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Biomedical subjects

H Poizner

Publications and source records attributed to H Poizner.

At least 37 records · Page 2Linked to original sources

Pointing to remembered targets in 3-D space in Parkinson's disease.

A three-dimensional tracking system was used to examine whether subjects with Parkinson's disease (PD) would show characteristic performance deficits in an unconstrained pointing task. Five targets were presented in a pyramidal array in space to 11 individuals with mild to moderate PD and 8 age-matched controls. After the target was indicated, subjects closed their eyes and pointed to the remembered target locations without vision. Despite the absence of visual feedback during movement, PD subjects were as accurate overall as controls. However, PD subjects showed greater variable errors, more irregular trajectories, and a vertical endpoint bias in which their endpoints were significantly lower than controls. They also showed deficiencies in the compensatory organization of joint rotations to ensure consistency in azimuthal (horizontal) positioning of the arm endpoint. We concluded that, under appropriate task conditions, PD subjects may not show overall deficits in accuracy even when making targeting movements at normal speed without visual feedback. Nevertheless, our findings indicate that there are certain dimensions of performance which are selectively altered in Parkinson's disease even when overall performance is normal.

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Pointing in 3D space to remembered targets. I. Kinesthetic versus visual target presentation.

This study investigated the influence of different modalities of target information (visual, kinesthetic) on the accuracy, kinematics, and interjoint coordination of pointing movements to remembered targets. The targets were presented by a robot arm in five locations in three-dimensional (3D) space, either as a point of light in a dark room ("visual" condition), or kinesthetically. Relative pointing accuracy in the visual compared with kinesthetic conditions was influenced by the target location: pointing errors were the largest for the visual targets most eccentric relative to the subject's head. In addition, for the two most lateral targets, the final arm positions were, on average, closer to the center than the targets in the visual condition and farther from the center than the targets in the kinesthetic conditions. This result suggests that the pattern of errors in the visual condition described elsewhere ("range effect") may derive from visual processing rather than motor planning and implementation. Two modes of kinesthetic target presentation were utilized. During "passive" kinesthetic presentation of the target, the experimenter moved the subject's relaxed arm. Alternately, in "active" kinesthetic presentation of the target, the subject actively (with minimal help from the experimenter) moved his arm. No visual feedback was allowed in either kinesthetic condition. The variability in the final fingertip position was significantly smaller in the active condition than in the passive condition. In contrast, variability in the final values of arm orientation angles did not differ significantly in the active and passive conditions. This apparent contradiction may be resolved by the fact that, for the given target location, the influence of the deviation of these angles in the given trial from their average values on the position of the fingertip tended to be mutually compensated, and this tendency was stronger in the active condition. Our analysis of the correlations among the arm orientation angles and of the relationship between the initial and final arm configurations suggests that the kinesthetic conditions enabled the implementation of a mixture of strategies for achieving accuracy. The first strategy is to use a specific memory of an adequate arm configuration (that assumed during target presentation), such that accuracy is achieved by using this memory as a template. The second strategy is to use synergistically coordinating joint angles, such that accuracy is achieved by focusing on a specific endpoint that can be reached by a range of equivalent arm positions. The latter strategy was better utilized in the active condition. In conclusion, our results indicate that human subjects can use diverse sensory information to achieve comparable final accuracy, but that the details of the strategies employed differ with the kind of information available.

Adult↗

Visual-imitative dissociation apraxia.

Liepmann posited that, in right handers, the left parietal lobe contains movement formulas or representations. Therefore, performance failures may be induced by degraded representations, a failure of these representations to influence motor systems or a failure of stimuli to fully access these representations. Imitation may help the performance of subjects with degraded representations. However, patients who have impaired visual access to movement representations may perform more poorly with imitation than to verbal command. Trajectories of repetitive 'slicing' gestures made by a previously reported subject (Raymer et al.) with an infarction in the left visual association cortex (left occipital and inferior temporal lobe) that spared the parietal lobe were contrasted with those of three apraxic subjects with lesions that included the left parietal lobe and four non-brain-damaged control subjects. All subjects were asked to produce the gesture to verbal command and to imitation. Movements of the left hand, wrist, elbow and shoulder were digitized from neighboring views, reconstructed in three dimensions, and analysed graphically and numerically. The apraxic subjects with left parietal damage were unable to maintain the proper linearity and spatiotemporal attributes of their wrist motions and showed interjoint coordination deficits. Their deficits were most pronounced to verbal command, with their movements improving though remaining poorly performed when they imitated. The subject with the left occipital and inferior temporal lesion that spared parietal cortex, however, showed an opposite pattern. This subject exhibited close to normal performance when producing the movement to verbal command, but significant deficits when imitating.

Aged↗

Progressive ideomotor apraxia: evidence for a selective impairment of the action production system.

We report a patient with slowly progressive bilateral limb apraxia associated with an asymmetrical focal degenerative process of the parietal lobes. Clinical assessment of praxis production suggested a striking deficit in controlling the spatiotemporal attributes of purposeful skilled limb movements, consistent with ideomotor apraxia. The precise nature of the action production impairment was further defined by objective three-dimensional computergraphic analysis of transitive movements which demonstrated significant kinematic deficits in spatial accuracy, timing, spatiotemporal coupling, and joint coordination. Gesture comprehension and discrimination were spared. Furthermore, detailed evaluation of the conceptual praxis system revealed that despite an almost complete inability to perform transitive movements accurately, abstract knowledge of tool function and action was remarkably well preserved. The critical dissociation between intact conceptual knowledge of action and impaired movement execution documented in this case points to a fundamental competence/performance dichotomy in apraxia and provides empirical support for cognitive models of praxis that divide the action system into distinct conceptual and production subcomponents. Within this theoretical framework, our patient's severe ideomotor apraxia is interpreted to represent a selective disruption of the action production system.

Apraxias↗

Aphasic and parkinsonian signing: differences in phonological disruption.

Since movements of the articulators in sign, unlike in speech, are directly observable, we can investigate signing not only as linguistic behavior but also as motor behavior and directly contrast linguistic-representational and motor-execution disorders of signing. We compared the temporal sequencing characteristics (duration of segments, pausing, periods of change in handshape posture), intactness of distinctive features, and correct use of prosodic templates in three pairs of signers--two Deaf aphasic signers with posterior damage in the left hemisphere, two signers with Parkinson's disease, and two gender- and age-matched control signers. With respect to distinctive features, the aphasic signers exhibited selection errors in the American Sign Language (ASL) distinctive features system, while the Parkinsonian signers showed an intact distinctive feature inventory, but with disturbances in executing these features. The Parkinsonian signers, unlike the aphasic and control signers, showed marked disturbances in the temporal organization and coordination of what we argue are the two subsystems of the ASL sign stream--handshape and movement. The findings demonstrate a phonetic deficit in Parkinsonian signers, in contrast with aphasic signers who showed a disruption in the underlying representation and syllabification processes in the language.

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The interaction of visual and proprioceptive inputs in pointing to actual and remembered targets.

Errors in pointing to actual and remembered targets presented in three-dimensional (3D) space in a dark room were studied under various conditions of visual feedback. During their movements, subjects either had no vision of their arms or of the target, vision of the target but not of their arms, vision of a light-emitting diode (LED) on their moving index fingertip but not of the target, or vision of an LED on their moving index fingertip and of the target. Errors depended critically upon feedback condition. 3D errors were largest for movements to remembered targets without visual feedback, diminished with vision of the moving fingertip, and diminished further with vision of the target and vision of the finger and the target. Moreover, the different conditions differentially influenced the radial distance, azimuth, and elevation errors, indicating that subjects control motion along all three axes relatively independently. The pattern of errors suggest that the neural systems that mediate processing of actual versus remembered targets may have different capacities for integrating visual and proprioceptive information in order to program spatially directed arm movements.

Adult↗

Joint coordination deficits in limb apraxia.

Competing models of the basis of limb apraxia were tested through analysis of joint coordination deficits in three apraxic subjects with lesions that included the left parietal lobe. Three-dimensional shoulder, elbow, wrist and hand trajectories were recorded for repetitive 'slicing' gestures made in a series of conditions in which contextual cues were introduced in a graded fashion. The apraxic subjects showed marked deficits in joint coordination across context conditions. Even when actually manipulating a tool and object, the apraxic subjects failed to show proper joint synchronization, failed to apportion their relative joint amplitudes properly, and failed to produce the correct phase relationships among pairs of arm angles. Thus, apraxic subjects not only have deficits in the spatial plan for the movement, but they also have deficits in translating those plans into the details of the angular motions at the joints, even when actually manipulating a tool and object. These data support a model of apraxia in which apraxia can result from either the destruction of visuo-kinaesthetic motor representations of learned movement, stored in posterior association cortex, or from a separation of these representations from premotor or motor areas.

Aged↗

Control of limb dynamics in normal subjects and patients without proprioception.

1. We recently showed that patients lacking proprioceptive input from their limbs have particular difficulty performing multijoint movements. In a pantomimed slicing gesture requiring sharp reversals in hand path direction, patients showed large hand path distortions at movement reversals because of failure to coordinate the timing of the separate reversals at the shoulder and elbow joints. We hypothesized that these reversal errors resulted from uncompensated effects of inertial interactions produced by changes in shoulder joint acceleration that were transferred to the elbow. We now test this hypothesis and examine the role of proprioceptive input by comparing the motor performance of five normal subjects with that of two patients with large-fiber sensory neuropathy. 2. Subjects were to trace each of six template lines presented randomly on a computer screen by straight overlapping out-and-back movements of the hand on a digitizing tablet. The lines originated from a common starting position but were in different directions and had different lengths. Directions and lengths were adjusted so that tracing movements would all require the same elbow excursion, whereas shoulder excursion would vary. The effects of varying interaction torques on elbow kinematics were then studied. The subject's dominant arm was supported in the horizontal plane by a low-inertia brace equipped with ball bearing joints and potentiometers under the elbow and shoulder. Hand position was monitored by a magnetic pen attached to the brace 1 cm above a digitizing tablet and could be displayed as a screen cursor. Vision of the subject's arm was blocked and the screen cursor was blanked at movement onset to prevent visual feedback during movement. Elbow joint torques were calculated from joint angle recordings and compared with electromyographic recordings of elbow joint musculature. 3. In control subjects, outward and inward paths were straight and overlapped the template lines regardless of their direction. As prescribed by the task, elbow kinematics remained the same across movement directions, whereas interaction torques varied substantially. The timing of the onsets of biceps activity and the offsets of triceps activity during elbow flexion varied systematically with direction-dependent changes in interaction torques. Controls exploited or dampened these interaction torques as needed to meet the kinematic demands of the task. 4. In contrast, the patients made characteristic errors at movement reversals that increased systematically across movement directions. These reversal errors resulted from improper timing of elbow and shoulder joint reversals.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Influence of movement speed on accuracy of pointing to memorized targets in 3D space.

Subjects performed three-dimensional (3D) pointing movements as accurately as possible with their eyes closed under four different speed conditions: 'slow', 'normal', 'fast' and 'maximal' (peak velocities of 0.62, 1.61, 2.51 and 4.68 m/s, respectively). Movement speed did not significantly affect the magnitude of constant pointing errors, nor that of variable errors, except for movements in the 'maximal' condition when peak velocity values larger than 4.5 m/s were reached. The findings are consistent with the hypothesis that final arm position may be specified regardless of movement dynamics.

Acceleration↗

Azimuth errors in pointing to remembered targets under extreme head rotations.

Errors in pointing to remembered target locations in 3-D space were studied when subjects were free to move their heads, and when they rotated their heads to the extreme right or left. Relative to pointing when the head was free to move, head rotations to the right shifted the final position of the responding arm to the left, whereas head rotations to the left shifted the final position of arm to the right. Horizontal rotation of the head had no systematic influence on elevation and radial distance errors. The influence of head rotations on pointing errors may be mediated by small shifts in the internal representation of external space, shifting the presentation of space in the opposite direction of the head rotation.

Adult↗

Spatial planning deficits in limb apraxia.

Geschwind (1975) proposed a disconnection model in which an apraxic subject is unable to carry out movements to command because the left hemisphere that comprehended the verbal command is disconnected from the right premotor and motor areas which controls the left hand. An alternate model, however, proposes that apraxia results from destruction of spatiotemporal representations of learned movement stored in the left hemisphere (Heilman, 1979). The disconnection hypothesis would predict that apraxic subjects should be able to correctly imitate gestures and correctly use actual tools since these tasks do not require language. The movement representation model predicts that imitation and actual tool use would also be impaired. Motion analyses were performed on the trajectories of repetitive 'slicing' gestures made in a series of conditions in which contextual cues were introduced in a graded fashion. Four cue conditions were presented: no cues (verbal command), object present, tool present and both object and tool present. Positions of the hand, wrist, elbow, and shoulder were digitized from neighbouring views, reconstructed in three dimensions and analysed with respect to specific spatiotemporal features of the trajectories. Three subjects with limb apraxia, who had lesions that included left parietal cortex, and four neurologically intact subjects participated. The apraxic subjects showed disturbances in planning the movement of the hand in space across the cue conditions. For example, they showed deficits in the plane of motion, the shape of the trajectory and in the coupling of hand speed and trajectory shape even when given full contextual cues. These data support the hypothesis that apraxia can result from the destruction of spatiotemporal representations of learned movement, rather than from a disconnection between the receptive language areas in the left hemisphere and the contralateral motor cortices.

Aged↗

Loss of proprioception produces deficits in interjoint coordination.

1. We analyzed the performance of a simple pantomimed gesture in 2 patients with large-fiber sensory neuropathy and 11 control subjects to determine how proprioceptive deafferentation disrupts unconstrained multijoint movements. Both patients had near-total loss of joint position, vibration, and discriminative touch sensation in the upper extremities. Muscle strength remained intact. 2. Subjects performed a gesture similar to slicing a loaf of bread. In this gesture, the hand first moves outward from the body, reverses direction sharply, and then moves back toward the body. Accurate performance requires precise coordination between the shoulder and elbow joints during movement reversals. Movements were performed under two conditions: with eyes open and with eyes closed. Three dimensional shoulder, elbow, wrist, and hand trajectories were recorded on a WATSMART system. 3. When control subjects performed the gesture with their eyes closed, their wrist trajectories were relatively straight and individual cycles of motion were planar. Movements reversed direction sharply, such that outward and inward portions of the wrist path were closely aligned. Corresponding to this spatial profile, the reversals in movement direction at the shoulder joint, from flexion to extension, and at the elbow joint, from extension to flexion, were synchronous. 4. In contrast, when deafferented patients performed the gesture with their eyes closed, their wrist trajectories were highly curved and individual cycles were severely nonplanar. The wrist paths showed a characteristic anomaly during the reversal in movement direction, when elbow joint movement became transiently locked. Correspondingly, the movement reversals at the shoulder and elbow joints were severely temporally decoupled. 5. When patients were able to view their limbs during performance of this gesture there was significant improvement in the linearity and planarity of movements. However, the patients remained unable to synchronize the movements at the shoulder and elbow joints to produce spatially precise wrist paths. 6. We conclude that loss of proprioception disrupts interjoint coordination and discuss the hypothesis that this interjoint coordination deficit results from a failure to control the interaction forces that arise between limb segments during multijoint movements.

Adult↗

Dissociation between linguistic and nonlinguistic gestural systems: a case for compositionality.

This paper addresses the issue of the separability of disorders of sign language from disorders of gesture and pantomime. The study of a left-lesioned deaf signer presents one of the most striking examples to date of the cleavage between linguistic signs and manual pantomime. The left-hemisphere lesion produced a marked sign language aphasia disrupting both the production and the comprehension of sign language. However, in sharp contrast to the breakdown of sign language, the ability to communicate in nonlinguistic gesture was remarkably spared. This case has important implications for our understanding of the neural mediation of language and gesture. We argue that the differences observed in the fractionation of linguistic versus nonlinguistic gesture reflect differing degrees of compositionality of systems underlying language and gesture. The compositionality hypothesis receives support for the existence of phonemic paraphasias in sign language production, illustrating structural dissolution which is absent in the production of pantomimic gesture. Understanding the neural encoding of compositional motoric systems may lead to a principled anatomical account of the neural separability of language and gesture. This case provides a powerful indication of the left hemisphere's specialization for language-specific functions.

Aphasia↗

Three-dimensional trajectory analysis of congenital mirror movements in a single subject.

Mirror movements are involuntary movements executed by one side of the body that occur with voluntary activation of homologous muscles of the other side. Although such movements have been described qualitatively and with surface EMG recordings, the spatial and temporal characteristics of these movements remain relatively unexplored. We studied selected simple and complex upper limb movements in a 20-yr.-old woman with congenital mirror movements and no other neurological disorder. Movements were digitized in three-dimensional space, reconstructed computergraphically, and analyzed numerically and graphically. Mirror movements had smaller amplitudes than did the corresponding voluntary movements, and there was, in general, temporal coupling between mirror and voluntary movements. Nonetheless, mirror movements were not always a perfect mirror image of the corresponding voluntary movements and sometimes differed in timing and trajectory shape from the original movement. Substantially larger mirror movements were elicited by distal than by proximal movements, and mirror movements were enhanced when loads were applied to the hand executing the voluntary movement. These data support the proposal that congenital mirror movements are produced by a partial failure of decussation of the pyramidal tract. We suggest that the variability in the extent to which mirror movements correspond to the voluntary movements is due to propriospinal and descending extrapyramidal input.

Adult↗

Three-dimensional computergraphic analysis of apraxia. Neural representations of learned movement.

The left cerebral hemisphere in man contains anatomical structures specialized not only for language but also for higher-order motor programming. One method of studying the nature of these motor programs is by observing the type of errors made by patients who have left hemisphere damage. A major problem, however, in investigating the disorders that result from failure of this specialized left hemisphere system (the apraxias) has been the difficulty in obtaining objective measurement of movement in three-dimensional space. To this end, we provide the first three-dimensional analysis of the nature of movement errors in apraxia. Two apraxic subjects with lesions to the left hemisphere and 5 matched control subjects were studied. The apraxic subjects showed impairments in the control of movement timing and spatial relations, as well as decoupling in the normally tight relation between certain spatial and temporal aspects of their movement trajectories. Further, the use of the distal musculature by apraxic subjects was more impaired than their use of the proximal musculature, suggesting more distal representation in any space-time maps of learned movement. These data provide further insight into the nature of the representations of learned skilled movements in the left cerebral hemisphere.

Aged↗

Hand dominance for signing: clues to brain lateralization of language.

Virtually all right-handed individuals are left hemisphere dominant for language. Sign languages of the deaf provide an unusual vehicle for exploring the link between handedness and hemispheric specialization for language since in sign language the hands themselves are the language articulators. Performance of the right and left hand was examined in deaf native users of American Sign Language (ASL) for speeded production of one-handed signs and for shadowing of signed discourse. Opposite patterns of asymmetries in hand performance were found in right- and left-handers. However, left-handers were more flexible than right-handers in signing with their non-preferred hand. Furthermore, unusual patterns of hand use for sign were found in a deaf signer with a left hemisphere lesion, possibly indexing increased mediation of the intact hemisphere. Implications for brain organization of language in a visual-gestural mode are discussed.

Adult↗