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Biomedical subjects

Mindy F Levin

Publications and source records attributed to Mindy F Levin.

18 recordsLinked to original sources

Central resetting of neuromuscular steady states may underlie rhythmical arm movements.

Changing the steady-state configuration of the body or its segments may be an important function of central pattern generators for locomotion and other rhythmical movements. Thereby, muscle activation, forces, and movement may emerge following a natural tendency of the neuromuscular system to achieve the current steady-state configuration. To verify that transitions between different steady states occur during rhythmical movements, we asked standing subjects to swing one or both arms synchronously or reciprocally at approximately 0.8 Hz from the shoulder joints. In randomly selected cycles, one arm was transiently arrested by an electromagnetic device. Swinging resumed after some delay and phase resetting. During bilateral swinging, the nonperturbed arm often stopped before resuming swinging at a position that was close to either the extreme forward or the extreme backward arm position observed before the perturbation. Oscillations usually resumed when both arms arrived at similar extreme positions when a synchronous bilateral pattern was initially produced or at the opposite positions if the initial pattern was reciprocal. Results suggest that a central generator controls both arms as a coherent unit by producing transitions between its steady state (equilibrium) positions. By controlling these positions, the system may define the spatial boundaries of movement. At these positions, the system may halt the oscillations, resume them at a new phase (as observed in the present study), or initiate a new motor action. Our findings are relevant to locomotion and suggest that walking may also be generated by transitions between several equilibrium configurations of the body, possibly accomplished by modulation and gating of proprioceptive reflexes.

Acoustic Stimulation↗

Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial.

BACKGROUND AND PURPOSE: Task-specific training improves functional outcomes after stroke. However, gains may be accompanied by increases in movements compensating for motor impairments. We hypothesized that restriction of compensatory trunk movements may encourage recovery of premorbid movement patterns leading to better functional outcomes. The goal was to determine whether task-specific training with trunk-restraint (TR) produces greater improvements in arm impairment and function than training without TR in patients with chronic hemiparesis. METHODS: Double-blind randomized control trial of a therapist-supervised home program (3 times per week, 5 weeks) in 30 patients with chronic hemiparesis stratified by arm impairment level (Fugl-Meyer) was performed. Intervention group (TR group) received progressive object-related reach-to-grasp training with prevention of trunk movements. Control group (C) practiced tasks without TR. Main outcome measures were upper limb impairment (Fugl-Meyer Arm Section) and function (TEMPA) and movement kinematics (trunk displacement, elbow extension; Optotrak, 10 trials) of a reach-to-grasp movement. Evaluations were repeated before, immediately after, and 1 month postintervention by blind evaluators. RESULTS: TR training led to greater improvements in impairment and function compared with C. Improvements were accompanied by increased active joint range and were greater in initially more severe patients. In these patients, TR decreased trunk movement and increased elbow extension, whereas C had opposite effects (increased compensatory movements). In TR, changes in arm function were correlated with changes in arm and trunk kinematics. CONCLUSIONS: Treatment should be tailored to arm impairment severity with particular attention to controlling excessive trunk movements if the goal is to improve arm movement quality and function.

Aged↗

Basic elements of arm postural control analyzed by unloading.

To address the question of how arm posture is controlled, we analyzed shoulder-elbow unloading responses in the horizontal plane for different directions of the initial load. The initial load, produced by a double-joint manipulandum, was suddenly diminished to 1of 12 randomly presented levels (60 to -10% of the initial load; in 6 out of 12 cases the final load direction varied by +/-20 degrees ). Subjects were instructed "not to intervene" in response to unloading. Neither the unloading onset nor the final load level was predictable and we assumed that the responses to rapid unloading were involuntary. Unloading elicited a smooth hand movement characterized by a bell-shaped velocity profile. The changes in hand position, joint angles, and joint torques generally increased with greater amounts of unloading. For each direction of the initial load, tonic electromyographic activity of the shoulder and elbow muscles also changed, depending on the amount of unloading. The shoulder and elbow joint torques before and after unloading were a function of the difference between the actual configuration of the arm and its referent configuration (R) described by the angles at which each joint torque was zero. The R configuration changed depending on the direction of the initial load. Our electromyographic data imply that these changes result from a central modification of muscle activation thresholds. The nervous system may thus control the R configuration in a task-specific way by leaving it unchanged to generate involuntary responses to unloading or modifying it to accommodate a new load direction at the same initial position. It is concluded that the R configuration is a major variable in both intentional and involuntary control of posture.

Adult↗

Differences in multi-joint kinematic patterns of repetitive hammering in healthy, fatigued and shoulder-injured individuals.

BACKGROUND: Work-related musculo-skeletal disorders have been previously related to movement repetition, inadequate postures, non-ergonomic environments, muscular imbalance and fatigue. However, no direct link between fatigue and injury has been experimentally shown. To address this problem, we compared the effects of fatigue and injury on the kinematics of repetitive hammering. METHODS: Healthy subjects (n=30) hammered repetitively both before and after fatigue. Fatigue was induced by a combination of static and dynamic procedures. Shoulder-injured subjects (n=15) hammered for 30s without fatigue. Kinematics of motion was recorded. FINDINGS: The movement time and shoulder range of motion during hammering were not affected by either fatigue or shoulder injury. When fatigued, the healthy subjects displayed decreased range of joint motion, peak velocity and peak acceleration of elbow motion during hammering as well as reduced grip strength. Shoulder-injured individuals had a smaller hammer trajectory amplitude than healthy controls with or without fatigue. They also had lower wrist range of motion, elbow peak velocity, and peak wrist and elbow acceleration compared to healthy subjects hammering without fatigue but only lower wrist peak acceleration compared to healthy subjects hammering with fatigue. INTERPRETATION: Results showed that fatigue affects elbow motion while shoulder injury affects both wrist and elbow motions during hammering. However, shoulder kinematics were not changed by either fatigue or shoulder injury. These changes at the wrist and elbow may reflect strategies used by individuals with shoulder injury to maintain constant movement duration and shoulder kinematics during movement.

Adult↗

Effect of tactile feedback on movement speed and precision during work-related tasks using a computer mouse.

Effects of tactile feedback on movement accuracy and speed were studied. Younger and older participants performed three tasks (1, select and drag word; 2, menu navigation; 3, select and drag cell) using commercial software and a mouse with or without tactile feedback. Task time and error number were recorded. Tasks were divided according to presence or absence of tactile feedback, and participants were divided into subgroups (high, average, low) based on Task 1 performance. Overall, older participants took longer (p < .0001) and made more errors (p < .001) than younger participants. There was an effect of feedback by task in younger participants for all six outcomes (p < 0.02). At the task level, with feedback, younger participants reduced performance time (13%) and errors (24%) on Task 1. Low- and average-performance younger participants benefited most from feedback for Task 1. Older low-performance participants also benefited from feedback for Task 1. For Task 3, older participants tended to take more time and make more errors with feedback. Tactile feedback may enhance performance when feedback is event related. Older people may not integrate sensation as well as younger individuals to enhance performance. Potential applications of this research include the development of tactile feedback interfaces to facilitate computer use.

Adult↗

Reaching in reality and virtual reality: a comparison of movement kinematics in healthy subjects and in adults with hemiparesis.

BACKGROUND: Virtual reality (VR) is an innovative tool for sensorimotor rehabilitation increasingly being employed in clinical and community settings. Despite the growing interest in VR, few studies have determined the validity of movements made in VR environments with respect to real physical environments. The goal of this study was to compare movements done in physical and virtual environments in adults with motor deficits to those in healthy individuals. METHODS: The participants were 8 healthy adults and 7 adults with mild left hemiparesis due to stroke. Kinematics of functional arm movements involving reaching, grasping and releasing made in physical and virtual environments were analyzed in two phases: 1) reaching and grasping the ball and 2) ball transport and release. The virtual environment included interaction with an object on a 2D computer screen and haptic force feedback from a virtual ball. Temporal and spatial parameters of reaching and grasping were determined for each phase. RESULTS: Individuals in both groups were able to reach, grasp, transport, place and release the virtual and real ball using similar movement strategies. In healthy subjects, reaching and grasping movements in both environments were similar but these subjects used less wrist extension and more elbow extension to place the ball on the virtual vertical surface. Participants with hemiparesis made slower movements in both environments compared to healthy subjects and during transport and placing of the ball, trajectories were more curved and interjoint coordination was altered. Despite these differences, patients with hemiparesis also tended to use less wrist extension during the whole movement and more elbow extension at the end of the placing phase. CONCLUSION: Differences in movements made by healthy subjects in the two environments may be explained by the use of a 2D instead of a 3D virtual environment and the absence of haptic feedback from the VR target. Despite these differences, our findings suggest that both healthy subjects and individuals with motor deficits used similar movement strategies when grasping and placing a ball in the two reality conditions. This suggests that training of arm movements in VR environments may be a valid approach to the rehabilitation of patients with motor disorders.

Journal Article↗

Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke: a controlled trial.

BACKGROUND AND PURPOSE: In prehension tasks with objects placed within arm's reach, patients with hemiparesis caused by stroke use excessive trunk movement to compensate for arm motor impairments. Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term. Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination. To evaluate the potential of this technique as a therapeutic intervention, we compared the effects of short-term reach-to-grasp training (60-trial training session) with and without physical trunk restraint on arm movement patterns in patients with chronic hemiparesis. METHODS: A total of 28 patients with hemiparesis were assigned to 2 groups: 1 group practiced reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness (trunk restraint), and the second group practiced the same task while verbally instructed not to move the trunk (control). Kinematics of reaching and grasping an object placed within arm's length were recorded before, immediately after, and 24 hours after training. RESULTS: The trunk restraint group used more elbow extension, less anterior trunk displacement, and had better interjoint coordination than the control group after training, and range of motion was maintained 24 hours later in only the trunk restraint group. CONCLUSIONS: Restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements in patients with chronic stroke than practice alone, and longer-term effects of this intervention should be evaluated.

Aged↗

Compensation for distal impairments of grasping in adults with hemiparesis.

Previous studies have shown that patients with arm and hand paresis following stroke recruit an additional degree of freedom (the trunk) to transport the hand during reaching and use alternative strategies for grasping. The few studies of grasping parameters of the impaired hand have been case studies mainly focusing on describing grasping in the presence of particular impairments such as hemi-neglect or optic ataxia and have not focussed on the role of the trunk in prehension. We hypothesized that the trunk movement not only ensures the transport of the hand to the object, but it also assists in orienting the hand for grasping when distal deficits are present. Nineteen patients with chronic hemiparesis and seven healthy subjects participated in the study. Patients had sustained a stroke of non-traumatic origin 6-82 months previously (31+/-22 months) and had mild or moderate to severe arm paresis. Using a whole hand grasp, subjects reached and grasped a cylinder (35 mm) that was placed sagittally (T1) or at a 45 degrees angle to the sagittal midline in the ipsilateral workspace (T2), both at about 90% arm's length (10 trials per target). Eight infrared emitting diodes were placed on bony landmarks of the hand, arm and trunk and kinematic data were recorded by an optical motion analysis system (Optotrak) for 2-5 s at 120 Hz. Hand position and orientation were recorded by a Fastrack Polhemus system. Our results show that during goal-directed prehension tasks, individuals with hemiparesis oriented the hand more frontally for grasping and used more trunk anterior displacement or rotation to transport the hand to the target compared to healthy subjects. Despite these changes, the major characteristics of reaching and grasping such as grip aperture size, temporal coordination between hand transport and aperture formation and the relative timing of grip aperture were largely preserved. For patients with more severe distal impairments, the amount of trunk displacement was also correlated with a more frontal hand orientation for grasping. Furthermore, in healthy subjects and patients without distal impairments, the trunk movement was mostly related to proximal arm movements while in those with distal impairments, trunk movement was related to both proximal and distal arm movements. Data support the hypothesis that the trunk movement is used to assist both arm transport and hand orientation for grasping when distal deficits are present.

Adult↗

Development and validation of a scale for rating motor compensations used for reaching in patients with hemiparesis: the reaching performance scale.

BACKGROUND AND PURPOSE: Recent movement analysis studies have described compensatory movement strategies used by people with hemiparesis secondary to stroke during reaching and grasping tasks. The purpose of this article is to describe the development of a new scale--the Reaching Performance Scale (RPS)--for assessing compensatory movements for upper-extremity reaching in people with hemiparesis secondary to stroke. SUBJECTS: Twenty-eight individuals with hemiparesis, with a mean age of 54.9 years (SD=18.6), participated. METHODS: The study design involved scale development with expert panels and criterion standards for validity. Participants were evaluated on the new scale as well as other clinical tests for validity. They were videotaped while performing reaching and grasping movements. RESULTS: The RPS scores correlated with measurements of grip force and Chedoke-McMaster Stroke Assessment and Upper Extremity Performance Test for the Elderly (TEMPA) scores. The RPS discriminated patients with different impairment levels according to the Chedoke-McMaster Stroke Assessment. Preliminary intrarater and interrater reliability coefficients were acceptable for the whole scale. Mean kappa values on individual scale components for 3 raters represented a mean of 67% (SD=13.5%) agreement. DISCUSSION AND CONCLUSION: Although the RPS shows some types of validity, more rigorous tests of reliability are needed for meaningful conclusions. This study is a first step in validating the scale to assess efficacy of intervention for motor recovery of the arm.

Adult↗

Hand orientation for grasping and arm joint rotation patterns in healthy subjects and hemiparetic stroke patients.

We previously demonstrated that the hand orientation for grasping (azimuth) is strongly coupled to arm movement direction in the horizontal plane. The question is whether this coupling is directly controlled or secondary to a regulation of the arm angular configuration. To this purpose, we quantified hand orientation and arm joint rotations during unconstrained reaching movements in healthy subjects and in patients with hemiparesis due to stroke since they use altered joint rotation patterns for reaching. Seven healthy subjects and eight patients with a right hemiparesis participated (four had a moderate and four had a mild disorder). Four electromagnetic sensors were used to measure hand orientation and to compute the wrist, elbow and shoulder joint angles. Hand azimuth at the time of grasping was correlated to arm movement direction in all the healthy and hemiparetic individuals. In healthy subjects, a regression analysis of the arm joint rotations suggested that the coupling between hand azimuth and movement direction was not due to a correlation with a particular degree of freedom. Patients used different hand orientations for grasping and different joint rotation patterns that varied according to their level of disability and the use of compensatory strategies. The findings observed in both healthy subjects and patients with stroke show that the coupling of hand azimuth for grasping to movement direction was controlled independently of the set of joint rotations used for reaching. This suggests that it is a basic synergy directly controlled by the motor system.

Adult↗

Hemispheric specialization in the co-ordination of arm and trunk movements during pointing in patients with unilateral brain damage.

During pointing movements involving trunk displacement, healthy subjects perform stereotypically, selecting a strategy in which the movement is initiated with either the hand or trunk, and where the trunk continues after the end of the hand movement. In a previous study, such temporal co-ordination was not found in patients with left-hemispheric brain lesions reaching with either their dominant paretic or with their non-dominant non-paretic arm. This co-ordination deficit may be associated in part with the presence of a lesion in the dominant left hemisphere. If so, then no deficit should be observed in patients with stroke-related damage in their non-dominant right hemisphere moving with their ipsilesional arm. To verify this, 21 right-hand dominant adults (7 who had had a stroke in the right hemisphere, 7 who had had a stroke in the left hemisphere and 7 healthy subjects) pointed to two targets located on a table in front of them in the ipsilateral and contralateral workspace. Pointing was done under three movement conditions: while not moving the trunk, while bending the trunk forward and while bending the trunk backwards. The experiment was repeated with the non-paretic arm of patients with stroke and for the right and left arms of healthy subjects. Kinematic data were recorded (Optotrak). Results showed that, compared to healthy subjects, arm-trunk timing was disrupted in patients with stroke for some conditions. As in patients with lesions in the dominant hemisphere, arm-trunk timing in those with lesions in the non-dominant hemisphere was equally more variable than movements in healthy subjects. However, patients with dominant hemisphere lesions used significantly less trunk displacement than those with non-dominant hemisphere lesions to accomplish the task. The deficit in trunk displacement was not due to problems of trunk control or sitting balance since, in control experiments, all subjects were able to move the trunk the required distance, with and without the added weight of the limb. Results support the hypothesis that the temporal co-ordination of trunk and arm recruitment during pointing movements is mediated bilaterally by each hemisphere. However, the difference in the range of trunk displacement between patients with left and right brain lesions suggests that the left (dominant) hemisphere plays a greater role than the right in the control of movements involving complex co-ordination between the arm and trunk.

Adult↗

Movement reorganization to compensate for fatigue during sawing.

Peripheral (muscle) aspects of fatigue are well documented. However, little is known about the central aspects of fatigue that could influence, in particular, multijoint coordination. To investigate the central aspects of fatigue, we compared the multijoint kinematics of non-fatigued and fatigued individuals while sawing. Muscle fatigue was associated with decreases in sawing force and movement amplitude at the elbow whereas the basic characteristics of the saw trajectory, including the movement direction, extent and duration, remained invariant. This invariance was maintained by increasing the movement amplitude at the wrist, shoulder and trunk. The system thus takes advantage of the redundancy of the motor apparatus to maintain the endpoint trajectory despite fatigue.

Adult↗

The development of coordination for reach-to-grasp movements in children.

When adults reach to grasp stationary targets, movement kinematics (endpoint trajectories, interjoint coordination) are highly stereotyped and stable. The emergence of an optimal coordination for reaching involves mastering the redundant number of degrees of freedom while the body grows. Reaching has been well studied in healthy children under the age of 3 years. We characterised the development of coordination during reaching in children over the age of 3 years and identified age ranges in which stable patterns emerge. A random sample of 38 healthy children aged 4-11 years and nine adults participated in the study. They reached from the seated position with the dominant arm and grasped a cone placed at three distances in the forward sagittal plane in front of the body. Kinematic data from markers placed on the arm, head and trunk were recorded at 100 Hz (Optotrak Motion Analysis System). Immature patterns of reaching were characterised by increased variability in younger compared to older children. Hand trajectories became smoother and less variable with age. Interjoint coordination became more consistent, while trunk displacement and variability decreased with age. Only children between 8 and 10 years old had variability similar to adults. Our data suggest that different aspects of movement kinematics mature at different rates. However, our data do not support the idea of a sequential maturation of different biomechanical variables.

Adult↗

Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain.

STUDY DESIGN: Transverse pelvis and thorax rotations were studied during walking in 39 patients with nonspecific low back pain and 19 healthy participants. OBJECTIVES: To gain insight into the consequences of low back pain for gait and to identify clinically useful measures for characterizing the quality of walking in patients with low back pain. SUMMARY OF BACKGROUND DATA: Gait studies in patients with low back pain have reported a decrease in walking velocity. In normal gait, in-phase pelvis-thorax coordination (synchronicity) evolves toward antiphase coordination (counterrotation) as walking velocity increases. This study examined the effect of walking velocity on pelvis and thorax rotations in patients with low back pain. METHODS: Amplitudes of pelvis and thorax rotations were calculated, and spectral analyses were performed. Pelvis-thorax coordination was characterized in terms of relative Fourier phase, and coupling strength was assessed by means of cross-spectral analysis. RESULTS: In comparison with healthy participants, relative Fourier phase was significantly smaller in low back pain patients for walking velocities of 3.8 km/h and higher, whereas coupling strength was significantly higher for velocities from 1.4 to 3.0 km/h. No significant group differences were found in amplitude or spectral content of individual pelvis and thorax rotations. CONCLUSION: In comparison with healthy participants, the gait of patients with low back pain was characterized by a more rigid, less flexible pelvis-thorax coordination in the absence of significant differences in the kinematics of the component rotations. This result suggests that coordination measures are more adequate in assessing quality of walking in patients with low back pain than are kinematic measures pertaining to the individual segment rotations, and that conservative therapy should use methods aimed at improving intersegmental coordination.

Adult↗

Use of the trunk for reaching targets placed within and beyond the reach in adult hemiparesis.

Multijoint movements such as reaching are impaired after brain lesions involving sensorimotor areas and pathways. However, the mechanisms by which such lesions affect motor control are not fully understood. Direct effects of the lesion may be partly compensated by both the system's redundancy and its plasticity. Indeed stroke patients with limited arm movement can reach objects placed within the reach of the arm by using a compensatory strategy involving trunk recruitment. A similar strategy is observed in healthy individuals reaching for objects placed beyond the reach of the arm. Determining the control mechanism(s) governing this compensatory strategy in stroke patients was the goal of this study. Kinematics of reaching movements in hemiparetic and healthy participants to targets placed within and beyond the length of the arm were analysed. Targets were placed sagittally in front of the midline of the body. Two targets (targets 1 and 2) were within reaching distance defined as the length of the stretched arm from axilla to wrist crease. Two others were beyond arm's reach so that one required a forward trunk inclination (target 3) and the other required body raising to a semi-standing position (target 4). Healthy participants used minimal trunk displacement for reaches to targets 1 and 2. For reaches to targets 3 and 4, trunk displacement increased with target distance. Whenever the trunk was involved, there was a stereotyped sequential recruitment of the arm and trunk in that the trunk began moving simultaneously with or before the hand and stopped moving after the end of hand movement. This suggested that the control system predicts that the trunk movement will be needed to extend the reach and includes the trunk, in an anticipatory way, into the reach. In contrast, most hemiparetic participants recruited their trunk for reaches to all four targets, even those placed close to the body. Similar to healthy individuals, the sequence of hand and trunk recruitment was stereotyped, suggesting that temporal planning aspects of the motor program underlying movement coordination were relatively unaffected. In contrast to healthy participants, the contribution of the trunk movement to the endpoint displacement was substantially higher in the hemiparetic group and occurred earlier in the reach. It is suggested that the target distance at which the trunk is integrated into the movement to extend the reach of the arm is attained around the limit of arm extension and that this limit is reduced in hemiparetic individuals.

Adult↗

Error correction strategies for motor behavior after unilateral brain damage: short-term motor learning processes.

In order to identify the mechanisms underlying motor impairments and motor learning following stroke-related brain damage, we analyzed correction strategies used by hemiparetic individuals to produce precise elbow flexion movements of the paretic arm and compared them to those of healthy individuals. Participants made rapid elbow flexion movements to a 6 degrees wide target and were instructed to correct movement errors as quickly as possible when a spring-like load was unexpectedly introduced. Angular positions and torques before correction were used to identify error patterns. Results showed that participants with mild hemiparesis minimized movement errors within three trials, as did healthy participants. In contrast, severely affected individuals needed more trials to diminish errors and their movements were inconsistent. Participants with a moderate motor disability used both typical and atypical correction strategies. The differences in correction behaviors likely reflect deficits in arm motor function (r=0.79) and executive function (r=0.58) rather than levels of intellectual function (IQ ratings). Results indicate that the deficits that individuals with stroke experience when adapting their movements to changed load conditions may be due to difficulty in rapidly integrating visual and proprioceptive information. Deficits in executive function could also contribute to problems in producing accurate and consistent movements from trial to trial. Taken together, these results imply that all hemiparetic individuals would not benefit equally from the same motor re-training approaches.

Adolescent↗

Development and validation of two new sensory tests of the hand for patients with stroke.

OBJECTIVE: To establish validity and reliability of two new sensory tests evaluating moving (MTP) and sustained (STP) touch-pressure and their relationship to hand function for patients with stroke. The STP had four components in which a light or heavy ball was applied passively or held actively. PARTICIPANTS: Twenty-eight participants with hemiparesis (1-109 months) from rehabilitation hospitals or outpatient programmes. DESIGN: Content validity was established. Then reliability and concurrent and construct validity were determined. Sensation was compared with hand functional ability using the Modified Moberg recognition task, the Box and Block test and one task of the TEMPA test. RESULTS: Reliability: Both types of reliability were significant for MTP (ICC = 0.92) and all components of STP (ICC = 0.62 to 0.92). Concurrent validity: MTP and STP correlated significantly (r = -0.39 to -0.83) with the Semmes-Weinstein Monofilament test used as a 'gold standard' comparison. Construct validity: MTP was significantly related to Moberg (r = 0.49). Three of four components of STP correlated with TEMPA (r = 0.49-0.53) and Moberg (0.45-0.71). Only STP (heavy ball) correlated with Box and Block (0.42-0.48). Of the four components of STP, only the passive STP (light ball) was not related to hand function. CONCLUSION: The new sensory tests of moving, and three components of sustained touch-pressure were reliable. The passive STP (light ball) was discarded. All but this test were relevant to the two functional roles of sensation: exploration for MTP and dexterity during holding for STP.

Adult↗