Neurogeriatrics-a vision for improved care and research for geriatric patients with predominating neurological disabilities.

Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson's disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.

A new method to record and control for 2D-movement kinematics during functional magnetic resonance imaging (fMRI).

The recording of movement kinematics during functional magnetic resonance imaging (fMRI) experiments is complicated due to technical constraints of the imaging environment. Nevertheless, to study the functions of brain areas related to motor control, reliable and accurate records of movement trajectories and speed profiles are needed. We present a method designed to record and characterize the kinematic properties of drawing- and handwriting-like forearm movements during fMRI studies by recording pen stroke trajectories. The recording system consists of a translucent plastic board, a plastic pen containing fiber optics and a halogen light power source, a CCD camera, a video monitor and a PC with a video grabber card. Control experiments using a commercially available digitizer tablet have demonstrated the reliability of the data recorded during fMRI. Since the movement tracking signal is purely optical, there is no interaction with the MR (echoplanar) images. Thus, the method allows to obtain movement records with high spatial and temporal resolution which are suitable for the kinematic analysis of hand movements in fMRI studies.

The activity in the contralateral primary motor cortex, dorsal premotor and supplementary motor area is modulated by performance gains.

There is growing experimental evidence that the engagement of different brain areas in a given motor task may change with practice, although the specific brain activity patterns underlying different stages of learning, as defined by kinematic or dynamic performance indices, are not well understood. Here we studied the change in activation in motor areas during practice on sequences of handwriting-like trajectories, connecting four target points on a digitizing table "as rapidly and as accurately as possible" while lying inside an fMRI scanner. Analysis of the subjects' pooled kinematic and imaging data, acquired at the beginning, middle, and end of the training period, revealed no correlation between the amount of activation in the contralateral M1, PM (dorsal and ventral), supplementary motor area (SMA), preSMA, and Posterior Parietal Cortex (PPC) and the amount of practice per-se. Single trial analysis has revealed that the correlation between the amount of activation in the contralateral M1 and trial mean velocity was partially modulated by performance gains related effects, such as increased hand motion smoothness. Furthermore, it was found that the amount of activation in the contralateral preSMA increased when subjects shifted from generating straight point-to-point trajectories to their spatiotemporal concatenation into a smooth, curved trajectory. Altogether, our results indicate that the amount of activation in the contralateral M1, PMd, and preSMA during the learning of movement sequences is correlated with performance gains and that high level motion features (e.g., motion smoothness) may modulate, or even mask correlations between activity changes and low-level motion attributes (e.g., trial mean velocity).

The acquisition and implementation of the smoothness maximization motion strategy is dependent on spatial accuracy demands.

We recently showed that extensive training on a sequence of planar hand trajectories passing through several targets resulted in the co-articulation of movement components and in the formation of new movement elements (primitives) (Sosnik et al. in Exp Brain Res 156(4):422-438, 2004). Reduction in movement duration was accompanied by the gradual replacing of a piecewise combination of rectilinear trajectories with a single, longer curved one, the latter affording the maximization of movement smoothness ("global motion planning"). The results from transfer experiments, conducted by the end of the last training session, have suggested that the participants have acquired movement elements whose attributes were solely dictated by the figural (i.e., geometrical) form of the path, rather than by both path geometry and its time derivatives. Here we show that the acquired movement generation strategy ("global motion planning") was not specific to the trained configuration or total movement duration. Performance gain (i.e., movement smoothness, defined by the fit of the data to the behavior, predicted by the "global planning" model) transferred to non-trained configurations in which the targets were spatially co-aligned or when participants were instructed to perform the task in a definite amount of time. Surprisingly, stringent accuracy demands, in transfer conditions, resulted not only in an increased movement duration but also in reverting to the straight trajectories (loss of co-articulation), implying that the performance gain was dependent on accuracy constraints. Only 28.5% of the participants (two out of seven) who were trained in the absence of visual feedback from the hand (dark condition) co-articulated by the end of the last training session compared to 75% (six out of eight) who were trained in the light, and none of them has acquired a geometrical motion primitive. Furthermore, six naive participants who trained in dark condition on large size targets have all co-articulated by the end of the last training session, still, none of them has acquired a geometrical motion primitive. Taken together, our results indicate that the acquisition of a geometrical motion primitive is dependent on the existence of visual feedback from the hand and that the implementation of the smoothness-maximization motion strategy is dependent on spatial accuracy demands. These findings imply that the specific features of the training experience (i.e., temporal or spatial task demands) determine the attributes of an acquired motion planning strategy and primitive.

When practice leads to co-articulation: the evolution of geometrically defined movement primitives.

The skilled generation of motor sequences involves the appropriate choice, ordering and timing of a sequence of simple, stereotyped movement elements. Nevertheless, a given movement element within a well-rehearsed sequence can be modified through interaction with its neighboring elements (co-articulation). We show that extensive training on a sequence of planar hand trajectories passing through several targets resulted in the co-articulation of movement components, and in the formation of new movement elements (primitives). Reduction in movement duration was accompanied by the gradual replacement of straight trajectories by longer curved ones, the latter affording the maximization of movement smoothness. Surprisingly, the curved trajectories were generated even when new target configurations were introduced, i.e., when target distances were scaled, movement direction reversed or when different start and end positions were used, indicating the acquisition of geometrically defined movement elements. However, the new trajectories were not shared by the untrained hand. Altogether, our results suggest that novel movement elements can be acquired through extensive training in adults.