Expertise with pathological actions modulates a viewer's motor system

Brain mechanisms for action understanding rely on matching the observed actions into the viewer's motor system. Health professionals, who treat patients affected by movement disorders as dystonia, frequently see hyperkinetic action patterns characterized by an overflow of muscle co-contractions. To avert an overload of the motor system during observation of those actions, they might need to look at dystonic motor symptoms in a cool, detached way. To investigate whether visual expertise about atypical movement kinematics influences the viewer's motor system, we applied transcranial magnetic stimulation to clinicians and to naive subjects, while they observed handwriting actions performed with two different kinematics: fluent and non-fluent. Crucially, the latter movement pattern was easily recognized by the clinicians as a typical expression of writer's cramp, whereas it was unknown to the naive subjects. Results showed that clinicians had similar corticospinal activation during observation of dystonic and healthy writings, whereas naive subjects were hyper-activated during observation of dystonic movements. Hyper-activation was selective for the muscles directly involved in the dystonic co-contractions and inversely correlated with subjective movement fluency scores, hinting at a fine-tuned association between the breakdown of observed movement fluency and corticospinal activation. These findings suggest that observation of unusual pathological actions differently modulates the viewer's motor system, depending on knowledge, visual expertise, and ability in recognizing suboptimal movement kinematics.