We permanently deal with gravity force. Experimental evidences revealed that moving against gravity strongly differs from moving along the gravity vector. This directional asymmetry has been attributed to an optimal planning process that optimizes gravity force effects to minimize energy. Yet, only few studies have considered the case of vertical movements in the context of optimal control. What kind of cost is better suited to explain kinematic patterns in the vertical plane? Here, we aimed to understand further how the central nervous system (CNS) plans and controls vertical arm movements. Our reasoning was the following: if the CNS optimizes gravity mechanical effects on the moving limbs, kinematic patterns should change according to the direction and the magnitude of the gravity torque being encountered in the motion. Ten subjects carried out single-joint movements, i.e., rotation around the shoulder (whole arm), elbow (forearm), and wrist (hand) joints, in the vertical plane. Joint kinematics were analyzed and compared with various theoretical optimal model predictions (minimum absolute work-jerk, jerk, torque change, and variance). We found both direction-dependent and joint-dependent variations in several kinematic parameters. Notably, directional asymmetries decreased according to a proximodistal gradient. Numerical simulations revealed that our experimental findings could be attributed to an optimal motor planning (minimum absolute work-jerk) that integrates the direction and the magnitude of gravity torque and minimizes the absolute work of forces (energy-related cost) around each joint. Present results support the general idea that the CNS implements optimal solutions according to the dynamic context of the action.

BackgroundThe “frailty syndrome” (a geriatric multidimensional condition characterized by decreased reserve and diminished resistance to stressors) represents a promising target of preventive interventions against disability in elders. Available screening tools for the identification of frailty in the absence of disability present major limitations. In particular, they have to be administered by a trained assessor, require special equipment, and/or do not discriminate between frail and disabled individuals. Aim of this study is to verify the agreement of a novel self-reported questionnaire (the “Frail Non-Disabled” [FiND] instrument) designed for detecting non-mobility disabled frail older persons with results from reference tools.Methodology/Principal FindingsData are from 45 community-dwelling individuals aged ≥60 years. Participants were asked to complete the FiND questionnaire separately exploring the frailty and disability domains. Then, a blinded assessor objectively measured the frailty status (using the phenotype proposed by Fried and colleagues) and mobility disability (using the 400-meter walk test). Cohen's kappa coefficients were calculated to determine the agreement between the FiND questionnaire with the reference instruments. Mean age of participants (women 62.2%) was 72.5 (standard deviation 8.2) years. Seven (15.6%) participants presented mobility disability as being unable to complete the 400-meter walk test. According to the frailty phenotype criteria, 25 (55.6%) participants were pre-frail or frail, and 13 (28.9%) were robust. Overall, a substantial agreement of the instrument with the reference tools (kappa = 0.748, quadratic weighted kappa = 0.836, both p values<0.001) was reported with only 7 (15.6%) participants incorrectly categorized. The agreement between results of the FiND disability domain and the 400-meter walk test was excellent (kappa = 0.920, p<0.001).Conclusions/SignificanceThe FiND questionnaire presents a very good capacity to correctly identify frail older persons without mobility disability living in the community. This screening tool may represent an opportunity for diffusing awareness about frailty and disability and supporting specific preventive campaigns.

When submitted to a visuomotor rotation, subjects show rapid adaptation of visually guided arm reaching movements, indicated by a progressive reduction in reaching errors. In this study, we wanted to make a step forward by investigating to what extent this adaptation also implies changes into the motor plan. Up to now, classical visuomotor rotation paradigms have been performed on the horizontal plane, where the reaching motor plan in general requires the same kinematics (i.e., straight path and symmetric velocity profile). To overcome this limitation, we considered vertical and horizontal movement directions requiring specific velocity profiles. This way, a change in the motor plan due to the visuomotor conflict would be measurable in terms of a modification in the velocity profile of the reaching movement. Ten subjects performed horizontal and vertical reaching movements while observing a rotated visual feedback of their motion. We found that adaptation to a visuomotor rotation produces a significant change in the motor plan, i.e., changes to the symmetry of velocity profiles. This suggests that the central nervous system takes into account the visual information to plan a future motion, even if this causes the adoption of nonoptimal motor plans in terms of energy consumption. However, the influence of vision on arm movement planning is not fixed, but rather changes as a function of the visual orientation of the movement. Indeed, a clear influence on motion planning can be observed only when the movement is visually presented as oriented along the vertical direction. Thus vision contributes differently to the planning of arm pointing movements depending on motion orientation in space.

Several studies suggest that when subjects mentally rehearse or execute a familiar action, they engage similar neural and cognitive operations. Here, we examined whether muscle fatigue could influence mental movements. Participants mentally and actually performed a sequence of vertical arm movements (rotation around the shoulder joint) before and after a fatiguing exercise involving the right arm. We found similar durations for actual and mental movements before fatigue, but significant temporal discrepancies after fatigue. Specifically, mental simulation was accelerated immediately after fatigue, while the opposite was observed for actual execution. Furthermore, actual movements showed faster adaptation (i.e., return to prefatigue values) than mental movements. The EMG analysis showed that postfatigue participants programmed larger, compared to prefatigue, neural drives. Therefore, immediately after fatigue, the forward model received dramatically greater efferent copies and predicted faster, compared to prefatigue, arm movements. During actual movements, the discrepancy between estimated (forward model output) and actual state (sensory feedback) of the arm guided motor adaptation; i.e., durations returned rapidly to prefatigue values. Since during mental movements there is no sensory information and state estimation derives from the forward model alone, mental durations remained faster after fatigue and their adaptation was longer than those of actual movements. This effect was specific to the fatigued arm because actual and mental movements of the left nonfatigued arm were unaffected. The current results underline the interdependence of motor and cognitive states and suggest that mental actions integrate the current state of the motor system.

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Evidence from RCTs is limited and does not support that exercise reduces the risk of developing clinically important cognitive outcomes. Further long-term exercise RCTs are needed before solid conclusions can be drawn.

With the development of next generation sequencing, beyond identifying the cause of manifestations that justified prescription of the test, other information with potential interest for patients and their families, defined as secondary findings (SF), can be provided once patients have given informed consent, in particular when therapeutic and preventive options are available. The disclosure of such findings has caused much debate. The aim of this work was to summarize all opinion-based studies focusing on SF, so as to shed light on the concerns that this question generate. A review of the literature was performed, focusing on all PubMed articles reporting qualitative, quantitative or mixed studies that interviewed healthcare providers, participants, or society regarding this subject. The methodology was carefully analysed, in particular whether or not studies made the distinction between actionable and non-actionable SF, in a clinical or research context. From 2010 to 2016, 39 articles were compiled. A total of 14,868 people were interviewed (1259 participants, 6104 healthcare providers, 7505 representatives of society). When actionable and non-actionable SF were distinguished (20 articles), 92% of respondents were keen to have results regarding actionable SF (participants: 88%, healthcare providers: 86%, society: 97%), against 70% (participants: 83%, healthcare providers: 62%, society: 73%) for non-actionable SF. These percentages were slightly lower in the specific situation of children probands. For respondents, the notion of the «patient's choice» is crucial. For healthcare providers, the importance of defining policies for SF among diagnostic lab, learning societies and/or countries is outlined, in particular regarding the content and extension of the list of actionable genes to propose, the modalities of information, and the access to information about adult-onset diseases in minors. However, the existing literature should be taken with caution, since most articles lack a clear definition of SF and actionability, and referred to hypothetical scenarios with limited information to respondents. Studies conducted by multidisciplinary teams involving patients with access to results are sadly lacking, in particular in the medium term after the results have been given. Such studies would feed the debate and make it possible to measure the impact of such findings and their benefit-risk ratio.

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