Selective neural electrical stimulation restores hand and forearm movements in individuals with complete tetraplegia.

BACKGROUND: We hypothesized that a selective neural electrical stimulation of radial and median nerves enables the activation of functional movements in the paralyzed hand of individuals with tetraplegia. Compared to previous approaches for which up to 12 muscles were targeted through individual muscular stimulations, we focused on minimizing the number of implanted electrodes however providing almost all the needed and useful hand movements for subjects with complete tetraplegia. METHODS: We performed acute experiments during scheduled surgeries of the upper limb with eligible subjects. We scanned a set of multicontact neural stimulation cuff electrode configurations, pre-computed through modeling simulations. We reported the obtained isolated and functional movements that were considered useful for the subject (different grasping movements). RESULTS: In eight subjects, we demonstrated that selective stimulation based on multicontact cuff electrodes and optimized current spreading over the active contacts provided isolated, compound, functional and strong movements; most importantly 3 out of 4 had isolated fingers or thumb flexion, one patient performed a Key Grip, another one the Power and Hook Grips, and the 2 last all the 3 Grips. Several configurations were needed to target different areas within the nerve to obtain all the envisioned movements. We further confirmed that the upper limb nerves have muscle specific fascicles, which makes it possible to activate isolated movements. CONCLUSIONS: The future goal is to provide patients with functional restoration of object grasping and releasing with a minimally invasive solution: only two cuff electrodes above the elbow. Ethics Committee / ANSM clearance prior to the beginning of the study (inclusion period 2016-2018): CPP Sud Méditerranée, #ID-RCB:2014-A01752-45, first acceptance 10th of February 2015, amended 12th of January 2016. TRIAL REGISTRATION: (www.clinicaltrials.gov): #NCT03721861, Retrospectively registered on 26th of October 2018.

Inhibition of vection by grasping an object.

The present study investigated whether vection could be modified by an object grasping movement. Twenty-five university students were asked to do one of the following four types of left-hand movements while they were viewing a radial optic flow: (1) grasping the hand-gripper strongly; (2) holding the hand-gripper; (3) clenching fist strongly; and (4) open hand without having anything in their left hands (normal hand condition). The participants' tasks were to keep pressing a button with their right hands while they were perceiving vection. After each trial, they estimated the subjective strength of vection on a 101-point scale. The result showed that the vection was inhibited by strongly grasping the hand-gripper task more than by the other hand movements. Vection could be weakened by the object grasping movement. It might be suggested that vection could be inhibited by the presence of an object being grasped and also by the grasping movement itself. We speculated that the mechanism underlying this inhibition might be related to cognitive pressure, attentional load, power and muscle tonus, and multisensory and proprioception interactions.

Earlier and greater hand pre-shaping in the elderly: a study based on kinematic analysis of reaching movements to grasp objects.

BACKGROUND: Elderly people are less able to manipulate objects skilfully than young adults. Although previous studies have examined age-related deterioration of hand movements with a focus on the phase after grasping objects, the changes in the reaching phase have not been studied thus far. We aimed to examine whether changes in hand shape patterns during the reaching phase of grasping movements differ between young adults and the elderly. METHODS: Ten healthy elderly adults and 10 healthy young adults were examined using the Simple Test for Evaluating Hand Functions and kinetic analysis of hand pre-shaping reach-to-grasp tasks. The results were then compared between the two groups. For kinetic analysis, we measured the time of peak tangential velocity of the wrist and the inter-fingertip distance (the distance between the tips of the thumb and index finger) at different time points. RESULTS: The results showed that the elderly group's performance on the Simple Test for Evaluating Hand Functions was significantly lower than that of the young adult group, irrespective of whether the dominant or non-dominant hand was used, indicating deterioration of hand movement in the elderly. The peak tangential velocity of the wrist in either hand appeared significantly earlier in the elderly group than in the young adult group. The elderly group also showed larger inter-fingertip distances with arch-like fingertip trajectories compared to the young adult group for all object sizes. CONCLUSIONS: To perform accurate prehension, elderly people have an earlier peak tangential velocity point than young adults. This allows for a longer adjustment time for reaching and grasping movements and for reducing errors in object prehension by opening the hand and fingers wider. Elderly individuals gradually modify their strategy based on previous successes and failures during daily living to compensate for their decline in dexterity and operational capabilities.

Anticipatory planning reveals segmentation of cortical motor output during action observation.

It has been argued that the variation in brain activity that occurs when observing another person reflects a representation of actions that is indivisible, and which plays out in full once the intent of the actor can be discerned. We used transcranial magnetic stimulation to probe the excitability of corticospinal projections to 2 intrinsic hand muscles while motions to reach and grasp an object were observed. A symbolic cue either faithfully indicated the required final orientation of the object and thus the nature of the grasp that was required, or was in conflict with the movement subsequently displayed. When the cue was veridical, modulation of excitability was in accordance with the functional role of the muscles in the action observed. If however the cue had indicated that the alternative grasp would be required, modulation of output to first dorsal interosseus was consistent with the action specified, rather than the action observed--until the terminal phase of the motion sequence during which the object was seen lifted. Modulation of corticospinal output during observation is thus segmented--it progresses initially in accordance with the action anticipated, and if discrepancies are revealed by visual input, coincides thereafter with that of the action seen.

How Tilting the Head Interferes With Eye-Hand Coordination: The Role of Gravity in Visuo-Proprioceptive, Cross-Modal Sensory Transformations.

To correctly position the hand with respect to the spatial location and orientation of an object to be reached/grasped, visual information about the target and proprioceptive information from the hand must be compared. Since visual and proprioceptive sensory modalities are inherently encoded in a retinal and musculo-skeletal reference frame, respectively, this comparison requires cross-modal sensory transformations. Previous studies have shown that lateral tilts of the head interfere with the visuo-proprioceptive transformations. It is unclear, however, whether this phenomenon is related to the neck flexion or to the head-gravity misalignment. To answer to this question, we performed three virtual reality experiments in which we compared a grasping-like movement with lateral neck flexions executed in an upright seated position and while lying supine. In the main experiment, the task requires cross-modal transformations, because the target information is visually acquired, and the hand is sensed through proprioception only. In the other two control experiments, the task is unimodal, because both target and hand are sensed through one, and the same, sensory channel (vision and proprioception, respectively), and, hence, cross-modal processing is unnecessary. The results show that lateral neck flexions have considerably different effects in the seated and supine posture, but only for the cross-modal task. More precisely, the subjects' response variability and the importance associated to the visual encoding of the information significantly increased when supine. We show that these findings are consistent with the idea that head-gravity misalignment interferes with the visuo-proprioceptive cross-modal processing. Indeed, the principle of statistical optimality in multisensory integration predicts the observed results if the noise associated to the visuo-proprioceptive transformations is assumed to be affected by gravitational signals, and not by neck proprioceptive signals per se. This finding is also consistent with the observation of otolithic projections in the posterior parietal cortex, which is involved in the visuo-proprioceptive processing. Altogether these findings represent a clear evidence of the theorized central role of gravity in spatial perception. More precisely, otolithic signals would contribute to reciprocally align the reference frames in which the available sensory information can be encoded.

Seizure manifesting as a reaching/grasping movement in a patient with post-traumatic epilepsy.

Electrical stimulation (ES) of the pre-supplementary or cingulate motor area can cause reaching/grasping (R/G) movements with the hand contralateral to the side of the brain receiving the ES. We report this phenomenon occurring in a 23-year-old right-handed man during spontaneous epileptic seizure, which developed after traumatic brain injury.

In vitro experimental investigation of the forces and torque acting on the scaphoid during light grasp.

The aim of this study was to measure the magnitude and direction of forces and torque within osteotomized scaphoids within cadaveric wrists during grasping movement of the hand. The mechanical contributions of clinically relevant individual wrist-crossing tendon groups were investigated. Wrists of eight forearms were immobilized in the sagittal, transverse, and coronal plane on a fixation device with unhindered axial gliding. The scaphoid was osteotomized and the fragments stabilized using an interlocking nail. The nail served as a sensor for measurement of inter-fragmentary forces orthogonal and torque around the sensor axis. Thus, torque and cantilever forces were measured which originated between the fragments through co-contraction through the activity of wrist-crossing tendons. Grasping movement of the hand induced a mean maximum torque of 0.038 ± 0.051 Nm and a force of 4.01 ± 1.71 N on the scaphoid. The isolated activation of thumb tendons resulted in a torque of 9.9 E-3 ± 7.7 E-3 Nm and a force of 1.42 ± 0.49 N. Despite immobilization of the wrist, grasping movement of the hand caused substantial forces and torque within the osteotomized scaphoid bone in varying directions and severity among different specimens. These factors may contribute to the development of nonunions and malunions in unstable scaphoid fractures through interfragmentary micromotion. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1734-1742, 2016.