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With a series of novel arm-reaching tasks, we have shown that visuomotor sequence learning encompasses the acquisition of the order of sequence elements, and the ability to combine them in a single, skilled behavior. The first component, which is mostly declarative, is reflected by changes in movement onset time (OT); the second, which occurs without subject’s awareness, is measured by changes in kinematic variables, including movement time (MT). Key-press-based serial reaction time tasks (SRTT) have been used to investigate sequence learning and results interpreted as indicative of the implicit acquisition of the sequence order. One limitation to SRT studies, however, is that only one measure is used, the response time, the sum of OT and MT: this makes interpretation of which component is learnt difficult and disambiguation of implicit and explicit processes problematic. Here, we used an arm-reaching version of SRTT to propose a novel interpretation of such results. The pattern of response time changes we obtained was similar to the key-press-based tasks. However, there were significant differences between OT and MT, suggesting that both partial learning of the sequence order and skill improvement took place. Further analyses indicated that the learning of the sequence order might not occur without subjects’ awareness. [ABSTRACT FROM AUTHOR]

Professional athletes, compared to beginners, can better predict the outcome of sport-related observed movements, via mirror motor-system modulations (motor resonance). Furthermore, motor-system inhibition occurs when observing other people experiencing pain (pain resonance). Here we investigated whether observing sport-related actions, whose outcome can lead or not to a painful experience, results into different prediction performances depending on expertise and history of injury. Experiment 1 revealed that professional skiers, relative to beginners, show greater prediction accuracy but slower reaction times. Experiment 2 revealed that, among professional skiers, those previously injured, compared to uninjured ones, are slower in predicting the outcome of the observed action when it actually leads to an injury. We hypothesize that such results could be explained by an automatic activation of both motor and pain resonance mechanisms in the onlooker, inducing a sort of experience-dependant freezing response while observing actions likely leading to an injury. • We address if motor expertise and pain experience affect motor and pain resonance. • Accuracy & reaction time are collected in beginners and professional skiers (Exp1). • Accuracy & reaction time are collected in injured and non-injured athletes (Exp2). • Motor expertise enhances prediction accuracy of ski-related action outcome. • Pain experience boosts the ability to anticipate an injury via a freezing reaction. [ABSTRACT FROM AUTHOR]

Abstract: We have previously shown in normal subjects that motor adaptation to imposed visual rotation is significantly enhanced when tested few days later. This occurs through a process of sleep-dependent memory consolidation. Here we ascertained whether patients with Parkinson''s disease (PD) learn, improve, and retain new motor skills in the same way as normal subjects. We tested 16 patients in early stages of PD and 21 control subjects over two days. All subjects performed reaching movements on a digitizing tablet. Vision of the limb was precluded with an opaque screen; hand paths were shown on the screen with the targets'' position. Unbeknownst to the subjects, the hand path on the screen was rotated by 30°. In experiment 1, patients taking dopaminergic treatment and controls adapted to rotation with targets appearing in an unpredictable order. In experiment 2, drug-naïve patients and controls adapted to rotation in a less challenging task where target''s appearance was predictable. Patients and controls made similar movements and adapted to rotation in the same way. However, when tested again over the following days, controls'' performance significantly improved compared to training, while patients'' performance did not. This lack of consolidation, which is present in the early stages of the disease and is independent from therapy, may be due to abnormal homeostatic processes that occur during sleep. [Copyright &y& Elsevier]

Complex motor tasks are learned through training which results in lasting improvement in sensorimotor performance and accuracy. Learning a motor skill is commonly attained via physical execution. However, research has shown that cognitive training, such as motor imagery (MI), effectively facilitates skill learning. Neurophysiological findings suggest that learning-induced plasticity in the human motor cortex, subserving consolidation and retention of motor skills, is stronger after movement execution (ME) than after MI training. Here, we designed an experimental task able to test for the fast and slow learning phases and for retention of motor skills for both MI and ME. We hypothesize that differences between MI and ME training would emerge in terms of reduced consolidation and retention of motor skills. Twenty-four young healthy subjects were divided into two groups, performing MI or ME training. Participants wore sensor-engineered gloves and their sensorimotor performance was assessed over a period of 15 days with 4-days training. We analysed the touch duration (TD), the inter-tapping interval (ITI), movement rate and accuracy. Results showed that (i) during the first phase of acquisition of motor skills, sensorimotor performance improved similarly in MI and ME groups; (ii) during the second learning phase movement rate increased more in ME than MI group and this difference was mainly driven by differences in the duration of TD; (iii) consolidation deficits with MI training reflected in impaired retention of the acquired skills, as TD and ITI were larger and movement rate was lower in the MI group with respect to the ME, till to 10 days after the last training session. Explicit component of motor learning, accuracy, was maintained in retention phase in both groups. Following our hypothesis, our findings show that MI training is as effective as ME within the first learning phase, but consolidation and retention of motor skills are less effective following MI training. This study highlights MI limitations and suggests option to enhance MI, as by providing an external sensory feedback. • Motor imagery (MI) is as effective as actual training within the 1st learning phase. • Learning processes are less efficient in the 2nd learning phase with MI training. • Consolidation deficits reflect in impaired retention of motor skills with MI training. [ABSTRACT FROM AUTHOR]

• Positive relationships between VO2max and two cognitive tests (PASAT and SDMT) were observed in young healthy participants. • Auditory test (PASAT) was correlated to aerobic capacity in primary and secondary school students. • Visual test (SDMT) was correlated to aerobic capacity in university students. • Specific effects of aerobic exercise on different domains of cognitive performance can be suggested during development. The aim of this study was to investigate the correlation between a field test assessing aerobic capacity (namely, the 12 minute-walk/run test, 12m-WRT) and the performance of students of distinct school-grade levels at two different working memory (WM)-related tasks. Forty participants (21 males, 19 females, mean age 19.18 ± 6.18 years, range 10-24) have been assessed using the Paced Auditory Serial Addition Test (PASAT) and the Symbol Digit Modalities Test (SDMT) as WM measures, and a walk/run test of 12 minutes to indirectly measure the aerobic capacity (VO2max). We found significant correlations between VO2max and PASAT and between VO2max and SDMT. Two different trends were identified in relation to the individual level of formal education. In particular, aerobic fitness showed higher predictive values on WM performance when investigated with PASAT in primary and secondary school students, whilst increasing predictive values of physical condition on SDMT's scores were observed with the progressing of students' school career, reaching maximal values in university students. No significant correlations were observed between age and the cognitive tests, nor between age and VO2max. The present findings suggest that the 12m-WRT is associated with WM performance, showing different correlation with PASAT and SDMT according to the school-grade level. This might be due to the different effects that aerobic fitness has on specific neural substrates during development and opens avenues to research new tools able to monitor the health of the brain in young subjects. [ABSTRACT FROM AUTHOR]

Significance: Motion artifacts are a notorious challenge in the functional near-infrared spectroscopy (fNIRS) field. However, little is known about how to deal with them in resting-state data., Aim: We assessed the impact of motion artifact correction approaches on assessing functional connectivity, using semi-simulated datasets with different percentages and types of motion artifact contamination., Approach: Thirty-five healthy adults underwent a 15-min resting-state acquisition. Semi-simulated datasets were generated by adding spike-like and/or baseline-shift motion artifacts to the real dataset. Fifteen pipelines, employing various correction approaches, were applied to each dataset, and the group correlation matrix was computed. Three metrics were used to test the performance of each approach., Results: When motion artifact contamination was low, various correction approaches were effective. However, with increased contamination, only a few pipelines were reliable. For datasets mostly free of baseline-shift artifacts, discarding contaminated frames after pre-processing was optimal. Conversely, when both spike and baseline-shift artifacts were present, discarding contaminated frames before pre-processing yielded the best results., Conclusions: This study emphasizes the need for customized motion correction approaches as the effectiveness varies with the specific type and amount of motion artifacts present., (© 2024 The Authors.)

The aim of our study was to develop a methodology that uses the metronome to constrain the swimmers' stroke rate with the aim to monitor changes in stroke length (SL) during two different periods of the season. Thirteen young trained swimmers (15.7 ± 1.7 y) performed three 50 m front crawl time trials during pre-season (PRE) and after 2 months, during the in-season period (IN). They were asked: (I) to swim at their maximum intensity (NO-MET condition); (II) to synchronize their stroke with a metronome beat set to their preferred intra-stroke-interval (ISI) (100% condition, corresponding to 48 ± 0.7 cycles/min); (III) to synchronize their stroke with a metronome beat set at 5% higher than their preferred ISI (95% condition, corresponding to 51 ± 0.8 cycles/min). The outcome parameters used to evaluate the performance were ISI, SL and total time of 50 m (TT). In NO-MET condition, results showed that TT in IN improved with respect to PRE, but no changes in ISI and SL. In 100% condition, no differences were obtained between the imposed and the performed ISI, whilst in 95% condition, the performed ISI was lower than the metronome ISI, and lower than that in 100% condition. At last, when using the metronome, SL was higher during IN compared to PRE and SL was lower in the 95% condition compared to the 100% condition. Results indicate that the use of the metronome successfully allowed monitoring changes in SL during different periods of the season. This methodology provides valuable information to coaches and athletes to enhance their performance throughout the season., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2023 Fassone, Bisio, Puce, Biggio, Tassara, Faelli, Ruggeri and Bove.)

Introduction: Personality shapes the cognitive, affective, and behavioral interactions between individuals and the environment. Defensive peripersonal space (DPPS) is the projected interface between the body and the world with a protective function for the body. Previous studies suggest that DPPS displays inter-individual variability that is associated with psychiatric symptoms, such as anxiety. However, DPPS may share a link with personality traits., Methods: Fifty-five healthy participants were assessed with the Personality Inventory for DSM-5 (PID-5)-Adult to evaluate personality dimensions. Subjects underwent the Hand Blink Reflex (HBR) task that estimates the DPPS limits by assessing the modulation of blink intensity in response to the median nerve stimulation. Data of the HBR was analyzed with Bayesian multilevel models, while the relationship between DPPS and personality traits was explored using network analysis., Results: HBR was best modeled using a piecewise linear regression model, with two distinct slope parameters for electromyographic data. Network analyzes showed a positive correlation between the proximal slope and detachment personality trait, suggesting that individuals with higher scores in the detachment trait had an increased modulation of HBR, resulting in a larger extension of the DPPS., Discussion: Features of the detachment personality trait include avoidance of interpersonal experiences, restricted affectivity, and suspiciousness, which affect interpersonal functioning. We suggest that DPPS may represent a characteristic feature of maladaptive personality traits, thus constitute a biomarker or a target for rehabilitative interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer CF declared a past co-authorship with the authors MoB, AB, and MaB., (Copyright © 2023 Biggio, Escelsior, Murri, Trabucco, Delfante, da Silva, Bisio, Serafini, Bove and Amore.)

Priming is a learning process that refers to behavioral changes caused by previous exposure to a similar stimulus. Motor imagery (MI), which involves the mental rehearsal of action representations in working memory without engaging in actual execution, could be a strategy for priming the motor system. This study investigates whether MI primes action execution in Multiple Sclerosis (MS). Here, 17 people with MS (PwMS) and 19 healthy subjects (HS), all right-handed and good imaginers, performed as accurately and quickly as possible, with a pencil, actual or mental pointing movements between targets of small (1.0 × 1.0 cm) or large (1.5 × 1.5 cm) size. In actual trials, they completed five pointing cycles between the left and right targets, whereas in mental trials, the first 4 cycles were imagined while the fifth was actually executed. The fifth cycle was introduced to assess the MI priming effect on actual execution. All conditions, presented randomly, were performed with both dominant (i.e., right) and non-dominant arms. Analysis of the duration of the first 4 cycles in both actual and mental trials confirmed previous findings, showing isochrony in HS with both arms and significantly faster mental than actual movements (anisochrony) in PwMS ( p  < 0.01) [time (s); HS right: actual: 4.23 ± 0.15, mental: 4.36 ± 0.16; left: actual: 4.32 ± 0.15, mental: 4.43 ± 0.18; PwMS right: actual: 5.85 ± 0.16, mental: 5.99 ± 0.21; left: actual: 6.68 ± 0.20, mental: 5.94 ± 0.23]; anisochrony in PwMS was present when the task was performed with the non-dominant arm. Of note, temporal analysis of the fifth actual cycle showed no differences between actual and mental trials for HS with both arms, whereas in PwMS the fifth actual cycle was significantly faster after the four actual cycles for the non-dominant arm ( p  < 0.05) [time (s); HS right: actual: 1.03 ± 0.04, mental: 1.03 ± 0.03; left: actual: 1.08 ± 0.04, mental: 1.05 ± 0.03; PwMS right: actual: 1.48 ± 0.04, mental: 1.48 ± 0.06; left: actual: 1.66 ± 0.05, mental: 1.48 ± 0.06]. These results seem to suggest that a few mental repetitions of an action might be sufficient to exert a priming effect on the actual execution of the same action in PwMS. This would indicate further investigation of the potential use of MI as a new motor-cognitive tool for MS neurorehabilitation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tacchino, Pedullà, Podda, Monti Bragadin, Battaglia, Bisio, Bove and Brichetto.)

Music is an important tool for the induction and regulation of emotion. Although learning a sequential motor behaviour is essential to normal motor function, to our knowledge, the role of music-induced emotion on motor learning has not been explored. Our experiment aimed to determine whether listening to different emotional music could influence motor sequence learning. We focused on two sub-components of motor sequence learning: the acquisition of the order of the elements in the sequence (the "what"), and the ability to carry out the sequence, combining the elements in a single, skilled action (the "how"). Twenty subjects performed a motor sequence-learning task with a digitizing tablet in three different experimental sessions. In each session they executed the task while listening to three different musical pieces, eliciting fearful, pleasant, and neutral mood. Eight targets were presented in a pre-set order and subjects were asked to learn the sequence while moving. Music-induced pleasure had an impact on movement kinematics with onset time and peak velocity decreasing and movement time increasing more with respect to neutral music session. Declarative learning, verbal recall of the sequence order, was improved under emotional manipulation, but only for fear-condition. Results suggest that music-induced emotion can influence both sub-components of motor learning in a different way. Music-induced pleasure may have improved motor components of sequence learning by means of increased striatal dopamine availability whereas music-induced fear may facilitate the recruitment of attentional circuits, thus acting on declarative knowledge of the sequence order., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 IBRO. Published by Elsevier Ltd. All rights reserved.)

The ability to predict the weight of objects is important for skilled and dexterous manipulation during activities of daily living. The observation of other people moving objects might represent an important source of information on object features and help to plan the correct motor interaction with it. In aging, an impaired ability to evaluate the object weight might have negative drawbacks in term of the safety of the person. The aim of this study was to investigate the role of aging in the ability to discriminate the object weight during action observation. Twenty older adults (Old) and twenty young subjects (Young) performed a two-interval forced-choice task consisting in the observation of a couple of videos showing an actor moving a box of different weights. The observer had to evaluate which video showed the heavier box. Handgrip strength was acquired from all subjects. Sensitivity analysis was performed and psychometric curves were built on participants' responses. The results showed a diminished sensitivity in the object weight discrimination in Old than in Young group. The analysis of the psychometric curves revealed that this impairment pertained both the light and heavy boxes and the minimum difference to discriminate different weights was greater in Old than in Young. At last, the sensitivity and the discrimination ability significantly correlated with individuals' handgrip strength. These findings allow us to deeply characterize the impairments older adults have in discriminating the weight of an object moved by another individual., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Albergoni, Biggio, Faelli, Ruggeri, Avanzino, Bove and Bisio.)

This study aimed to investigate the role of sensorimotor expertise in evaluating relative weight of a lifted object during the observation of a sport-specific gesture, namely the deadlift. Fifty-six participants, assigned to three groups according to their experience in weight lifting, powerlifters, CrossFit® practitioners and naïve participants (controls), performed a perceptual weight judgments task. Participants observed videos showing a powerlifter executing a deadlift at the 80%, 90% and 100% of 1 repetition maximum (1RM) and answered a question about the weight of the lifted object. Participants' response accuracy and variability were evaluated. Findings showed that powerlifters were more accurate than controls. No differences appeared between powerlifter and CrossFit® practitioners, and between CrossFit® practitioners and controls. Response variability was similar in the three groups. These findings suggest that a fine sensorimotor expertise specific for the observed gesture is crucial to detect the weight of the object displayed in the observed movement, since it might allow detecting small changes in the observed movement kinematics, which we speculate are at the basis of the object weight recognition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Albergoni, Biggio, Faelli, Pesce, Ruggeri, Avanzino, Bove and Bisio.)

Time-of-day is rarely considered during experimental protocols investigating motor behavior and neural activity. The goal of this work was to investigate differences in functional cortical connectivity at rest linked to the time of the day using functional Near-Infrared Spectroscopy (fNIRS). Since resting-state brain is shown to be a succession of cognitive, emotional, perceptual, and motor processes that can be both conscious and nonconscious, we studied self-generated thought with the goal to help in understanding brain dynamics. We used the New-York Cognition Questionnaire (NYC-Q) for retrospective introspection to explore a possible relationship between the ongoing experience and the brain at resting-state to gather information about the overall ongoing experience of subjects. We found differences in resting-state functional connectivity in the inter-hemispheric parietal cortices, which was significantly greater in the morning than in the afternoon, whilst the intra-hemispheric fronto-parietal functional connectivity was significantly greater in the afternoon than in the morning. When we administered the NYC-Q we found that the score of the question 27 ("during RS acquisition my thoughts were like a television program or film") was significantly greater in the afternoon with respect to the morning. High scores in question 27 point to a form of thought based on imagery. It is conceivable to think that the unique relationship found between NYC-Q question 27 and the fronto-parietal functional connectivity might be related to a mental imagery process during resting-state in the afternoon., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Iester, Biggio, Cutini, Brigadoi, Papaxanthis, Brichetto, Bove and Bonzano.)

In healthy people, motor resonance mechanisms are flexible to negative emotional contextual clues with greater motor resonance during the observation of a reach to grasp movement performed in an environment eliciting disgust. The link between emotion and motor control has become an interesting topic in Parkinson's disease (PD). Here, we aimed to study the response of the mirror neuron system, specifically motor resonance, to an emotion-enriched context in people with PD. Corticospinal excitability was recorded in a total of 44 participants, divided into two groups (23 PD patients and 21 healthy subjects). We recorded motor-evoked potentials from a muscle involved in the grasping movement while participants were watching the same reach-to-grasp movement embedded in surrounds with negative emotional valence, but different levels of arousal: sadness (low arousal) and disgust (high arousal). Basic motor resonance mechanisms were less efficient in PD than controls. Responsiveness to emotional contextual clues eliciting sadness was similar between PD and controls, whereas responsiveness to emotional contextual clues eliciting disgust was impaired in PD patients. Our findings show reduced motor resonance flexibility to the disgusting context, supporting the hypothesis that PD patients may have a deficit in "translating" an aversive motivational state into a physiologic response. The amygdala, which is implicated in the appraisal of fearful stimuli and response to threatening situations, might be implicated in this process., Competing Interests: The study's authors affirm that there were no financial or commercial relationships that might be viewed as having a potential conflict of interest., (Copyright © 2022 Giovanna Lagravinese et al.)

Introduction: Regular exercise is strongly recommended for people with MS (pwMS), but recent studies still describe them as sedentary and insufficiently active. The purpose of this study is to identify the major barriers that prevent pwMS from exercising and underline the importance of the general practitioner (GP) in promoting an active lifestyle., Materials and Methods: We performed a multicenter cross-sectional study using a self-administered questionnaire among pwMS. Data about demographics, the disease, current exercise practice, barriers, previous GP's advice to practice, and motivation were collected., Results: A total of 741 pwMS (age 55.6 ± 12.5 years, 66% females) completed the survey. Most responders (75.3%) did not practice any exercise. Fatigue was the most limiting factor to attending and/or starting an exercise program, followed by travel and/or moving issues, and the lack of time. Only 25.5% of participants received GP's advice to practice exercise, but 48.6% of them attended an exercise program. A greater likelihood of practice was evidenced for people that received the GP's advice than those who had not received it (OR 2.96; p < 0.001). Finally, among those who did not practice exercise but received advice from GPs, 69 out of 99 (69.7%) were motivated to start an exercise program., Conclusion: Fatigue and physical issues are the main barriers to exercise for pwMS, but also other factors not related to the disease seem to be relevant, like travel issues and lack of time. Although few participants received advice to exercise from their general practitioner, his role proved effective in encouraging the practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Correale, Martinis, Tavazzi, Pedullà, Mallucci, Brichetto, Bove, Ponzio, Borrelli, Monti, Bergamaschi and Montomoli.)

We recently demonstrated, by means of short latency afferent inhibition (SAI), that before an imagined movement, during the reaction time (RT), SAI decreases only in the movement-related muscle (sensorimotor modulation) and that a correlation exists between sensorimotor modulation and motor imagery (MI) ability. Excitatory anodal transcranial direct current stimulation (a-tDCS) on M1 could enhance the MI outcome; however, mechanisms of action are not completely known. Here, we assessed if a-tDCS on M1 prior to an MI task could affect sensorimotor modulation. Participants imagined abducting the index or little finger in response to an acoustic signal. SAI was evaluated from the first dorsal interosseus after the "go" signal, before the expected electromyographic (EMG) activity. Participants received 20-min 1.5 mA a-tDCS or sham-tDCS on M1 on two different days, in random order. Results showed that a-tDCS on M1 increases the sensorimotor modulation consisting of a weakening of SAI after the Go signal with respect to sham-tDCS, in the movement-related muscle right before the beginning of MI. These results suggest that a-tDCS on M1 further potentiate those circuits responsible for sensorimotor modulation in the RT phase of MI. Increased sensorimotor modulation during MI may be one of the mechanisms involved in MI improvement after a-tDCS over M1., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bonassi, Lagravinese, Putzolu, Botta, Bove, Pelosin and Avanzino.)

Background: Hand dexterity impairment is a key feature of disability in people with primary progressive multiple sclerosis (PPMS). So far, ocrelizumab, a recombinant humanized monoclonal antibody that selectively depletes CD20-expressing B cells, is the only therapy approved for PPMS and recent analysis reported its ability to reduce the risk of upper limb disability progression. However, the neural mechanisms underlying hand impairment in PPMS and the brain networks behind the effect of ocrelizumab on manual dexterity are not fully understood., Objective: Main aims of our study were: (i) to investigate neurophysiological and behavioural correlates of hand function impairment in subjects with PPMS, and (ii) to use neurophysiologic and behavioural measures to track the effects of ocrelizumab therapy on manual dexterity., Methods: Seventeen PPMS patients and 17 healthy-controls underwent routine neurophysiological protocols assessing the integrity of cortico-spinal and somatosensory pathways and advanced transcranial magnetic stimulation (TMS) protocols evaluating inhibitory (short and long interval intracortical inhibition, short-latency afferent inhibition) and facilitatory (motor thresholds, intracortical facilitation, short-interval intracortical facilitation) circuits in the primary motor cortex. All subjects also underwent behavioural analysis of hand dexterity by means of nine-hole peg test and finger movement analysis, and hand strength with handgrip and three-point pinch test. Neurophysiological and clinical assessments of hand functionality were also performed after 1 year of ocrelizumab therapy., Results: At baseline PPMS patients displayed a significant impairment of hand dexterity and strength compared to healthy controls (all p < 0.03). Neurophysiological study disclosed prolonged latencies of standard somatosensory and motor evoked potentials (all p < 0.025) and an overall reduction of intracortical excitability at TMS protocols, involving both excitatory and inhibitory circuits. Importantly, hand dexterity impairment, indexed by delayed 9HPT, correlated with TMS protocols investigating cortical sensorimotor integration (short-latency afferent inhibition, SAI), p = 0.009. Both parameters, 9HPT (p = 0.01) and SAI (p = 0.01), displayed a significant improvement after 1 year of therapy with ocrelizumab., Conclusion: Intracortical sensorimotor networks are involved in hand dexterity dysfunction of PPMS. Ocrelizumab therapy displays a beneficial effect on hand dexterity impairment most likely through intracortical networks implicated in fast sensorimotor integration., (© 2022. The Author(s).)

In the seed-based method for studying functional connectivity (FC), seed selection is relevant. Here, we propose a new methodological approach for resting-state FC analysis of hand motor networks using the individual hand motor hotspot (hMHS) as seed. Nineteen right-handed healthy volunteers underwent a transcranial magnetic stimulation (TMS) session and resting-state fMRI. For each subject, the hMHS in both hemispheres was identified by TMS with the contralateral abductor pollicis brevis muscle as the target, the site eliciting the highest and most reliable motor-evoked potentials. Seed regions were built on coordinates on the cortex corresponding to the individual left and right hMHSs. For comparison, the left and right Brodmann's area 4 (BA4) masks extracted from a standard atlas were used as seed. The left and right hMHSs showed FC patterns at rest mainly including sensorimotor regions, with a bilateral connectivity only for the left hMHS. The statistical contrast BA4 > hMHS for both hemispheres showed different extension and lateralization of the functionally connected cortical regions. On the contrary, no voxels survived the opposite contrast (hMHS > BA4). This suggests that detection of individual hand motor seeds by TMS allows to identify functionally connected motor networks that are more specific with respect to those obtained starting from the a priori atlas-based identification of the primary motor cortex., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bonzano, Bortoletto, Zazio, Iester, Stango, Gasparotti, Miniussi and Bove.)

Drafting in swimming is a tactic in which an athlete (drafter) swims in the wave of another athlete (leader). Our aim was to compare the effects of this tactic on the drafter, as far as muscle fatigue, muscle activity, and swimming efficiency are concerned. Fifteen drafters performed three 200 m front crawl trials at a controlled submaximal pace in three configurations: Behind Drafting (BD), Lateral Drafting (LD), and Free Swimming (FS). Muscle fatigue, muscle activity, and swimming efficiency were obtained by surface electromyography (EMG) and video analysis from flexor carpi radialis, triceps brachii, latissimus dorsi, and rectus femoris muscles. The outcome measures were: time slope of Mean Frequency (MNF), for muscle fatigue; time slope of Root Mean Square (RMS), for muscle activity; and Stroke Index (SI) for swimming efficiency. Negative variations of MNF were 5.1 ± 1.7%, 6.6 ± 4.1%, and 11.1 ± 2.7% in BD, LD, and FS, respectively. Statistical significance was found for all cases except for the rectus femoris. Positive variations of RMS were 3.4 ± 1.2%, 4.7 ± 2.7%, and 7.8 ± 4.6% in BD, LD, and FS, respectively. Statistical significance was found only for the slopes of latissimus dorsi in FS and LD. The largest mean in SI was measured in the BD (2.01 m 2 /s), while the smallest was measured in the FS (1.86 m 2 /s). BD was found to be the best swimming configuration, in terms of lower muscle fatigue and higher swimming efficiency. Also, LD resulted to be advantageous with respect to FS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Puce, Chamari, Marinelli, Mori, Bove, Faelli, Fassone, Cotellessa, Bragazzi and Trompetto.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

This study compared the effects of two breathing conditions during the freestyle turn approach phase in swimmers. Thirty-four prepubertal swimmers (mean ± SD: 10.59 ± 0.97 years) were divided into two groups: No Breath (NB), not breathing at the last stroke, and Breath Stroke (BS). Swimmers performed three turns with 5 min of rest between the repetitions. Kinematic parameters were recorded with two underwater and two surface cameras. Total turn time (NB: 9.31 ± 1.34 s; BS: 10.31 ± 1.80 s; p = 0.049), swim-in time (NB: 3.89 ± 0.63 s; BS 4.50 ± 0.79 s; p = 0.02) and rotation time (NB: 2.42 ± 0.29 s; BS: 3.03 ± 0.41 s; p = 0.0001) were significantly shorter and swim-in distance [NB: 0.70 (0.58,0.77) m; BS: 0.47 (0.34,0.55) m; p = 0.0001], glide distance (NB: 1.06 ± 0.21 m; BS: 0.70 ± 0.20 m; p = 0.0001) and surfacing distance [NB: 1.79 (1.19,2.24) m; BS: 1.18 (0.82,1.79) m; p = 0.043] were significantly longer in NB than in BS. Moreover, speed-in (NB: 1.04 ± 0.14 m/s; BS: 0.93 ± 0.14 m/s; p = 0.031) and push-off speed (NB: 2.52 ± 0.30 m/s; BS: 1.23 ± 0.20 m/s; p = 0.001) were significantly higher in NB than in BS. Swim-in time was positively and negatively correlated with rotation time and glide distance, respectively, whilst negative relationships between total turn time and swim-in distance, total turn time and surfacing distance and total turn time and speed-in were found. Our study showed that in prepubertal swimmers not breathing at the last stroke during the approach phase positively affected kinematic parameters of the turn, allowing to approach the wall faster, rotate the body quicker, increase push-off speed, reduce turn execution time, thus improving overall turn performance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Faelli, Strassera, Ottobrini, Ferrando, Bisio, Puce, Panascì, Lagorio, Ruggeri and Bove.)

This randomized crossover counterbalanced study investigated, in recreational runners, the acute effects of pre-exercise stretching on physiological and metabolic responses, endurance performance, and perception of effort. Eight male endurance runners (age 36 ± 11 years) performed three running-until-exhaustion tests, preceded by three warm-ups, including the following different stretching protocols: static (SS), dynamic (DS), and no-stretching (NS). During the SS and DS sessions, the warm-up consisted of 10 min of running plus 5 min of SS or DS, respectively, while during the NS session, the warm-up consisted of 15 min of running. Physiological and metabolic responses, and endurance running performance parameters, were evaluated. The perception of effort was derived from the rating of perceived exertion (RPE). Running economy significantly improved after SS ( p < 0.05) and DS ( p < 0.01), and RPE values were significantly lower in SS ( p < 0.05) and DS ( p < 0.01), compared to NS. No differences in physiological and metabolic responses among the sessions were found. This study showed that including SS and DS within the warm-up ameliorated running economy and decreased the perception of effort during a running-until-exhaustion test, highlighting the benefits of stretching on endurance performance. These results should encourage recreational runners to insert stretching during warm-up, to optimize the running energy costs, reducing the perception of effort and making the training sessions more enjoyable.

Handwriting is a complex activity including motor planning and visuomotor integration and referring to some brain areas identified as "writing centers." Although temporal features of handwriting are as important as spatial ones, to our knowledge, there is no evidence of the description of specific brain areas associated with handwriting tempo. People with multiple sclerosis (PwMS) show handwriting impairments that are mainly referred to as the temporal features of the task. The aim of this work was to assess differences in the brain activation pattern elicited by handwriting between PwMS and healthy controls (HC), with the final goal of identifying possible areas specific for handwriting tempo. Subjects were asked to write a sentence at their spontaneous speed. PwMS differed only in temporal handwriting features from HC and showed reduced activation with a subset of the clusters observed in HC. Spearman's correlation analysis was performed between handwriting temporal parameters and the activity in the brain areas resulting from the contrast analysis, HC > PwMS. We found that the right inferior parietal lobule (IPL) negatively correlated with the duration of the sentence, indicating that the higher the right IPL activity, the faster the handwriting performance. We propose that the right IPL might be considered a "writing tempo center.", Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bonzano, Bisio, Pedullà, Brichetto and Bove.)

It has been theorized that hemispheric dominance and more segregated information processing have evolved to overcome long conduction delays through the corpus callosum (transcallosal conduction delay - TCD) but that this may still impact behavioral performance, mostly in tasks requiring high timing accuracy. Nevertheless, a thorough understanding of the temporal features of interhemispheric communication is lacking. Here, we aimed to assess the relationship between TCD and behavioral performance with a noninvasive directional cortical measure of TCD obtained from transcranial magnetic stimulation (TMS)-evoked potentials (TEPs) in the motor system. Twenty-one healthy right-handed subjects were tested. TEPs were recorded during an ipsilateral silent period (iSP) paradigm and integrated with diffusion tensor imaging (DTI) and an in-phase bimanual thumb-opposition task. Linear mixed models were applied to test relationships between measures. We found TEP indexes of transcallosal communication at ∼15 ms both after primary motor cortex stimulation (M1-P15) and after dorsal premotor cortex stimulation (dPMC-P15). Both M1-and dPMC-P15 were predicted by mean diffusivity in the callosal body. Moreover, M1-P15 was positively related to iSP. Importantly, M1-P15 latency was linked to bimanual coordination with direction-dependent effects, so that asymmetric TCD was the best predictor of bimanual coordination. Our findings support the idea that transcallosal timing in signal transmission is essential for interhemispheric communication and can impact the final behavioral outcome. However, they challenge the view that a short conduction delay is always beneficial. Rather, they suggest that the effect of the conduction delay may depend on the direction of information flow., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2021. Published by Elsevier Inc.)

The investigation of how humans perceive and respond to emotional signals conveyed by the human body has been for a long time secondary compared with the investigation of facial expressions and emotional scenes recognition. The aims of this behavioral study were to assess the ability to process emotional body postures and to test whether motor response is mainly driven by the emotional content of the picture or if it is influenced by motor resonance. Emotional body postures and scenes (IAPS) divided into three clusters (fear, happiness, and neutral) were shown to 25 healthy subjects (13 males, mean age ± SD: 22.3 ± 1.8 years) in a three-alternative forced choice task. Subjects were asked to recognize the emotional content of the pictures by pressing one of three keys as fast as possible in order to estimate response times (RTs). The rating of valence and arousal was also performed. We found shorter RTs for fearful body postures as compared with happy and neutral postures. In contrast, no differences across emotional categories were found for the IAPS stimuli. Analysis on valence and arousal and the subsequent item analysis showed an excellent reliability of the two sets of images used in the experiment. Our results show that fearful body postures are rapidly recognized and processed, probably thanks to the automatic activation of a series of central nervous system structures orchestrating the defensive threat reactions, strengthening and supporting previous neurophysiological and behavioral findings in body language processing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Botta, Lagravinese, Bove, Avenanti and Avanzino.)

The purpose of this study was to assess validity, stability and sensitivity, of 4 spectral parameters-median frequency (F med ), mean frequency (F mean ), Dimitrov index (DI), and mean instant frequency (F mi )-in measuring localized muscle fatigue in swimming and to investigate their correlation with the variations of kinematic data and mechanical fatigue. Electrophysiological measures of muscle fatigue were obtained in real-time during a 100 m front crawl test at maximum speed in 15 experienced swimmers, using surface electromyography in six muscles employed in front crawl, while kinematic data of swimming was measured from video analysis. Mechanical fatigue was measured as the difference between muscle strength prior to and immediately after the 100 m front crawl in a dry-land multi-stage isometric contraction test. Statistically significant fatigue ( p < 0.0001) was found for all spectral parameters in all muscles. F med and F mean varied between 10 and 25%, DI between 50 and 150%, and F mi between 5 and 10%. Strong correlation (Pearson r ≥ 0.5) with mechanical fatigue was found for all spectral parameters except for F mi and it was strongest for F med and F mean . From our study, it turns out that F med and F mean are more valid and stable parameters to measure fatigue in swimming, while DI is more sensitive., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Puce, Pallecchi, Marinelli, Mori, Bove, Diotti, Ruggeri, Faelli, Cotellessa and Trompetto.)

Motor imagery (MI), i. e., the mental simulation of an action without its actual execution, is a promising technique to boost motor learning via physical practice in rehabilitation, sport, and educational fields. The purpose of the present pilot study was to test the feasibility and the effectiveness of the application of MI as learning methodology place alongside conventional teaching technique as employed for physical education lessons. Thirty-three high school students from two classes were enrolled for instruction in the underhand serve in volleyball. One group, the motor imagery group (MIG) carried out the physical exercise along with the kinesthetic MI of the action, while the other group (the control group) was limited to the merely physical exercise. The training period lasted 8 weeks. MI duration and the duration of real movement (ME), the isochrony index (differences between real and imagined movements duration), and the number of balls which passed over the net (NBN) were evaluated before and after training. Results showed a significant improvement in the isochrony index for the MIG group exclusively; namely, MI duration became more similar to ME duration. Moreover, in MIG a significantly negative relationship appeared between the percentage change in the isochrony index and the difference between NBN before and after training. These findings suggest improvement in sensorimotor representation of the action, which lies at the basis of enhanced motor performance. The present study constitutes initial proof of concept on the application of MI as learning technique applicable to physical education lesson at high school., (Copyright © 2020 Canepa, Sbragi, Saino, Biggio, Bove and Bisio.)

Context: Kinesio Taping (KT) produces several clinical effects, including pain relief, edema absorption, and improved muscle performance. When applied in the insertion to origin mode, it is claimed to inhibit excessive muscle contractions., Objective: Investigate whether KT applied in the insertion to origin mode could reduce the exaggerated reflex contraction of spastic muscles., Design: Randomized crossover trial, with a restricted block randomization., Setting: Clinical laboratory and swimming pool., Patients: Seven para-swimmers., Intervention: KT, applied in inhibitory mode, to investigate its effect on knee extensor spasticity., Main Outcome Measures: Primary outcome is stretch reflex, as compared with clinical assessment of spasticity by Modified Ashworth Scale and self-perceived spasticity by numeric rating scale. Secondary outcomes were Medical Research Council for strength of knee extensor muscles and chronometric swimming performance in 100-m freestyle., Results: KT significantly decreased the amplitude of stretch reflex (P < .001), whereas the placebo treatment produced no significant effects. Scores of Medical Research Council for strength and Modified Ashworth Scale did not change after KT, whereas numeric rating scale scores for spasticity significantly decreased (P = .001). The swimming performance was significantly improved after KT treatment as compared with baseline (P < .01)., Conclusions: This exploratory study performed on para-athletes suggests that KT could reduce spasticity. This outcome has 3-fold implications for clinical, rehabilitation, and sport methods.

Cognitive impairment and related abnormal brain activity are common in people with multiple sclerosis (PwMS). Adaptive training based on working memory (WM) has been shown to ameliorate cognitive symptoms, although the effects at a neural level are unclear. The aim of this study was to expand the existing research on the effects of an adaptive WM rehabilitative intervention on brain functional activity in PwMS. A sample of eighteen PwMS performed an 8-week home-based cognitive rehabilitation treatment based on adaptive WM training. PwMS were assessed before and after treatment using a validated neuropsychological battery and undergoing an fMRI session while carrying out a cognitive task (i.e., Paced Visual Serial Addition Test - PVSAT). fMRI activations were compared to the activation pattern elicited by eighteen matched healthy subjects performing the same task. At baseline, we found abnormal brain activity during PVSAT in PwMS when compared to healthy subjects, with a pattern including several bilateral activation clusters. Following rehabilitation, PwMS improved cognitive performance, as evaluated by the neuropsychological battery, and showed a different activation map with clusters mainly located in the right cerebellum and in the left hemisphere. The only significant cluster in the right hemisphere was located in the inferior parietal lobule, and the BOLD signal extracted in this area significantly correlated with cognitive performance both before and after the treatment. We suggest that WM training can improve the cognitive performance and reduce the abnormal activation of PwMS by partially maintaining or even restoring brain cognitive function.

Rehabilitation treatments have been proven to be a viable way to reduce fatigue and upper limb impairments in people with multiple sclerosis (PwMS). Our aim was to examine which treatment has better short-term and carryover effects on fatigue and manual dexterity in multiple sclerosis population. Twenty PwMS participated in a 16-week randomized crossover study composed of 20 sessions. The participants were divided into two groups (group A and group B). Sessions containing combined arm cycling and task-oriented exercises were administered by a physical therapist in hospital setting. Each group received 20 sessions of aerobic training and task-oriented exercises and then an 8-week rest period or vice versa with group A receiving sessions first. Fatigue was assessed by using the Modified Fatigue Impact Scale (MFIS) and Motor Fatigability Index (MFI), which was assessed using an engineered glove during a fatiguing finger tapping task. To measure manual dexterity, the nine hole peg test (NHPT) and a rate of tapping at maximum velocity task (RATE-MV) were utilized. Treatment effects were assessed by t-test or Mann-Whitney test at the end of both periods checking for carryover effects. After treatment the combined (Groups A and B) between-period differences were MFIS: 5.2 (10.7) points, P = 0.05; MFI: -0.007 (<0.001)Hz/s, P = 0.05 and RATE-MV: 0.2 (0.4) Hz/s, P = 0.05 in favor of the treatment period. No statistically significant between-period differences were found for the NHPT: 3.6 (25.0) s, P = 0.63. No carryover effects (P > 0.05) were observed. In conclusion, sessions of arm cycling and tailored task-oriented exercises have shown to be a viable resource for treating manual dexterity and fatigue in PwMS.

Training methods for Paralympic swimmers must take into account different pathologies, competitions classes, athlete's individual circumstances and peculiar physical adaptation mechanisms, hence general guidelines cannot be found in literature. In this study we present a training program, implemented for the physical preparation of a top level Paralympic swimmer. The athlete under study, affected by infantile cerebral palsy within a clinical picture of a spastic tetraparesis, by the end of 2016 was holder of Italian, European, world and Paralympic titles in the 400-m freestyle competition, S6 class. The training macrocycle was structured in a 3-fold periodization (three mesocycles), in view of the preparation to three international competitions. The 4-month training mesocycles prior to each competition differed substantially in terms of mileage load, intensity and recovery times. The first mesocycle was characterized by a sizeable low-intensity mileage load, the second one was shifted to lower mileage load, carried out at middle-to-high intensity levels, the third one entailed increased effort intensity, counterbalanced by lower mileage load. In all cases, recovery times were balanced to obtain optimized performance through physical adaptation to training stimuli, keeping into account the physiopatological response. Tapering phases were adjusted to maximize performance at competition. As an assessment of the effectiveness of the training method, correspondence between chronometric and technical parameters in the three competitions and the respective mesocycle training programs was found. The results of the present study may support the development of training guidelines for athletes affected by upper motor neuron lesions., Competing Interests: CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.

Background: People with multiple sclerosis (PwMS) often develop an autonomic dysfunction (AD), which onset should be assessed early at a subclinical level, as it may interfere with pharmacological treatments and exercise., Objective: To evaluate basal cardiac autonomic tone, its modulations during sit-to-stand, sub-maximal exercise and recovery in PwMS without clinical overt AD and its relationships with fatigue perception., Methods: Twenty-three PwMS (55 ± 8 yrs [mean ± SD]; EDSS score 5.7 ± 1.3) and 20 age-matched healthy controls (HC; 55 ± 8yrs) were enrolled. ECG was digitally acquired during:1) sitting at rest (low sympathetic activation); 2) standing (light sympathetic activation); and 3) during light exercise (moderate sympathetic activation) and recovery. Parasympathetic and sympatho-vagal parameters of heart rate (HR) variability in time and frequency domains were calculated from beat series., Results: HR was slightly but not significantly higher in PwMS compared to HC in all experimental conditions. Parasympathetic indexes were significantly lower (p < 0.05) in PwMS compared to HC during baseline sitting and post-exercise recovery, whereas sympathovagal parameters were similar in both groups. No correlation between autonomic tone and perceived fatigue was observed., Conclusion: Parasympathetic tone appears to be impaired in PwMS basal and post-exercise conditions, but not during postural challenge and exercise. In addition, AD does not affect perceived fatigue., (Copyright © 2018. Published by Elsevier B.V.)

Amputees with phantom limb sometimes report vivid experiences of moving their phantom. Is phantom movement only "imaginary", or, instead, it has physiological properties comparable to those pertaining to real movements? To answer this question, we took advantage of the intermanual transfer of sequence learning, occurring when one hand motor skills improve after training with the other hand. Ten healthy controls and two upper-limb amputees (with and without phantom-movement) were recruited. They were asked to perform with the right (intact) hand a fingers-thumb opposition sequence either in Naïve condition or after an active (Real condition) or a mental (Imagery condition) training with the left (phantom) hand. In healthy controls, the results showed different effects after active training (i.e., faster movement duration (MD) with stable accuracy) and after mental training (i.e., increased accuracy with stable MD). Opposite results between moving-phantom case and static-phantom case were found. In the Real condition, after an "active" training with her phantom hand, the moving-phantom case showed a faster performance of the intact hand. This transfer effect was not different from that found in healthy controls, actually performing the active training with an existing hand (Real condition), but, crucially, it was significantly different from both Imagery and Naïve conditions of controls. Contrariwise, in the static phantom case, the performance during the Real condition was significantly different from the Real condition of healthy controls and it was not significantly different from their Imagery and Naïve conditions. Importantly, a significant difference was found when the transfer effect in Real condition was compared between the two phantom cases. Taken together, these findings provide the first evidence that a phantom limb can learn motor skills and transfer them to the intact limb., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Handwriting is an important activity of daily living, which requires sensorimotor and cognitive skills that could deteriorate in presence of neurological diseases. Handwriting impairments are common in people with multiple sclerosis (PwMS). Aims of the present study were to characterize handwriting movement features of PwMS in comparison with those of healthy adults, and to evaluate the relationship between kinematic parameters of handwriting movements and the results of the assessment of cognitive and motor domains. A new handwriting evaluation methodology was applied to quantify handwriting features of 19 PwMS and 22 age-matched healthy controls who were required to write a sentence on a digitizing tablet. Kinematic parameters of the sentence and of the strokes were used to evaluate handwriting performance. PwMS showed an altered handwriting kinematics with respect to healthy controls: higher movement duration, fragmented velocity profile and higher jerk. Furthermore, motor abilities and cognitive status of PwMS were related to handwriting parameters in accordance with the evidence that MS is a multifactorial disease affecting different domains. These results suggested that the proposed methodology might be a valuable tool to quantitatively assess handwriting impairments and the efficacy of handwriting treatments in PwMS.

It is now well established that the motor system plays a pivotal role in action observation and that the neurophysiological processes underlying perception and action overlaps. However, while various experiments have shown a specific facilitation of the contralateral motor cortex during action observation, no information is available concerning the dynamics of interhemispheric interactions. The aim of the present study was, therefore, to assess interhemispheric inhibition during the observation of others' actions. We designed a transcranial magnetic stimulation (TMS) experiment in which we measured both corticospinal excitability and interhemispheric inhibition, this latter by means of the ipsilateral silent period (iSP), while participants observed two motor tasks (tapping or grasping). We show that the iSP is enhanced during movement observation and that this modulation is tuned to the kinematics of the observed movements. An additional experiment was performed in which the TMS intensity was adjusted to match corticospinal excitability between rest and action observation. This resulted in a relative decrease of iSP. Overall, our data strongly suggest that action observation, as action execution, involves interhemispheric inhibitory mechanisms between the two motor cortices, and that this neural activity appears to be firmly shaped by the ongoing observed movement and its intrinsic dynamics., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions., Objective: The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS)., Methods: COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training., Results: The adherence to the treatment was 84% (33.4/40). Of the patients with MS, 94% (15/16) understood the instructions given, 100% (16/16) felt independent to use COGNI-TRAcK at home, 75% (12/16) found the exercises interesting, and 81% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23)., Conclusions: As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention.

Limb immobilization and nonuse are well-known causes of corticomotor depression. While physical training can drive the recovery from nonuse-dependent corticomotor effects, it remains unclear if it is possible to gain access to motor cortex in alternative ways, such as through motor imagery (MI) or action observation (AO). Transcranial magnetic stimulation was used to study the excitability of the hand left motor cortex in normal subjects immediately before and after 10 h of right arm immobilization. During immobilization, subjects were requested either to imagine to act with their constrained limb or to observe hand actions performed by other individuals. A third group of control subjects watched a nature documentary presented on a computer screen. Hand corticomotor maps and recruitment curves reliably showed that AO, but not MI, prevented the corticomotor depression induced by immobilization. Our results demonstrate the existence of a visuomotor mechanism in humans that links AO and execution which is able to effect cortical plasticity in a beneficial way. This facilitation was not related to the action simulation, because it was not induced by explicit MI., (© The Author 2013. Published by Oxford University Press.)

Short-term upper limb disuse induces a hemispheric unbalance between the primary motor cortices (M1s). However, it is still unclear whether these changes are mainly attributable to the absence of voluntary movements or to the reduction of proprioceptive information. The goal of this work was to investigate the role of proprioception in modulating hemispheric balance during a short-term right arm immobilization. We evaluated the 2 M1s excitability and the interhemispheric inhibition (IHI) between M1s in 3 groups of healthy subjects. Two groups received during the immobilization a proprioceptive (P-VIB, 80 Hz) and tactile (T-VIB, 30 Hz) vibration to the right hand, respectively. Another group did not receive any conditioning sensory inputs (No-VIB). We found that in the No-VIB and in the T-VIB groups immobilization induced a decrease of left M1 excitability and IHI from left to right hemisphere and an increase of right M1 excitability and IHI from right to left hemisphere. Differently, only a partial decrease in left M1 excitability, no change in right M1 excitability and in IHI was observed in the P-VIB group. Our findings demonstrate that the maintenance of dynamic proprioceptive inputs in an immobilized arm through muscle vibration can prevent the hemispheric unbalance induced by short-term limb disuse., (© The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Microbiological diagnosis is crucial for the appropriate management of implant-associated orthopedic infections (IAOIs). Sonication of biomaterials for microbiological diagnosis has not yet been introduced in routine clinical practice. Aim of this study was to describe the advantages and feasibility of this procedure in the clinical setting. We prospectively studied 56 consecutive patients undergoing revision because of IAOI and compared the sensitivity of sonication of explanted orthopedic implants with standard cultures. Patients were divided into two groups: those with foreign body infection (FBI, 15 patients) and those with prosthetic joint infection (PJI, 41 patients). Clinical, radiological and microbiological features were recorded. In the PJI group the sensitivity of sonication in detecting bacterial growth was higher than conventional culture (77% vs 34.1% respectively, p<0.002), while no difference was observed in the FBI group (85.7% vs 86% respectively, p>0.05). Coagulase-negative Staphylococci accounted for 90% of the bacteria detected by sonication. Moreover, we found that in the PJI group the sensitivity of sonication was not affected by the timing of antibiotic interruption before surgery. Sonication remains an important tool to improve microbiological diagnosis in PJIs, especially in patients who received previous antimicrobial treatment.

Motor imagery is a mental process during which subjects internally simulate a movement without any motor output. Mental and actual movement durations are similar in healthy adults (isochrony) while temporal discrepancies (anisochrony) could be an expression of neurological deficits on action representation. It is unclear whether patients with multiple sclerosis (PwMS) preserve the capacity to simulate their own movements. This study investigates the ability of PwMS to predict their own actions by comparing temporal features of dominant and non-dominant actual and mental actions. Fourteen PwMS and nineteen healthy subjects (HS) were asked to execute and to imagine pointing arm movements among four pairs of targets of different sizes. Task duration was calculated for both actual and mental movements by an optoelectronic device. Results showed temporal consistency and target-by-target size modulation in actual movements through the four cycles for both groups with significantly longer actual and mental movement durations in PwMS with respect to HS. An index of performance (IP) was used to examine actual/mental isochrony properties in the two groups. Statistical analysis on IP showed in PwMS significantly longer actual movement durations with respect to mental movement durations (anisochrony), more relevant for the non-dominant than dominant arm. Mental prediction of motor actions is not well preserved in MS where motor and cognitive functional changes are present. Differences in performing imagined task with dominant and non-dominant arm could be related to increased cognitive effort required for performing non-dominant movements.

Background: Freezing of gait (FOG) is a disabling impairment for people with Parkinson's disease (PD) and may not respond to medications. The effectiveness of physical therapy for FOG is debatable. Action observation strategies to overcome FOG may enhance physical training., Objective: To assess whether action observation, combined with practicing the observed actions, may reduce FOG episodes., Methods: Twenty patients with PD entered a single-blind trial and were randomly assigned to the experimental (Action) or control (Landscape) groups. Those in the Action group watched video clips showing specific movements and strategies to circumvent FOG episodes, whereas those in the Landscape group watched video clips of static pictures showing different landscapes. All patients underwent identical physical therapy training, 3 sessions a week for 4 weeks., Results: The FOG Questionnaire score and the number of FOG episodes were significantly reduced in both groups after the training period. At follow-up examination (4 weeks after the end of the intervention), a significant reduction in the number of FOG episodes was observed only in the Action group. Motor performance (walking and balance) and quality-of-life assessments were significantly improved in both groups at the end of training and at follow-up., Conclusions: Our results suggest that action observation has a positive additional effect on recovery of walking ability in PD patients with FOG. Further studies on the combination of observation and imitation to supplement a physical training program may result in an innovative rehabilitative approach for FOG.

The cerebellum is involved in the generation of essential tremor (ET) and cerebellar timing function is altered in patients with ET showing an increased variability of rhythmic hand movements. Using a sensor-engineered glove, we evaluated motor behaviour during repetitive finger tapping movements in 15 patients with ET and in 11 age- and gender-matched normal subjects. In addition, we investigated whether, in patients with ET, an inhibitory repetitive transcranial magnetic stimulation (1 Hz-rTMS) over lateral cerebellum was able to change timing properties and motor behaviour. Patients with ET showed a longer touch duration (TD) and a lower inter tapping interval (ITI) than normal subjects. The temporal variability of the movement (coefficient of variation of ITI) was increased in patients with ET. Neither clinical rating scale or tremor measurements correlated with any parameter of motor performance in the ET group. 1 Hz-rTMS over ipsilateral lateral cerebellum transiently affected the performance of patients with ET, by reducing TD values and normalizing ITI values. After 1 Hz-rTMS, the coefficient of variation of ITI was restored to values similar to those of normal subjects. We postulate that the strategy to increase TD, probably adopted to allow a better perception of movement, can affect ITI and its variability. The results support the idea that the cerebellum plays a central role in the selection of motor strategy of rhythmic finger movements, particularly in terms of temporal organization of movement.

Patients with focal dystonia exhibit proprioception abnormalities that can lead to kinematic deficits. Proprioceptive abnormalities are present in both symptomatic and asymptomatic body parts of dystonic patients. To ascertain whether in patients with idiopathic cervical dystonia (CD) movements performed with nondystonic segments display kinematic abnormalities, we studied trajectory formation of out and back arm reaching movements in 10 patients with CD (before and 3 weeks after treatment with Botulinum toxin) and in 10 age-matched controls. Before treatment, patients with CD showed significant trajectory abnormalities when compared with normal controls. Patients' trajectories were more curved with asymmetrical temporal velocity profiles as well as increased hand path areas, and had longer reversal lags between the out and back segments. Treatment with botulinum toxin improved all the kinematic parameters. These results suggest that in patients with CD, movements performed with nondystonic segments are abnormal. The kinematic abnormalities are likely to derive from long-standing defective integration of the proprioceptive input, which, in turn, causes general changes in the internal models of limb dynamics. It is plausible that treatment with botulinum toxin partially restores proprioceptive processing and thus, such internal models.

The prevalence of hip subluxation and dislocation in cerebral palsy ranges between 3% and 75% in the literature. Clinical signs are rigidity, pain and instability. We assessed functionality, stability and symptoms in 20 patients preoperatively and after follow-up. A varus derotation osteotomy was performed in cases with subluxation or dislocation, while a Chiari osteotomy was performed in the presence of a concomitant acetabular dysplasia. Results were good in 64%, fair in 22% and poor in 14% of patients treated with a varus derotation osteotomy. In patients treated with a Chiari osteotomy, results were good in 43% of cases, fair in 43% and poor in 14%. Subluxated or dislocated hips generally show several anomalies: their severity is directly proportional to the degree of neurological impairment. In the most severe cases, correction of just one of such anomalies might not be sufficient to guarantee good results of the surgery.

To elucidate the role of ipsilateral motor cortex (M1) in the control of unilateral finger movements (UFMs) in humans we used a conditioning protocol of 1-Hz repetitive transcranial magnetic stimulation (1-Hz rTMS) over M1 in 11 right-handed healthy subjects. We analysed the effects of conditioning rTMS on UFMs of different complexity (simple vs sequential finger movements), and performed with a different modality (internally vs externally paced movements). UFMs were monitored with a sensor-engineered glove, and a quantitative evaluation of the following parameters was performed: touch duration (TD); inter-tapping interval (ITI); timing error (TE); and number of errors (NE). 1-Hz rTMS over ipsilateral M1 was able to affect the performance of a sequence of finger opposition movements in a metronome-paced condition, significantly increasing TD and reducing ITI without TE changes. The effects on motor behaviour had a different magnitude as a function of the sequence complexity. Further, we found a different effect of the ipsilateral 1-Hz rTMS on externally paced movements with respect to an internally paced condition. All these findings indicate that ipsilateral M1 plays an important role in the execution of sequential UFMs. Interestingly, NE did not change in any experimental condition, suggesting that ipsilateral M1 influences only the temporal and not the spatial accuracy of UFMs. Finally, the duration (up to 30 min) of 1-Hz rTMS effects on ipsilateral M1 can indicate its direct action on the mechanisms of cortical plasticity, suggesting that rTMS can be used to modulate the communication between the two hemispheres in rehabilitative protocols.

C. Ghez, J. Gordon, and M. R Ghilardi (1995; J. Gordon, M. R Ghilardi, & C. Ghez, 1995; R. L. Sainburg, M. R Ghilardi, H. Poizner, & C. Ghez, 1995) have found that proprio-ceptive deafferentation impairs feedforward and feedback mechanisms that control reaching movements. In the present study, the authors found immobilization-induced changes in limb kinematics, including joint motion, in 32 healthy participants who performed out-and-back movements before and after 0, 6, or 12 hr of immobilization of the left arm. Control participants did not undergo the arm immobilization procedure. Immobilization for 12 hr, but not 6 hr, caused trajectories with increased hand-path areas and altered interjoint coordination. The abnormalities were smaller in amplitude but similar in quality to those reported in deafferented patients (R. L. Sainburg et al.). In addition, movement onset point significantly drifted after immobilization. Thus, short-term limb disuse can affect interjoint coordination by acting on feedforward mechanisms. These behavioral alterations are potentially related to cortical plastic changes.

Several observations support the notion that integration of neck proprioceptive input is impaired in cervical dystonia (CD). An example is the inconsistent or opposite to normal effect of lateral neck muscle vibration on body rotation during stepping. We hypothesized that lateral neck vibration produces abnormal responses also in a static task. Normal subjects and patients with CD stood quietly with eyes closed, without or with vibration applied to the sternocleidomastoid muscle, and center of foot pressure and body sway were recorded by a dynamometric platform. Patients had a larger than normal sway under control condition. They showed little or no postural responses to vibration. When body tilt occurred, it was rarely in the frontal plane as in normal subjects, but in the sagittal plane. No relationship existed between vibration-induced tilt during stance and body rotation during stepping. Therefore, in CD, proprioceptive neck input is less used for the construction of the postural vertical during quiet stance than it is used for the definition of the subjective straight ahead during a dynamic task., ((c) 2006 Movement Disorder Society.)

Essential tremor (ET) is a common movement disorder causing an important functional disability. ET is generally regarded as a monosymptomatic disorder, but additional signs may be present. We analyzed postural sway in 19 patients with classic ET and in 19 sex- and age-matched normal controls (NC) to uncover possible abnormalities of balance control. Static posturography was performed with eyes open (EO) and closed during quiet stance and during performance of mental calculation or motor sequence of thumb opposition to the other fingers. No significant differences of center of foot pressure (COP) parameters were observed between patients and controls during quiet standing. Visual deprivation induced a similar worsening of postural sway in both groups. Concomitant performance of a cognitive or motor task did not affect COP area, whereas COP path was significantly modified by the cognitive task in both groups. In all EO conditions, the COP path was significantly lower in NC than in ET, but such offset was related only to the group of ET patients with head tremor. This study demonstrates that balance control is only minimally affected in ET, although patients with head involvement and longer disease duration tend to present a reduced postural stability. The "dual-task effect" is less important in ET than in Parkinson's disease patients., (Copyright (c) 2005 Movement Disorder Society.)