Dr Marie Martel

AIM To assess the prevalence of elementary visuospatial perception (EVSP) deficit inneurodevelopmental disorders in children.METHOD Using a screening test designed and validated to measure dorsal EVSP ability, 168children (122 males, 46 females; mean age 10y [SD 1y 10mo], range 4y 8mo–16y 4mo)diagnosed with developmental coordination disorder (DCD), specific learning disorder (SLD),attention-deficit/hyperactivity disorder (ADHD), and/or oral language disorder were comparedwith a group of 184 typically developing children. We also tested 14 children with binocularvision dysfunction and no neurodevelopmental disorder.RESULTS Children with SLD scored below the interquartile range of typically developingchildren as frequently (59%) as children with DCD, but only 5% were severely impaired (i.e.scored as outliers). Children with DCD were the most severely impaired (22% of outliers),even more so when they exhibited a co-occuring disorder. Children with language disorderand those with binocular vision dysfunction scored similarly to the group of typicallydeveloping children.INTERPRETATION These results confirm the importance of assessing EVSP in the clinicalevaluation of children with neurodevelopmental disorder, in particular those presenting withDCD or SLD.

Abstract Humans evolution is distinctly characterized by their exquisite mastery of tools, allowing them to shape their environment in more elaborate ways compared to other species. This ability is present ever since infancy and most theories indicate that children become proficient with tool use very early. In adults, tool use has been shown to plastically modify metric aspects of the arm representation, as indexed by changes in movement kinematics. To date, whether and when the plastic capability of updating the body representation develops during childhood remains unknown. This question is particularly important since body representation plasticity could be impacted by the fact that the human body takes years to achieve a stable metric configuration. Here we assessed the kinematics of 90 young participants (8–21 years old) required to reach for an object before and after tool use, as a function of their pubertal development. Results revealed that tool incorporation, as indexed by the adult typical kinematic pattern, develops very slowly and displays a u-shaped developmental trajectory. From early to mid puberty, the changes in kinematics following tool use seem to reflect a shortened arm representation, opposite to what was previously reported in adults. This pattern starts reversing after mid puberty, which is characterized by the lack of any kinematics change following tool use. The typical adult-like pattern emerges only at late puberty, when body size is stable. These findings reveal the complex dynamics of tool incorporation across development, possibly indexing the transition from a vision-based to a proprioception-based body representation plasticity.

The Motor-Cognitive model suggests a functional dissociation between motor imagery and overt action, in contrast to the Functional Equivalence view of common processes between the two behaviours. According to the Motor-Cognitive model, motor imagery differs from overt action primarily through the use of executive resources to monitor and elaborate a motor image during execution, which can result in a lack of correspondence between motor imagery and its overt action counterpart. The present study examined the importance of executive resources in motor imagery by using TMS to impair the function of the dorsolateral prefrontal cortex while measuring the time to complete imagined versus overt actions. In two experiments, TMS over the dorsolateral prefrontal cortex slowed motor imagery but did not affect overt actions. TMS over the same region also interfered with performance of a mental calculation task, though it did not reliably affect less demanding cognitive tasks also thought to rely on executive functions. Taken together, these results were consistent with the Motor-Cognitive model but not with the idea of functional equivalence. The implications of these results for the theoretical understanding of motor imagery, and potential applications of the Motor-Cognitive model to the use of motor imagery in training and rehabilitation, are discussed.

Over the last decades, scientists have questioned the origin of the exquisite human mastery of tools. Seminal studies in monkeys, healthy participants and brain-damaged patients have primarily focused on the plastic changes that tool-use induces on spatial representations. More recently, we focused on the modifications tool-use must exert on the sensorimotor system and highlighted plastic changes at the level of the body representation used by the brain to control our movements, i.e., the Body Schema. Evidence is emerging for tool-use to affect also more visually and conceptually based representations of the body, such as the Body Image. Here we offer a critical review of the way different tool-use paradigms have been, and should be, used to try disentangling the critical features that are responsible for tool incorporation into different body representations. We will conclude that tool-use may offer a very valuable means to investigate high-order body representations and their plasticity.

The reliability and validity of a screening test for a deficit in elementary visuo-spatial perception (EVSP) were evaluated. METHOD : This prospective study collected performance from 210 typically-developing individuals and evaluated the internal consistency of the EVSP screening test. Test-retest reliability was examined on 25 individuals. Validity also involved retrospective clinical data collected from 223 non-typically developing children coming to the hospital for out-patient consultation. Since EVSP matures through childhood, we standardized the EVSP screening test scores by age category and performed Pearson correlations with standardized clinical tests scores. RESULTS : Test-retest reliability (intraclass correlation coefficient =.76) and internal consistency (Cronbach's alpha = .76) were satisfactory. Construct validity included correlation with the subtests of the WISC-IV involving visuo-spatial analysis (Matrix Reasoning and Block Design: p

Tool-use has been shown to modify the way the brain represents the metrical characteristics of the effector controlling the tool. For example, the use of tools that elongate the physical length of the arm induces kinematic changes affecting selectively the transport component of subsequent free-hand movements. Although mental simulation of an action is known to involve -to a large extent- the same processes as those at play in overt motor execution, whether tool-use imagery can yield similar effects on the body representation remains unknown. Mentally simulated actions indeed elicit autonomic physiological responses and follow motor execution rules that are comparable to those associated with the correspondent overt performance. Therefore, here we investigated the effects of the mental simulation of actions performed with a tool on the body representation by studying subsequent free-hand movements. Subjects executed reach to grasp movements with their hand before and after an imagery task performed with either a tool elongating their arm length or, as a control, with their hand alone. Two main results were found: First, in agreement with previous studies, durations of imagined movements performed with the tool and the hand were similarly affected by task difficulty. Second, kinematics of free-hand movements was affected after tool-use imagery, but not hand-use imagery, in a way similar to that previously documented after actual tool-use. These findings constitute the first evidence that tool-use imagery is sufficient to affect the representation of the user's arm.

Autism spectrum disorders and developmental coordination disorders are both associated with sensorimotor impairments, yet their nature and specificity remain unknown. In order to clearly distinguish the specificity between the two disorders, children with autism spectrum disorder or developmental coordination disorder presenting the same degree of motor impairment, thus homogeneous profiles, were examined in a reach-to-displace paradigm, which allows the integrity of two main aspects of motor control (anticipation/feedforward control and movement correction/feedback control) to be separately interrogated. We manipulated children's previous knowledge of the weight of the object they were to displace: when known, participants could anticipate the consequences of the weight when reaching for the object, prior to contact with it, thus allowing for feedforward control. Conversely, when unknown prior to contact, participants had to cope with the object weight in the displacing phase of the movement, and use feedback control. Results revealed a preserved feedforward control, but an impaired movement execution (atypical slowness) in children with developmental coordination disorder, while children with autism spectrum disorder displayed the opposite pattern with an impaired feedforward control, but a preserved feedback one. These findings shed light on how specific motor impairments might differently characterize developmental disorders and call for motor rehabilitation programmes adapted to each population. Lay abstract A vast majority of individuals with autism spectrum disorder experience impairments in motor skills. Those are often labelled as additional developmental coordination disorder despite the lack of studies comparing both disorders. Consequently, motor skills rehabilitation programmes in autism are often not specific but rather consist in standard programmes for developmental coordination disorder. Here, we compared motor performance in three groups of children: a control group, an autism spectrum disorder group and a developmental coordination disorder group. Despite similar level of motor skills evaluated by the standard movement assessment battery for children, in a Reach-to-Displace Task, children with autism spectrum disorder and developmental coordination disorder showed specific motor control deficits. Children with autism spectrum disorder failed to anticipate the object properties, but could correct their movement as well as typically developing children. In contrast, children with developmental coordination disorder were atypically slow, but showed a spared anticipation. Our study has important clinical implications as motor skills rehabilitations are crucial to both populations. Specifically, our findings suggest that individuals with autism spectrum disorder would benefit from therapies aiming at improving their anticipation, maybe through the support of their preserved representations and use of sensory information. Conversely, individuals with developmental coordination disorder would benefit from a focus on the use of sensory information in a timely fashion.

Tool-use changes both peripersonal space and body representations, with several effects being nowadays termed tool embodiment. Since somatosensation was typically accompanied by vision in most previous tool use studies, whether somatosensation alone is sufficient for tool embodiment remains unknown. Here we address this question via a task assessing arm length representation at an implicit level. Namely, we compared movement's kinematics in blindfolded healthy participants when grasping an object before and after tool-use. Results showed longer latencies and smaller peaks in the arm transport component after tool-use, consistent with an increased length of arm representation. No changes were found in the hand grip component and correlations revealed similar kinematic signatures in naturally long-armed participants. Kinematics changes did not interact with target object position, further corroborating the finding that somatosensory-guided tool use may increase the represented size of the participants' arm. Control experiments ruled out alternative interpretations based upon altered hand position sense. In addition, our findings indicate that tool-use effects are specific for the implicit level of arm representation, as no effect was observed on the explicit estimate of the forearm length. These findings demonstrate for the first time that somatosensation is sufficient for incorporating a tool that has never been seen, nor used before.

Scientists have long questioned the origin of the exquisite human mastery of tools. How do we manage controlling a tool in the skillful way humans typically do, that is, as a body-part? Influential theories proposed that efficient tool use relies on the incorporation of the tool into body representations. Therefore, we critically review several tool use paradigms used to identify critical features responsible for incorporating tools in two body representations, Body Schema and Body Image. Considering complementary evidence stemming from behavioral, neuroimaging and neuropsychological findings, we try assessing whether different high-order representations of body morphology are modified when extending our body with tools. We finally refer to current computational models of motor control to offer some novel perspectives on how to provide a more complete theoretical framework to tool use and body representation plasticity.

Embodiment of action-related language into the motor system has been extensively documented. Yet the case of sensory words, especially referring to touch, remains overlooked. We investigated the influence of verbs denoting tactile sensations on tactile perception. In Experiment 1, participants detected tactile stimulations on their forearm, preceded by tactile or non-tactile verbs by one of three delays (170, 350, 500 ms) reflecting different word processing stages. Results revealed shorter reaction times to tactile stimulations following tactile than non-tactile verbs, irrespective of delay. To ensure that priming pertained to tactile, and not motor, verb properties, Experiment 2 compared the impact of tactile verbs to both action and non-tactile verbs, while stimulations were delivered on the index finger. No priming emerged following action verbs, therefore not supporting the motor-grounded interpretation. Facilitation by tactile verbs was however not observed, possibly owing to methodological changes. Experiment 3, identical to Experiment 2 except that stimulation was delivered to participants' forearm, replicated the priming effect. Importantly, tactile stimulations were detected faster after tactile than after both non-tactile and action verbs, indicating that verbs' tactile properties engaged resources shared with sensory perception. Our findings suggest that language conveying tactile information can activate somatosensory representations and subsequently promote tactile detection.

Developmental Coordination Disorder (DCD) is a pathological condition characterized by impaired motor skills. Current theories advance that a deficit of the internal models is mainly responsible for DCD children's altered behavior. Yet, accurate movement execution requires not only correct movement planning, but also integration of sensory feedback into body representation for action (Body Schema) to update the state of the body. Here we advance and test the hypothesis that the plasticity of this body representation is altered in DCD. To probe Body Schema (BS) plasticity, we submitted a well-established tool-use paradigm to seventeen DCD children, required to reach for an object with their hand before and after tool use, and compared their movement kinematics to that of a control group of Typically Developing (TD) peers. We also asked both groups to provide explicit estimates of their arm length to probe plasticity of their Body Image (BI). Results revealed that DCD children explicitly judged their arm shorter after tool use, showing changes in their BI comparable to their TD peers. Unlike them, though, DCD did not update their implicit BS estimate: kinematics showed that tool use affected their peak amplitudes, but not their latencies. Remarkably, the kinematics of tool use showed that the motor control of the tool was comparable between groups, both improving with practice, confirming that motor learning abilities are preserved in DCD. This study thus brings evidence in favor of an alternative theoretical account of the DCD etiology. Our findings point to a deficit in the plasticity of the body representation used to plan and execute movements. Though not mutually exclusive, this widens the theoretical perspective under which DCD should be considered: DCD may not be limited to a problem affecting the internal models and their motor functions, but may concern the state of the effector they have to use.

Motor control is classically described as relying on two components: anticipatory control (feedforward processing) and online control (feedback processing). Here we aimed to unveil the developmental steps of both feedback and feedforward control in 5-10 years old children, using a simple and ecological task. We manipulated object's weight in a reach-to-displace paradigm. When the weight was known before lifting it, anticipatory processes were quantifiable during the reaching phase. Conversely, an unknown weight triggered online corrections during the displacing phase. Movement kinematics revealed that children anticipate this objet property as young as 5 y-o. This anticipation becomes adequate around 7 y-o and is paralleled by poor online corrections. This simple yet relevant paradigm should allow quantifying deviations from neurotypical patterns in disorders of motor control.

Humans often misjudge where on the body a touch occurred. Theoretical accounts have ascribed such misperceptions to local interactions in peripheral and primary somatosensory neurons, positing that spatial-perceptual mechanisms adhere to limb boundaries and skin layout. Yet, perception often reflects integration of sensory signals with prior experience. On their trajectories, objects often touch multiple limbs; therefore, body–environment interactions should manifest in perceptual mechanisms that reflect external space. Here, we demonstrate that humans perceived the cutaneous rabbit illusion – the percept of multiple identical stimuli as hopping across the skin – along the Euclidian trajectory between stimuli on two body parts and regularly mislocalized stimuli from one limb to the other. A Bayesian model based on Euclidian, as opposed to anatomical, distance faithfully reproduced key aspects of participants' localization behavior. Our results suggest that prior experience of touch in space critically shapes tactile spatial perception and illusions beyond anatomical organization.

Evolution has allowed humans to become proficient tool users, using tools to interact with their environment and functionally extend their limbs. Tools extend the sensorimotor boundaries of their user's body and in doing so modulate their body representations. In this chapter, we review the empirical evidence for this body-tool integration, focusing on the effects of basic tools as well as robotic limbs. We first explore how tools update the user's sensorimotor representations, reviewing behavioral and neural findings from the past decade, and novel research on development. Next, we focus on tool sensing, a new paradigm for investigating the ability to localize external tactile stimuli beyond the body. We then review how the sensorimotor system adapts to the use of robotic limbs, both in a medical and nonmedical context. Throughout the chapter, we also turn our attention to the past and the future, to discuss how evolution shaped our sensorimotor system and how humans now seem to be able to integrate robotic devices, further extending the limits of their sensorimotor system.