Effects of Combining 2 Weeks of Passive Sensory Stimulation with Active Hand Motor Training in Healthy Adults

The gold standard to acquire motor skills is through intensive training and practicing. Recent studies have demonstrated that behavioral gains can also be acquired by mere exposure to repetitive sensory stimulation to drive the plasticity processes. Single application of repetitive electric stimulation (rES) of the fingers has been shown to improve tactile perception in young adults as well as sensorimotor performance in healthy elderly individuals. The combination of repetitive motor training with a preceding rES has not been reported yet. In addition, the impact of such a training on somatosensory tactile and spatial sensitivity as well as on somatosensory cortical activation remains elusive. Therefore, we tested 15 right-handed participants who underwent repetitive electric stimulation of all finger tips of the left hand for 20 minutes prior to one hour of motor training of the left hand over the period of two weeks. Overall, participants substantially improved the motor performance of the left trained hand by 34%, but also showed a relevant transfer to the untrained right hand by 24%. Baseline ipsilateral activation fMRI-magnitude in BA 1 to sensory index finger stimulation predicted training outcome for somatosensory guided movements: those who showed higher ipsilateral activation were those who did profit less from training. Improvement of spatial tactile discrimination was positively associated with gains in pinch grip velocity. Overall, a combination of priming rES and repetitive motor training is capable to induce motor and somatosensory performance increase and representation changes in BA1 in healthy young subjects.     

Absence of cross-limb transfer of performance gains following ballistic motor practice in older adults

The phenomenon of cross-limb transfer, in which unilateral strength training can result in bilateral strength gains, has recently been tested for ballistic movements. Performance gains associated with repetitive motor practice, and the associated transfer, occur within a few minutes. In this study, young and older adults were trained to perform ballistic abductions of their dominant (right) index finger as quickly as possible. Performance was assessed bilaterally before, during, and after this training. Both groups exhibited large performance gains in the right hand as a result of training (P < 0.001; young 84% improvement, older 70% improvement), which were not significantly different between groups (P = 0.40). Transcranial magnetic stimulation revealed that the performance improvements were accompanied by increases in excitability, together with decreases in intracortical inhibition, of the projections to both the trained muscle and the homologous muscle in the contralateral limb (P < 0.05). The young group also exhibited performance improvements as a result of cross-limb transfer in the left (untrained) hand (P < 0.005), equivalent to 75% of the performance increase in the trained hand. In contrast, there were no significant performance gains in the left hand for the older group (P = 0.23). This was surprising given that the older group exhibited a significantly greater degree of mirror activity than the young group (P < 0.01) in the left first dorsal interosseus muscle (FDI) during right hand movements. Our findings suggest that older adults exhibit a reduced capacity for cross-limb transfer, which may have implications for motor rehabilitation programs after stroke.     

Encoding of motor skill in the corticomuscular system of musicians

How motor skills are stored in the nervous system represents a fundamental question in neuroscience. Although musical motor skills are associated with a variety of adaptations [1-3], it remains unclear how these changes are linked to the known superior motor performance of expert musicians. Here we establish a direct and specific relationship between the functional organization of the corticomuscular system and skilled musical performance. Principal component analysis was used to identify joint correlation patterns in finger movements evoked by transcranial magnetic stimulation over the primary motor cortex while subjects were at rest. Linear combinations of a selected subset of these patterns were used to reconstruct active instrumental playing or grasping movements. Reconstruction quality of instrumental playing was superior in skilled musicians compared to musically untrained subjects, displayed taxonomic specificity for the trained movement repertoire, and correlated with the cumulated long-term training exposure, but not with the recent past training history. In violinists, the reconstruction quality of grasping movements correlated negatively with the long-term training history of violin playing. Our results indicate that experience-dependent motor skills are specifically encoded in the functional organization of the primary motor cortex and its efferent system and are consistent with a model of skill coding by a modular neuronal architecture [4].     

Writing in the Air: Contributions of Finger Movement to Cognitive Processing

The present study investigated the interactions between motor action and cognitive processing with particular reference to kanji-culture individuals. Kanji-culture individuals often move their finger as if they are writing when they are solving cognitive tasks, for example, when they try to recall the spelling of English words. This behavior is called kusho, meaning air-writing in Japanese. However, its functional role is still unknown. To reveal the role of kusho behavior in cognitive processing, we conducted a series of experiments, employing two different cognitive tasks, a construction task and a stroke count task. To distinguish the effects of the kinetic aspects of kusho behavior, we set three hand conditions in the tasks; participants were instructed to use either kusho, unrelated finger movements or do nothing during the response time. To isolate possible visual effects, two visual conditions in which participants saw their hand and the other in which they did not, were introduced. We used the number of correct responses and response time as measures of the task performance. The results showed that kusho behavior has different functional roles in the two types of cognitive tasks. In the construction task, the visual feedback from finger movement facilitated identifying a character, whereas the kinetic feedback or motor commands for the behavior did not help to solve the task. In the stroke count task, by contrast, the kinetic aspects of the finger movements influenced counting performance depending on the type of the finger movement. Regardless of the visual condition, kusho behavior improved task performance and unrelated finger movements degraded it. These results indicated that motor behavior contributes to cognitive processes. We discussed possible mechanisms of the modality dependent contribution. These findings might lead to better understanding of the complex interaction between action and cognition in daily life.     

Motor skill training and strength training are associated with different plastic changes in the central nervous system.

Changes in corticospinal excitability induced by 4 wk of heavy strength training or visuomotor skill learning were investigated in 24 healthy human subjects. Measurements of the input-output relation for biceps brachii motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation were obtained at rest and during voluntary contraction in the course of the training. The training paradigms induced specific changes in the motor performance capacity of the subjects. The strength training group increased maximal dynamic and isometric muscle strength by 31% (P < 0.001) and 12.5% (P = 0.045), respectively. The skill learning group improved skill performance significantly (P < 0.001). With one training bout, the only significant change in transcranial magnetic stimulation parameters was an increase in skill learning group maximal MEP level (MEP(max)) at rest (P = 0.02) for subjects performing skill training. With repeated skill training three times per week for 4 wk, MEP(max) increased and the minimal stimulation intensity required to elicit MEPs decreased significantly at rest and during contraction (P < 0.05). In contrast, MEP(max) and the slope of the input-output relation both decreased significantly at rest but not during contraction in the strength-trained subjects (P < or = 0.01). No significant changes were observed in a control group. A significant correlation between changes in neurophysiological parameters and motor performance was observed for skill learning but not strength training. The data show that increased corticospinal excitability may develop over several weeks of skill training and indicate that these changes may be of importance for task acquisition. Because strength training was not accompanied by similar changes, the data suggest that different adaptive changes are involved in neural adaptation to strength training.     

Sleep Is Associated with Offline Improvement of Motor Sequence Skill in Children

In adults, sleep is necessary for the offline improvement of certain skills, such as sequential finger tapping, but whether children show a similar effect is still debatable. Here, we tested whether sleep is associated with offline performance improvement in children. Nine- and 11-year-old children trained on an explicit sequential finger tapping task. On the night following training, their parents observed and recorded the duration of each child’s sleep. The following day, all children performed a surprise retest session on the previously trained sequence. In both 9- and 11-year-old children, skill performance was significantly improved during the first retest session relative to the end of training on the previous day, confirming the offline improvement in performance. There was a significant correlation between the degree of improvement and sleep duration the night after training, suggesting that in children, as in adults, sleep is associated with offline skill enhancement.     

Social Rewards Enhance Offline Improvements in Motor Skill

Motor skill memory is first encoded online in a fragile form during practice and then converted into a stable form by offline consolidation, which is the behavioral stage critical for successful learning. Praise, a social reward, is thought to boost motor skill learning by increasing motivation, which leads to increased practice. However, the effect of praise on consolidation is unknown. Here, we tested the hypothesis that praise following motor training directly facilitates skill consolidation. Forty-eight healthy participants were trained on a sequential finger-tapping task. Immediately after training, participants were divided into three groups according to whether they received praise for their own training performance, praise for another participant''s performance, or no praise. Participants who received praise for their own performance showed a significantly higher rate of offline improvement relative to other participants when performing a surprise recall test of the learned sequence. On the other hand, the average performance of the novel sequence and randomly-ordered tapping did not differ between the three experimental groups. These results are the first to indicate that praise-related improvements in motor skill memory are not due to a feedback-incentive mechanism, but instead involve direct effects on the offline consolidation process.     

Neural substrates of intermanual transfer of a newly acquired motor skill

In healthy humans, the two cerebral hemispheres show functional specialization to a degree unmatched in other animals, and such strong hemispheric specialization contributes to unimanual skill acquisition [1, 2]. When most humans learn a new motor skill with one hand, this process results in performance improvements in the opposite hand as well [3-6]. Despite the obvious adaptive advantage of such intermanual transfer, there is no direct evidence identifying the neural substrates of this form of skill acquisition [7-9]. Here, we used functional magnetic resonance imaging (fMRI) to study brain regions activated during intermanual transfer of a learned sequence of finger movements. First, we found that the supplementary motor area (SMA) has more activity when a skill has transferred well than when it has transferred poorly. Second, we found that fMRI activity in the ventrolateral posterior thalamic nucleus correlated with successful future intermanual transfer, whereas activity in the ventrolateral anterior thalamic nucleus correlated with past intermanual transfer. Third, we found that repetitive transcranial magnetic stimulation applied over the SMA blocked intermanual transfer without affecting skill acquisition. These findings provide direct evidence for an SMA-based mechanism that supports intermanual transfer of motor-skill learning.     

Enhanced motor unit rate coding with improvements in a force-matching task

These data describe improved modulation of discharge rates (rate coding) of first dorsal interosseous motor units throughout the acquisition of a complex force-matching skill involving isometric index finger abduction. In each of 15 consecutive trials, subjects attempted to match their force to a trajectory consisting of the sum of two sine waves (0.15 and 0.5 Hz) and random oscillations (overall mean force level ˜20% MVC). Reductions in root-mean-square (RMS) error of each subject’s force relative to the trajectory indicated substantial improvements in force-matching ability (F=33.8, p<0.001). With the acquisition of this new skill, there was increased amplitude modulation of muscular force near both dominant frequencies of the force-matching trajectory (F=10.6, p=0.008). The standard deviation and coefficient of variation of motor unit inter-spike intervals both decreased with improved performance indicating a general reduction in the amplitude of firing rate modulations (SD: F=18.69, p=0.001; CV: F=43.6, p<0.001). After skill acquisition, there was decreased firing rate modulation outside of the two dominant frequencies and increased amplitude of firing rate modulation at the higher of the two dominant frequencies (0.5 Hz, F=8.23, p=0.015). These findings indicate that improved precision of rate coding was a contributor to the acquisition of the new force-matching task. That the change in rate coding was frequency dependent suggests that factors other than frequency coding may contribute to the improved force matching at 0.15 Hz.     

Unilateral practice of a ballistic movement causes bilateral increases in performance and corticospinal excitability.

It has long been known that practicing a task with one limb can result in performance improvements with the opposite, untrained limb. Hypotheses to account for cross-limb transfer of performance state that the effect is mediated either by neural adaptations in higher order control centers that are accessible to both limbs, or that there is a "spillover" of neural drive to the opposite hemisphere that results in bilateral adaptation. Here we address these hypotheses by assessing performance and corticospinal excitability in both hands after unilateral practice of a ballistic finger movement. Participants (n = 9) completed 300 practice trials of a ballistic task with the right hand, the aim of which was to maximize the peak abduction acceleration of the index finger. Practice caused a 140% improvement in right-hand performance and an 82% improvement for the untrained left hand. There were bilateral increases in the amplitude of responses to transcranial magnetic stimulation, but increased corticospinal excitability was not correlated with improved performance. There were no significant changes in corticospinal excitability or task performance for a control group that did not train (n = 9), indicating that performance testing for the left hand alone did not induce performance or corticospinal effects. Although the data do not provide conclusive evidence whether increased corticospinal excitability in the untrained hand is causally related to the cross-transfer of ballistic performance, the finding that ballistic practice can induce bilateral corticospinal adaptations may have important clinical implications for movement rehabilitation.     

Differential corticostriatal plasticity during fast and slow motor skill learning in mice

BACKGROUND: Motor skill learning usually comprises "fast" improvement in performance within the initial training session and "slow" improvement that develops across sessions. Previous studies have revealed changes in activity and connectivity in motor cortex and striatum during motor skill learning. However, the nature and dynamics of the plastic changes in each of these brain structures during the different phases of motor learning remain unclear. RESULTS: By using multielectrode arrays, we recorded the simultaneous activity of neuronal ensembles in motor cortex and dorsal striatum of mice during the different phases of skill learning on an accelerating rotarod. Mice exhibited fast improvement in the task during the initial session and also slow improvement across days. Throughout training, a high percentage of striatal (57%) and motor cortex (55%) neurons were task related; i.e., changed their firing rate while mice were running on the rotarod. Improvement in performance was accompanied by substantial plastic changes in both striatum and motor cortex. We observed parallel recruitment of task-related neurons in both structures specifically during the first session. Conversely, during slow learning across sessions we observed differential refinement of the firing patterns in each structure. At the neuronal ensemble level, we observed considerable changes in activity within the first session that became less evident during subsequent sessions. CONCLUSIONS: These data indicate that cortical and striatal circuits exhibit remarkable but dissociable plasticity during fast and slow motor skill learning and suggest that distinct neural processes mediate the different phases of motor skill learning.     

Concatenation of Observed Grasp Phases with Observer’s Distal Movements: A Behavioural and TMS Study

The present study aimed at determining how actions executed by two conspecifics can be coordinated with each other, or more specifically, how the observation of different phases of a reaching-grasping action is temporary related to the execution of a movement of the observer. Participants observed postures of initial finger opening, maximal finger aperture, and final finger closing of grasp after observation of an initial hand posture. Then, they opened or closed their right thumb and index finger (experiments 1, 2 and 3). Response times decreased, whereas acceleration and velocity of actual finger movements increased when observing the two late phases of grasp. In addition, the results ruled out the possibility that this effect was due to salience of the visual stimulus when the hand was close to the target and confirmed an effect of even hand postures in addition to hand apparent motion due to the succession of initial hand posture and grasp phase. In experiments 4 and 5, the observation of grasp phases modulated even foot movements and pronunciation of syllables. Finally, in experiment 6, transcranial magnetic stimulation applied to primary motor cortex 300 ms post-stimulus induced an increase in hand motor evoked potentials of opponens pollicis muscle when observing the two late phases of grasp. These data suggest that the observation of grasp phases induced simulation which was stronger during observation of finger closing. This produced shorter response times, greater acceleration and velocity of the successive movement. In general, our data suggest best concatenation between two movements (one observed and the other executed) when the observed (and simulated) movement was to be accomplished. The mechanism joining the observation of a conspecific’s action with our own movement may be precursor of social functions. It may be at the basis for interactions between conspecifics, and related to communication between individuals.     

Sequence specific motor performance gains after memory consolidation in children and adolescents

Memory consolidation for a trained sequence of finger opposition movements, in 9- and 12-year-old children, was recently found to be significantly less susceptible to interference by a subsequent training experience, compared to that of 17-year-olds. It was suggested that, in children, the experience of training on any sequence of finger movements may affect the performance of the sequence elements, component movements, rather than the sequence as a unit; the latter has been implicated in the learning of the task by adults. This hypothesis implied a possible childhood advantage in the ability to transfer the gains from a trained to the reversed, untrained, sequence of movements. Here we report the results of transfer tests undertaken to test this proposal in 9-, 12-, and 17-year-olds after training in the finger-to-thumb opposition sequence (FOS) learning task. Our results show that the performance gains in the trained sequence partially transferred from the left, trained hand, to the untrained hand at 48-hours after a single training session in the three age-groups tested. However, there was very little transfer of the gains from the trained to the untrained, reversed, sequence performed by either hand. The results indicate sequence specific post-training gains in FOS performance, as opposed to a general improvement in performance of the individual, component, movements that comprised both the trained and untrained sequences. These results do not support the proposal that the reduced susceptibility to interference, in children before adolescence, reflects a difference in movement syntax representation after training.     

Cross-Limb Interference during Motor Learning

It is well known that following skill learning, improvements in motor performance may transfer to the untrained contralateral limb. It is also well known that retention of a newly learned task A can be degraded when learning a competing task B that takes place directly after learning A. Here we investigate if this interference effect can also be observed in the limb contralateral to the trained one. Therefore, five different groups practiced a ballistic finger flexion task followed by an interfering visuomotor accuracy task with the same limb. Performance in the ballistic task was tested before the training, after the training and in an immediate retention test after the practice of the interference task for both the trained and the untrained hand. After training, subjects showed not only significant learning and interference effects for the trained limb but also for the contralateral untrained limb. Importantly, the interference effect in the untrained limb was dependent on the level of skill acquisition in the interfering motor task. These behavioural results of the untrained limb were accompanied by training specific changes in corticospinal excitability, which increased for the hemisphere ipsilateral to the trained hand following ballistic training and decreased during accuracy training of the ipsilateral hand. The results demonstrate that contralateral interference effects may occur, and that interference depends on the level of skill acquisition in the interfering motor task. This finding might be particularly relevant for rehabilitation.     

Sensorimotor Learning of Acupuncture Needle Manipulation Using Visual Feedback

Objective

Humans can acquire a wide variety of motor skills using sensory feedback pertaining to discrepancies between intended and actual movements. Acupuncture needle manipulation involves sophisticated hand movements and represents a fundamental skill for acupuncturists. We investigated whether untrained students could improve their motor performance during acupuncture needle manipulation using visual feedback (VF).

Methods

Twenty-one untrained medical students were included, randomly divided into concurrent (n = 10) and post-trial (n = 11) VF groups. Both groups were trained in simple lift/thrusting techniques during session 1, and in complicated lift/thrusting techniques in session 2 (eight training trials per session). We compared the motion patterns and error magnitudes of pre- and post-training tests.

Results

During motion pattern analysis, both the concurrent and post-trial VF groups exhibited greater improvements in motion patterns during the complicated lifting/thrusting session. In the magnitude error analysis, both groups also exhibited reduced error magnitudes during the simple lifting/thrusting session. For the training period, the concurrent VF group exhibited reduced error magnitudes across all training trials, whereas the post-trial VF group was characterized by greater error magnitudes during initial trials, which gradually reduced during later trials.

Conclusions

Our findings suggest that novices can improve the sophisticated hand movements required for acupuncture needle manipulation using sensorimotor learning with VF. Use of two types of VF can be beneficial for untrained students in terms of learning how to manipulate acupuncture needles, using either automatic or cognitive processes.     

Reduced Motor Cortex Activity during Movement Preparation following a Period of Motor Skill Practice

Experts in a skill produce movement-related cortical potentials (MRCPs) of smaller amplitude and later onset than novices. This may indicate that, following long-term training, experts require less effort to plan motor skill performance. However, no longitudinal evidence exists to support this claim. To address this, EEG was used to study the effect of motor skill training on cortical activity related to motor planning. Ten non-musicians took part in a 5-week training study learning to play guitar. At week 1, the MRCP was recorded from motor areas whilst participants played the G Major scale. Following a period of practice of the scale, the MRCP was recorded again at week 5. Results showed that the amplitude of the later pre-movement components were smaller at week 5 compared to week 1. This may indicate that, following training, less activity at motor cortex sites is involved in motor skill preparation. This supports claims for a more efficient motor preparation following motor skill training.     

Neuron selection by relative importance for neural decoding of dexterous finger prosthesis control application

Future generations of upper limb prosthesis will have dexterous hand with individual fingers and will be controlled directly by neural signals. Neurons from the primary motor (M1) cortex code for finger movements and provide the source for neural control of dexterous prosthesis. Each neuron's activation can be quantified by the change in firing rate before and after finger movement, and the quantified value is then represented by the neural activity over each trial for the intended movement. Since this neural activity varies with the intended movement, we define the relative importance of each neuron independent of specific intended movements. The relative importance of each neuron is determined by the inter-movement variance of the neural activities for respective intended movements. Neurons are ranked by the relative importance and then a subpopulation of rank-ordered neurons is selected for the neural decoding. The use of the proposed neuron selection method in individual finger movements improved decoding accuracy by 21.5% in the case of decoding with only 5 neurons and by 9.2% in the case of decoding with only 10 neurons. With only 15 highly ranked neurons, a decoding accuracy of 99.5% was achieved. The performance improvement is still maintained when combined movements of two fingers were included though the decoding accuracy fell to 95.7%. Since the proposed neuron selection method can achieve the targeting accuracy of decoding algorithms with less number of input neurons, it can be significant for developing brain–machine interfaces for direct neural control of hand prostheses.     

Practice reduces motor unit discharge variability in a hand muscle and improves manual dexterity in old adults.

A steadiness-improving intervention was used to determine the contribution of variability in motor unit discharge rate to the fluctuations in index finger acceleration and manual dexterity in older adults. Ten healthy and sedentary old adults (age 72.9 +/- 5.8 yr; 5 men) participated in the study involving abduction of the left index finger. Single motor unit activity was recorded in the first dorsal interosseus muscle before, after 2 wk of light-load training (10% maximal load), and after 4 wk of heavy-load training (70% maximal load). As expected, the light-load training was effective in reducing the fluctuations in index finger acceleration during slow shortening (0.25 +/- 0.12 to 0.13 +/- 0.08 m/s(2)) and lengthening contractions (0.29 +/- 0.10 to 0.14 +/- 0.06 m/s(2)). Along with the decline in the magnitude of the fluctuations, there was a parallel decrease in the coefficient of variation for discharge rate during both contraction types (33.8 +/- 6.8 to 25.0 +/- 5.9%). The heavy-load training did not further improve either the fluctuations in acceleration or discharge rate variability. Furthermore, the manual dexterity of the left hand improved significantly with training (Purdue pegboard test: 11 +/- 3 to 14 +/- 1 pegs). Bivariate correlations indicated that the reduction in fluctuations in motor output during shortening (r(2) = 0.24) and lengthening (r(2) = 0.14) contractions and improvement in manual dexterity (r(2) = 0.26) was directly associated with a decline in motor unit discharge rate variability. There was a strong association between the fluctuations in motor output and manual dexterity (r(2) = 0.56). These results indicate that practice of a simple finger task was accompanied by a reduction in the discharge rate variability of motor units, a decrease in the fluctuations in motor output of a hand muscle, and an improvement in the manual dexterity of older adults.     

Tendon displacements during voluntary and involuntary finger movements

In the human hand, independent movement control of individual fingers is limited. One potential cause for this is mechanical connections between the tendons and muscle bellies corresponding to the different fingers. The aim of this study was to determine the tendon displacement of the flexor digitorum superficialis (FDS) of both the instructed and the neighboring, non-instructed fingers during single finger flexion movements. In nine healthy subjects (age 22–29 years), instructed and non-instructed FDS finger tendon displacement of the index, middle and ring finger was measured using 2D ultrasound analyzed with speckle tracking software in two conditions: active flexion of all finger joints with all fingers free to move and active flexion while the non-instructed fingers were restricted. Our results of the free movement protocol showed an average tendon displacement of 27 mm for index finger flexion, 21 mm for middle finger flexion and 17 mm for ring finger flexion. Displacements of the non-instructed finger tendons (≈12 mm) were higher than expected based of the amount of non-instructed finger movement. In the restricted protocol, we found that, despite minimal joint movements, substantial non-instructed finger tendon displacement (≈9 mm) was still observed, which was interpreted as a result of tendon strain. When this strain component was subtracted from the tendon displacement of the non-instructed fingers during the free movement condition, the relationship between finger movement and tendon displacement of the instructed and non-instructed finger became comparable. Thus, when studying non-instructed finger tendon displacement it is important to take tendon strain into consideration.     

A Loud Auditory Stimulus Overcomes Voluntary Movement Limitation in Cervical Dystonia

Background

Patients with cervical dystonia (CD) present with an impaired performance of voluntary neck movements, which are usually slow and limited. We hypothesized that such abnormality could involve defective preparation for task execution. Therefore, we examined motor preparation in CD patients using the StartReact method. In this test, a startling auditory stimulus (SAS) is delivered unexpectedly at the time of the imperative signal (IS) in a reaction time task to cause a faster execution of the prepared motor programme. We expected that CD patients would show an abnormal StartReact phenomenon.

Methods

Fifteen CD patients and 15 age matched control subjects (CS) were asked to perform a rotational movement (RM) to either side as quick as possible immediately after IS perception (a low intensity electrical stimulus to the II finger). In randomly interspersed test trials (25%) a 130 dB SAS was delivered simultaneously with the IS. We recorded RMs in the horizontal plane with a high speed video camera (2.38 ms per frame) in synchronization with the IS. The RM kinematic-parameters (latency, velocity, duration and amplitude) were analyzed using video-editing software and screen protractor. Patients were asked to rate the difficulty of their RMs in a numerical rating scale.

Results

In control trials, CD patients executed slower RMs (repeated measures ANOVA, p<0.10⁻⁵), and reached a smaller final head position angle relative to the midline (p<0.05), than CS. In test trials, SAS improved all RMs in both groups (p<0.10⁻¹⁴). In addition, patients were more likely to reach beyond their baseline RM than CS (χ², p<0.001) and rated their performance better than in control trials (t-test, p<0.01).

Conclusion

We found improvement of kinematic parameters and subjective perception of motor performance in CD patients with StartReact testing. Our results suggest that CD patients reach an adequate level of motor preparation before task execution.