMI performance. However, those with PCS demonstrated a significantly thicker and larger precuneus, and significantly smaller cerebellar lobules (VIIIa, VIIIb, X) compared to controls. When groups were combined, volumes of both the cerebellar lobules and cortical regions were associated with CMI task performance. CONCLUSION: The lack of behavioral differences combined with the structural differences may reflect a compensatory mechanism for those with PCS. In addition, this study highlights the effectiveness of CMI tasks in estimating the structural integrity of the frontoparietal-cerebellar network and is among the first to demonstrate structural correlates of PCS.

Motor Deficits in Youth with Concussion History: Issues with Task Novelty or Task Demand?

The present study expands previous work on eye-hand decoupling deficits in youth with concussion history. It examines whether deficits can be linked to difficulties adapting to new task constraints or meeting ongoing task demands. Data from 59 youth with concussion history (M=11 months post-concussion) and 55 no history controls were analyzed. All 114 participants (M=12.5 yrs.) performed two touchscreen-based eye-hand coordination tasks: A standard task with vision and motor action in alignment, and an eye-hand decoupling task with both spatially decoupled, with twenty trials per task condition. First (trial 1-4), middle (trial 9-12), and last (trial 17-20) trial blocks were analyzed in each condition across groups, as well as first and last blocks only. The latter analysis showed in the first block longer response times in the concussion history group in the eye-hand decoupling condition due to a general slowdown of the reaction times across blocks and a trend for higher movement times. Our findings suggest that youth with concussion history have difficulty to adapt to new task constraints associated with complex skill performance during a short series of trials. These results are relevant for athletic trainers, therapists and coaches who work with youth with concussion history.

Looking up while reaching out: the neural correlates of making eye and arm movements in different spatial planes.

Standard visually guided reaching begins with foveation of a target of interest followed by an arm movement to the same spatial location. However, many visually guided arm movements, as well as a majority of imaging studies examining such movements, require participants to perform non-standard visuomotor mappings where the locations of gaze and arm movements are spatially dissociated (e.g. gaze fixation peripheral to the target of a reaching movement, or use of a tool such as a joystick while viewing stimuli on a screen). In this study, we compare brain activity associated with the production of standard visually guided arm movements to activity during a visuomotor mapping where saccades and reaches were made in different spatial planes. Multi-voxel pattern analysis revealed that while spatial patterns of voxel activity remain quite similar for the two visuomotor mappings during presentation of a cue for movement, patterns of activity become increasingly more discriminative throughout the brain as planning progresses toward motor execution. Decoding of the visuomotor mappings occurs throughout visuomotor-related regions of the brain including the premotor, primary motor and somatosensory, posterior parietal, middle occipital, and medial occipital cortices, and in the cerebellum. These results show that relative to standard visuomotor tasks, activity differs substantially in areas throughout the brain when a task requires an implicit sensorimotor recalibration.

The Contribution of Different Cortical Regions to the Control of Spatially Decoupled Eye-Hand Coordination.

Our brain's ability to flexibly control the communication between the eyes and the hand allows for our successful interaction with the objects located within our environment. This flexibility has been observed in the pattern of neural responses within key regions of the frontoparietal reach network. More specifically, our group has shown how single-unit and oscillatory activity within the dorsal premotor cortex (PMd) and the superior parietal lobule (SPL) change contingent on the level of visuomotor compatibility between the eyes and hand. Reaches that involve a coupling between the eyes and hand toward a common spatial target display a pattern of neural responses that differ from reaches that require eye-hand decoupling. Although previous work examined the altered spiking and oscillatory activity that occurs during different types of eye-hand compatibilities, they did not address how each of these measures of neurological activity interacts with one another. Thus, in an effort to fully characterize the relationship between oscillatory and single-unit activity during different types of eye-hand coordination, we measured the spike-field coherence (SFC) within regions of macaque SPL and PMd. We observed stronger SFC within PMdr and superficial regions of SPL (areas 5/PEc) during decoupled reaches, whereas PMdc and regions within SPL surrounding medial intrapareital sulcus had stronger SFC during coupled reaches. These results were supported by meta-analysis on human fMRI data. Our results support the proposal of altered cortical control during complex eye-hand coordination and highlight the necessity to account for the different eye-hand compatibilities in motor control research.

The Epidemiology of Concussions: Number and Nature of Concussions and Time to Recovery Among Female and Male Canadian Varsity Athletes 2008 to 2011.

OBJECTIVE: To provide incidence rates and days to symptom resolution and cognitive recovery stratified by sex and sport at a Canadian institution. STUDY DESIGN: A retrospective chart analysis. SUBJECTS: Seven hundred fifty-nine varsity level athletes competing in men's football, men's and women's soccer, men's and women's volleyball, men's and women's basketball, men's and women's ice hockey, women's field hockey, women's rugby, men's and women's tennis, men's and women's water polo, men's and women's swimming, badminton, cross-country, and track and field in the 2008 to 2009 season through the 2010 to 2011 season. MAIN OUTCOME MEASURES: Incidence of concussion, days to symptom recovery, and days to cognitive recovery as measured by clinical interpretation using the sports concussion assessment tool (SCAT)/SCAT2 and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) with baseline and follow-up data. RESULTS: A total of 81 concussions were reported and diagnosed among 759 athletes. Significantly, more female athletes were concussed than male athletes (13.08%-7.53%, respectively; P = 0.014) with the highest rates in women's rugby [incidence density (ID) = 20.00 concussions per athlete-season], women's ice hockey (ID = 18.67 per athlete-season), and men's basketball (ID = 20.00 per athlete-season). Sex differences in symptom recovery and cognitive recovery were not significant. CONCLUSIONS: The incidence of concussion across multiple sports in a Canadian varsity athlete population is of concern. There are inconsistencies found between the time an athlete claims to have no symptoms and the time of neurocognitive recovery as measured by computerized neurocognitive testing. Therefore, objective computerized testing is recommended to ensure that athletes are functionally recovered before return to play.

Evidence for distinct brain networks in the control of rule-based motor behavior.

Reach guidance when the spatial location of the viewed target and hand movement are incongruent (i.e., decoupled) necessitates use of explicit cognitive rules (strategic control) or implicit recalibration of gaze and limb position (sensorimotor recalibration). In a patient with optic ataxia (OA) and bilateral superior parietal lobule damage, we recently demonstrated an increased reliance on strategic control when the patient performed a decoupled reach (Granek JA, Pisella L, Stemberger J, Vighetto A, Rossetti Y, Sergio LE. PLoS One 8: e86138, 2013). To more generally understand the fundamental mechanisms of decoupled visuomotor control and to more specifically test whether we could distinguish these two modes of movement control, we tested healthy participants in a cognitively demanding dual task. Participants continuously counted backward while simultaneously reaching toward horizontal (left or right) or diagonal (equivalent to top-left or top-right) targets with either veridical or rotated (90°) cursor feedback. By increasing the overall neural load and selectively compromising potentially overlapping neural circuits responsible for strategic control, the complex dual task served as a noninvasive means to disrupt the integration of a cognitive rule into a motor action. Complementary to our previous results observed in patients with optic ataxia, here our dual task led to greater performance deficits during movements that required an explicit rule, implying a selective disruption of strategic control in decoupled reaching. Our results suggest that distinct neural processing is required to control these different types of reaching because in considering the current results and previous patient results together, the two classes of movement could be differentiated depending on the type of interference.

Hand placement near the visual stimulus improves orientation selectivity in V2 neurons.

Often, the brain receives more sensory input than it can process simultaneously. Spatial attention helps overcome this limitation by preferentially processing input from a behaviorally-relevant location. Recent neuropsychological and psychophysical studies suggest that attention is deployed to near-hand space much like how the oculomotor system can deploy attention to an upcoming gaze position. Here we provide the first neuronal evidence that the presence of a nearby hand enhances orientation selectivity in early visual processing area V2. When the hand was placed outside the receptive field, responses to the preferred orientation were significantly enhanced without a corresponding significant increase at the orthogonal orientation. Consequently, there was also a significant sharpening of orientation tuning. In addition, the presence of the hand reduced neuronal response variability. These results indicate that attention is automatically deployed to the space around a hand, improving orientation selectivity. Importantly, this appears to be optimal for motor control of the hand, as opposed to oculomotor mechanisms which enhance responses without sharpening orientation selectivity. Effector-based mechanisms for visual enhancement thus support not only the spatiotemporal dissociation of gaze and reach, but also the optimization of vision for their separate requirements for guiding movements.

Decoupling the actions of the eyes from the hand alters beta and gamma synchrony within SPL.

Eye-hand coordination is crucial for our ability to interact with the world around us. However, much of the visually guided reaches that we perform require a spatial decoupling between gaze direction and hand orientation. These complex decoupled reaching movements are in contrast to more standard eye and hand reaching movements in which the eyes and the hand are coupled. The superior parietal lobule (SPL) receives converging eye and hand signals; however, what is yet to be understood is how the activity within this region is modulated during decoupled eye and hand reaches. To address this, we recorded local field potentials within SPL from two rhesus macaques during coupled vs. decoupled eye and hand movements. Overall we observed a distinct separation in synchrony within the lower 10- to 20-Hz beta range from that in the higher 30- to 40-Hz gamma range. Specifically, within the early planning phase, beta synchrony dominated; however, the onset of this sustained beta oscillation occurred later during eye-hand decoupled vs. coupled reaches. As the task progressed, there was a switch to low-frequency and gamma-dominated responses, specifically for decoupled reaches. More importantly, we observed local field potential activity to be a stronger task (coupled vs. decoupled) and state (planning vs. execution) predictor than that of single units alone. Our results provide further insight into the computations of SPL for visuomotor transformations and highlight the necessity of accounting for the decoupled eye-hand nature of a motor task when interpreting movement control research data.

Machine learning algorithms for detection of visuomotor neural control differences in individuals with PASC and ME.

The COVID-19 pandemic has affected millions worldwide, giving rise to long-term symptoms known as post-acute sequelae of SARS-CoV-2 (PASC) infection, colloquially referred to as long COVID. With an increasing number of people experiencing these symptoms, early intervention is crucial. In this study, we introduce a novel method to detect the likelihood of PASC or Myalgic Encephalomyelitis (ME) using a wearable four-channel headband that collects Electroencephalogram (EEG) data. The raw EEG signals are processed using Continuous Wavelet Transform (CWT) to form a spectrogram-like matrix, which serves as input for various machine learning and deep learning models. We employ models such as CONVLSTM (Convolutional Long Short-Term Memory), CNN-LSTM, and Bi-LSTM (Bidirectional Long short-term memory). Additionally, we test the dataset on traditional machine learning models for comparative analysis. Our results show that the best-performing model, CNN-LSTM, achieved an accuracy of 83%. In addition to the original spectrogram data, we generated synthetic spectrograms using Wasserstein Generative Adversarial Networks (WGANs) to augment our dataset. These synthetic spectrograms contributed to the training phase, addressing challenges such as limited data volume and patient privacy. Impressively, the model trained on synthetic data achieved an average accuracy of 93%, significantly outperforming the original model. These results demonstrate the feasibility and effectiveness of our proposed method in detecting the effects of PASC and ME, paving the way for early identification and management of the condition. The proposed approach holds significant potential for various practical applications, particularly in the clinical domain. It can be utilized for evaluating the current condition of individuals with PASC or ME, and monitoring the recovery process of those with PASC, or the efficacy of any interventions in the PASC and ME populations. By implementing this technique, healthcare professionals can facilitate more effective management of chronic PASC or ME effects, ensuring timely intervention and improving the quality of life for those experiencing these conditions.

Concussion can increase the risk of visually induced motion sickness.

Concussion can lead to various symptoms such as balance problems, memory impairments, dizziness, and/or headaches. It has been previously suggested that during self-motion relevant tasks, individuals with concussion may rely heavily on visual information to compensate for potentially less reliable vestibular inputs and/or problems with multisensory integration. As such, concussed individuals may also be more sensitive to other visually-driven sensations such as visually induced motion sickness (VIMS). To investigate whether concussed individuals are at elevated risk of experiencing VIMS, we exposed participants with concussion (n = 16) and healthy controls (n = 15) to a virtual scene depicting visual self-motion down a grocery store aisle at different speeds. Participants with concussion were further separated into symptomatic and asymptomatic groups. VIMS was measured with the SSQ before and after stimulus exposure, and visual dependence, self-reported dizziness, and somatization were recorded at baseline. Results showed that concussed participants who were symptomatic demonstrated significantly higher SSQ scores after stimulus presentation compared to healthy controls and those who were asymptomatic. Visual dependence was positively correlated with the level of VIMS in healthy controls and participants with concussion. Our results suggest that the presence of concussion symptoms at time of testing significantly increased the risk and severity of VIMS. This finding is of relevance with regards to the use of visual display devices such as Virtual Reality applications in the assessment and rehabilitation of individuals with concussion.

Neural activity in superior parietal cortex during rule-based visual-motor transformations.

Cognition allows for the use of different rule-based sensorimotor strategies, but the neural underpinnings of such strategies are poorly understood. The purpose of this study was to compare neural activity in the superior parietal lobule during a standard (direct interaction) reaching task, with two nonstandard (gaze and reach spatially incongruent) reaching tasks requiring the integration of rule-based information. Specifically, these nonstandard tasks involved dissociating the planes of reach and vision or rotating visual feedback by 180°. Single unit activity, gaze, and reach trajectories were recorded from two female Macaca mulattas. In all three conditions, we observed a temporal discharge pattern at the population level reflecting early reach planning and on-line reach monitoring. In the plane-dissociated task, we found a significant overall attenuation in the discharge rate of cells from deep recording sites, relative to standard reaching. We also found that cells modulated by reach direction tended to be significantly tuned either during the standard or the plane-dissociated task but rarely during both. In the standard versus feedback reversal comparison, we observed some cells that shifted their preferred direction by 180° between conditions, reflecting maintenance of directional tuning with respect to the reach goal. Our findings suggest that the superior parietal lobule plays an important role in processing information about the nonstandard nature of a task, which, through reciprocal connections with precentral motor areas, contributes to the accurate transformation of incongruent sensory inputs into an appropriate motor output. Such processing is crucial for the integration of rule-based information into a motor act.

Differences in spectral profiles between rostral and caudal premotor cortex when hand-eye actions are decoupled.

The aim of this research was to understand how the brain controls voluntary movement when not directly interacting with the object of interest. In the present study, we examined the role of premotor cortex in this behavior. The goal of this study was to characterize the oscillatory activity within the caudal and rostral subdivisions of dorsal premotor cortex (PMdc and PMdr) with a change from the most basic reaching movement to one that involves a simple dissociation between the actions of the eyes and hand. We were specifically interested in how PMdr and PMdc respond when the eyes and hand are decoupled by moving along different spatial planes. We recorded single-unit activity and local field potentials within PMdr and PMdc from two rhesus macaques during performance of two types of visually guided reaches. During the standard condition, a visually guided reach was performed whereby the visual stimulus guiding the movement was the target of the reach itself. During the nonstandard condition, the visual stimulus provided information about the direction of the required movement but was not the target of the motor output. We observed distinct task-related and topographical differences between PMdr and PMdc. Our results support functional differences between PMdr and PMdc during visually guided reaching. PMdr activity appears more involved in integrating the rule-based aspects of a visually guided reach, whereas PMdc is more involved in the online updating of the decoupled reach. More broadly, our results highlight the necessity of accounting for the nonstandard nature of a motor task when interpreting movement control research data.

True functional ability of chronic stroke patients.

BACKGROUND: There is a paucity of information regarding visuospatial (VS) and visuomotor (VM) task performance in patients with chronic right fronto-parietal lobe stroke, as the majority of knowledge to date in this realm has been gleaned from acute stroke patients. The goal of this paper is to determine how VS and VM performance in chronic stroke patients compare to the performance of healthy participants. METHODS: Nine patients with stroke involving the right fronto-parietal region were evaluated against match controls on neuropsychological tests and a computerized visuomotor assessment task. RESULTS: Initial evaluation indicated that performance between participant groups were relatively similar on all measures. However, an in-depth analysis of variability revealed observable differences between participant groups. In addition, large effect sizes were also observed supporting the theory that using only conventional examination (e.g., p-values) measures may result in miss-identifying crucial stroke-related differences. CONCLUSION: Through conventional evaluation methods it would appear that the chronic stroke participants had made significant functional gains relatively to a control group many years post-stroke. It was shown that the type of evaluation used is essential to identifying group differences. Thus, supplementary methods of evaluation are required to unmask the true functional ability of individuals many years post-stroke.

Differences in resting state functional connectivity underlie visuomotor performance declines in older adults with a genetic risk (APOE ε4) for Alzheimer's disease.

Introduction: Non-standard visuomotor integration requires the interaction of large networks in the brain. Previous findings have shown that non-standard visuomotor performance is impaired in individuals with specific dementia risk factors (family history of dementia and presence of the APOE ε4 allele) in advance of any cognitive impairments. These findings suggest that visuomotor impairments are associated with early dementia-related brain changes. The current study examined the underlying resting state functional connectivity (RSFC) associated with impaired non-standard visuomotor performance, as well as the impacts of dementia family history, sex, and APOE status. Methods: Cognitively healthy older adults (n = 48) were tested on four visuomotor tasks where reach and gaze were increasingly spatially dissociated. Participants who had a family history of dementia or the APOE ε4 allele were considered to be at an increased risk for AD. To quantify RSFC within networks of interest, an EPI sequence sensitive to BOLD contrast was collected. The networks of interest were the default mode network (DMN), somatomotor network (SMN), dorsal attention network (DAN), ventral attention network (VAN), and frontoparietal control network (FPN). Results: Individuals with the ε4 allele showed abnormalities in RSFC between posterior DMN nodes that predicted poorer non-standard visuomotor performance. Specifically, multiple linear regression analyses revealed lower RSFC between the precuneus/posterior cingulate cortex and the left inferior parietal lobule as well as the left parahippocampal cortex. Presence of the APOE ε4 allele also modified the relationship between mean DAN RSFC and visuomotor control, where lower mean RSFC in the DAN predicted worse non-standard visuomotor performance only in APOE ε4 carriers. There were otherwise no effects of family history, APOE ε4 status, or sex on the relationship between RSFC and visuomotor performance for any of the other resting networks. Conclusion: The preliminary findings provide insight into the impact of APOE ε4-related genetic risk on neural networks underlying complex visuomotor transformations, and demonstrate that the non-standard visuomotor task paradigm discussed in this study may be used as a non-invasive, easily accessible assessment tool for dementia risk.

Sex-related differences in visuomotor skill recovery following concussion in working-aged adults.

BACKGROUND: The ability to perform visually-guided motor tasks requires the transformation of visual information into programmed motor outputs. When the guiding visual information does not align spatially with the motor output, the brain processes rules to integrate somatosensory information into an appropriate motor response. Performance on such rule-based, "cognitive-motor integration" tasks is affected in concussion. Here, we investigate the relationship between visuomotor skill performance, concussion history, and sex during the course of a post-concussion management program. METHODS: Fifteen acutely concussed working-aged adults, 11 adults with a history of concussion, and 17 healthy controls all completed a recovery program over the course of 4 weeks. Prior to, mid-way, and following the program, all participants were tested on their visuomotor skills. RESULTS: We observed an overall change in visuomotor behaviour in all groups, as participants completed the tasks faster and more accurately. Specifically, we observed significant visuomotor skill improvement between the first and final sessions in participants with a concussion history compared to no-concussion-history controls. Notably, we observed a stronger recovery of these skills in females. CONCLUSIONS: Our findings indicate that (1) concussion impairs visuomotor skill performance, (2) the performance of complex, rule-based tasks showed improvement over the course of a recovery program, and (3) stronger recovery in females suggests sex-related differences in the brain networks controlling skilled performance, and the effect of injury on these networks.

Differences in structural MRI and diffusion tensor imaging underlie visuomotor performance declines in older adults with an increased risk for Alzheimer's disease.

Introduction: Visuomotor impairments have been demonstrated in preclinical AD in individuals with a positive family history of dementia and APOE e4 carriers. Previous behavioral findings have also reported sex-differences in performance of visuomotor tasks involving a visual feedback reversal. The current study investigated the relationship between grey and white matter changes and non-standard visuomotor performance, as well as the effects of APOE status, family history of dementia, and sex on these brain-behavior relationships. Methods: Older adults (n = 49) with no cognitive impairments completed non-standard visuomotor tasks involving a visual feedback reversal, plane-change, or combination of the two. Participants with a family history of dementia or who were APOE e4 carriers were considered at an increased risk for AD. T1-weighted anatomical scans were used to quantify grey matter volume and thickness, and diffusion tensor imaging measures were used to quantify white matter integrity. Results: In APOE e4 carriers, grey and white matter structural measures were associated with visuomotor performance. Regression analyses showed that visuomotor deficits were predicted by lower grey matter thickness and volume in areas of the medial temporal lobe previously implicated in visuomotor control (entorhinal and parahippocampal cortices). This finding was replicated in the diffusion data, where regression analyses revealed that lower white matter integrity (lower FA, higher MD, higher RD, higher AxD) was a significant predictor of worse visuomotor performance in the forceps minor, forceps major, cingulum, inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF), and uncinate fasciculus (UF). Some of these tracts overlap with those important for visuomotor integration, namely the forceps minor, forceps major, SLF, IFOF, and ILF. Conclusion: These findings suggest that measuring the dysfunction of brain networks underlying visuomotor control in early-stage AD may provide a novel behavioral target for dementia risk detection that is easily accessible, non-invasive, and cost-effective. The results also provide insight into the structural differences in inferior parietal lobule that may underlie previously reported sex-differences in performance of the visual feedback reversal task.

Specificity of human parietal saccade and reach regions during transcranial magnetic stimulation.

Single-unit recordings in macaque monkeys have identified effector-specific regions in posterior parietal cortex (PPC), but functional neuroimaging in the human has yielded controversial results. Here we used on-line repetitive transcranial magnetic stimulation (rTMS) to determine saccade and reach specificity in human PPC. A short train of three TMS pulses (separated by an interval of 100 ms) was delivered to superior parieto-occipital cortex (SPOC), a region over the midposterior intraparietal sulcus (mIPS), and a site close to caudal IPS situated over the angular gyrus (AG) during a brief memory interval while subjects planned either a saccade or reach with the left or right hand. Behavioral measures then were compared to controls without rTMS. Stimulation of mIPS and AG produced similar patterns: increased end-point variability for reaches and decreased saccade accuracy for contralateral targets. In contrast, stimulation of SPOC deviated reach end points toward visual fixation and had no effect on saccades. Contralateral-limb specificity was highest for AG and lowest for SPOC. Visual feedback of the hand negated rTMS-induced disruptions of the reach plan for mIPS and AG, but not SPOC. These results suggest that human SPOC is specialized for encoding retinally peripheral reach goals, whereas more anterior-lateral regions (mIPS and AG) along the IPS possess overlapping maps for saccade and reach planning and are more closely involved in motor details (i.e., planning the reach vector for a specific hand). This work provides the first causal evidence for functional specificity of these parietal regions in healthy humans.

Sabotage Detection Using DL Models on EEG Data From a Cognitive-Motor Integration Task.

Objective clinical tools, including cognitive-motor integration (CMI) tasks, have the potential to improve concussion rehabilitation by helping to determine whether or not a concussion has occurred. In order to be useful, however, an individual must put forth their best effort. In this study, we have proposed a novel method to detect the difference in cortical activity between best effort (no-sabotage) and willful under-performance (sabotage) using a deep learning (DL) approach on the electroencephalogram (EEG) signals. The EEG signals from a wearable four-channel headband were acquired during a CMI task. Each participant completed sabotage and no-sabotage conditions in random order. A multi-channel convolutional neural network with long short term memory (CNN-LSTM) model with self-attention has been used to perform the time-series classification into sabotage and no-sabotage, by transforming the time-series into two-dimensional (2D) image-based scalogram representations. This approach allows the inspection of frequency-based, and temporal features of EEG, and the use of a multi-channel model facilitates in capturing correlation and causality between different EEG channels. By treating the 2D scalogram as an image, we show that the trained CNN-LSTM classifier based on automated visual analysis can achieve high levels of discrimination and an overall accuracy of 98.71% in case of intra-subject classification, as well as low false-positive rates. The average intra-subject accuracy obtained was 92.8%, and the average inter-subject accuracy was 86.15%. These results indicate that our proposed model performed well on the data of all subjects. We also compare the scalogram-based results with the results that we obtained by using raw time-series, showing that scalogram-based gave better performance. Our method can be applied in clinical applications such as baseline testing, assessing the current state of injury and recovery tracking and industrial applications like monitoring performance deterioration in workplaces.

Group format rehabilitation is equally effective as individual therapy in patients with surgically repaired rotator cuff tears.

OBJECTIVE: Does group physiotherapy methods produce different results when compared with individual physiotherapy in persons with surgically repaired rotator cuff tears? No studies to date have examined the feasibility or effectiveness of such therapy formats. Given the prevalence of rotator cuff tears, a study examining group format therapy is warranted and can produce evidence to transform care for rotator cuff tear rehabilitation. METHODS: We analyzed the electronic medical records of persons that underwent rotator cuff repair surgery followed by the prescribedpost-surgical physiotherapy at Southlake Regional Health Centre. Both groups were provided standard physiotherapy intervention protocol for post-operative rotator cuff tear. Active range of motion (AROM), quick disabilities of the arm, shoulder and hand (Q-DASH) measures, and efficiency measures were examined for differences between groups. RESULTS: No significant differences between AROM (abduction p = .92, lateral rotation p = .64, and flexion p = 1.00) and Q-DASH (p = .62) measures between groups were observed at discharge. Overall, group therapy participants required a greater number of visits (p = .000); however, when separated by age groups, only the 60- to 69-year-old participants significantly differed in number of visits between groups (p = .000), whereas no difference was observed in the 50- to 59-year-old participants (p = .14). CONCLUSION: Group format physiotherapy may be equally effective as individual formats in improving AROM and functional outcomes of participants with surgically repaired rotator cuff tears. Further research is needed to determine the optimal age range for group therapy interventions in this population.