Modulation of corticospinal excitability and intracortical inhibition during motor imagery is task-dependent

Learning motor actions via imagery-perceptual or motor learning?

It is well accepted that repeatedly imagining oneself acting without any overt behavior can lead to learning. The prominent theory accounting for why imagery practice is effective, motor simulation theory, posits that imagined action and overt action are functionally equivalent, the exception being activation of the end effector. If, as motor simulation theory states, one can compile the goal, plan, motor program and outcome of an action during imagined action similar to overt action, then learning of novel skills via imagery should proceed in a manner equivalent to that of overt action. While the evidence on motor simulation theory is both plentiful and diverse, it does not explicitly account for differences in neural and behavioural findings between imagined and overt action. In this position paper, we briefly review theoretical accounts to date and present a perceptual-cognitive theory that accounts for often observed outcomes of imagery practice. We suggest that learning by way of imagery reflects perceptual-cognitive scaffolding, and that this 'perceptual' learning transfers into 'motor' learning (or not) depending on various factors. Based on this theory, we characterize consistently reported learning effects that occur with imagery practice, against the background of well-known physical practice effects and show that perceptual-cognitive scaffolding is well-suited to explain what is being learnt during imagery practice.

Changes in corticospinal excitability during motor imagery by physical practice of a force production task: Effect of the rate of force development during practice

Transcranial magnetic stimulation studies have indicated that the physical practice of a force production task increases corticospinal excitability during motor imagery (MI) of that task. However, it is unclear whether this practice-induced facilitation of corticospinal excitability during MI depends on a repeatedly practiced rate of force development (RFD). We aimed to investigate whether corticospinal excitability during MI of an isometric force production task is facilitated only when imagining the motor task with the same RFD as the physically practiced RFD. Furthermore, we aimed to examine whether corticospinal excitability during MI only occurs immediately after physical practice or is maintained. Twenty-eight right-handed young adults practiced isometric ramp force production using right index finger abduction. Half of the participants (high group) practiced the force production with high RFD, and the other half (low group) practiced the force production with low RFD. Questionnaire scores indicating MI ability were similar in the two groups. We examined the force error relative to the target force during the force production task without visual feedback, and motor evoked potential (MEP) amplitudes of the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles during the MI of the force production task under practiced and unpracticed RFD conditions before, immediately after, and 20 min after physical practice. Our results demonstrated that the force error in both RFD conditions significantly decreased immediately after physical practice, irrespective of the RFD condition practiced. In the high group, the MEP amplitude of the FDI muscle during MI in the high RFD condition significantly increased immediately after practice compared to that before, whereas the MEP amplitude 20 min after practice was not significantly different from that before practice. Conversely, the MEP amplitude during MI in the high RFD condition did not change significantly in the low group, and neither group had significant changes in MEP amplitude during MI in the low RFD condition. The facilitatory effect of corticospinal excitability during MI with high RFD observed only immediately after physical practice in the high RFD condition may reflect short-term functional changes in the primary motor cortex induced by physical practice.

Effects of finger pinch motor imagery on short-latency afferent inhibition and corticospinal excitability

Motor imagery is a cognitive process involving the simulation of motor actions without actual movements. Despite the reported positive effects of motor imagery training on motor function, the underlying neurophysiological mechanisms have yet to be fully elucidated. Therefore, the purpose of the present study was to investigate how sustained tonic finger-pinching motor imagery modulates sensorimotor integration and corticospinal excitability using short-latency afferent inhibition (SAI) and single-pulse transcranial magnetic stimulation (TMS) assessments, respectively. Able-bodied individuals participated in the study and assessments were conducted under two experimental conditions in a randomized order between participants: (1) participants performed motor imagery of a pinch task while observing a visual image displayed on a monitor (Motor Imagery), and (2) participants remained at rest with their eyes fixed on the monitor displaying a cross mark (Control). For each condition, sensorimotor integration and corticospinal excitability were evaluated during sustained tonic motor imagery in separate sessions. Sensorimotor integration was assessed by SAI responses, representing inhibition of motor-evoked potentials (MEPs) in the first dorsal interosseous muscle elicited by TMS following median nerve stimulation. Corticospinal excitability was assessed by MEP responses elicited by single-pulse TMS. There was no significant difference in the magnitude of SAI responses between motor imagery and Control conditions, while MEP responses were significantly facilitated during the Motor Imagery condition compared to the Control condition. These findings suggest that motor imagery facilitates corticospinal excitability, without altering sensorimotor integration, possibly due to insufficient activation of the somatosensory circuits or lack of afferent feedback during sustained tonic motor imagery.

Modulation of lower limb muscle corticospinal excitability during various types of motor imagery

Motor imagery (MI) is used for rehabilitation and sports training. Previous studies focusing on the upper limb have investigated the effects of MI on corticospinal excitability in the muscles involved in the imagined movement (i.e., the agonist muscles). The present study focused on several lower-limb movements and investigated the influences of MI on corticospinal excitability in the lower limb muscles. Twelve healthy individuals (ten male and two female individuals) participated in this study. Motor-evoked potentials (MEP) from the rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and soleus (SOL) muscles were elicited through transcranial magnetic stimulation (TMS) to the primary motor cortex during MI of knee extension, knee flexion, ankle dorsiflexion, and ankle plantarflexion and at rest. The results showed that the RF MEPs were significantly increased during MI in knee extension, ankle dorsiflexion, and ankle plantarflexion but not in knee flexion, compared with those at rest. The TA MEPs were significantly increased during MI in knee extension and foot dorsiflexion, while MEPs were not significantly different during MI in knee flexion and foot dorsiflexion than those at rest. For the BF and SOL muscles, there was no significant MEP modulation in either MI. These results demonstrated that corticospinal excitability of the RF and TA muscles was facilitated during MI of movements in which they are active and during MI of lower-limb movements in which they are not involved. On the contrary, corticospinal excitability of the BF and SOL muscles was not facilitated by MI of lower-limb movements. These results suggest that facilitation of corticospinal excitability depends on the muscle and the type of lower-limb MI.

Effect of virtual running with exercise on functionality in pre-frail and frail elderly people: randomized clinical trial

BACKGROUND

Virtual mirror therapies could increase the results of exercise, since the mirror neuron system produces an activation of motor execution cortical areas by observing actions performed by others. In this way, pre-frail and frail people could use this system to reach an exercise capacity threshold and obtain health benefits.

AIM

The aim of this study is to evaluate the effects of a virtual running (VR) treatment combined with specific physical gait exercise (PE) compared to placebo VR treatment combined with PE on functionality, pain, and muscular tone in pre-frail and frail older persons.

METHODS

A single blinded, two-arm, randomised controlled trial design was employed. Thirty-eight participants were divided into two intervention arms: Experimental Intervention (EI) group, in which VR and gait-specific physical exercises were administered and Control Intervention (CI) group, in which a placebo virtual gait and the same exercise programme was administered. Functionality, pain, and tone were assessed.

RESULTS

EI group improved in aerobic capacity, functional lower-limb strength, reaction time, and pain, while CI group remained the same. Regarding static balance and muscle tone, no differences were found for either group. Further analysis is needed to asses VR effectiveness for improving gait, stand-up and sit-down performance and velocity.

CONCLUSIONS

Virtual running therapy appears to enhance capacities related with voluntary movements (i.e., aerobic capacity, functional lower-limb strength, and reaction time) and reduce pain.

Motor Imagery and Frontal Head Oxygenation: An fNIRS Study

Motor imagery (MI) is a manifestation of mental movements, but it cannot be identified visually. Therefore, to a large extent, MI assessment has not yet been established. The present study aimed to investigate whether frontal oxy-Hb changes and cardiac autonomic nervous system activity during MI are associated with the psychometric scale assessment of MI and clarify the utility of each index in MI assessment. Thirty-one healthy men and women were included in this study, and Pocket NIRS Duo was used to assess frontal oxygenated hemoglobin levels during walking MI. Simultaneously, heart rate and sympathetic index (low and high frequency (LF/HF) during MI were evaluated using Chiryou Meijin, a heart rate frequency analyser. In addition, a psychometric scale evaluation was carried out in MC and VAS, and its correlation with oxy-Hb levels, heart rate (HR), and LF/HF was investigated. HRs and LF/HF during MI were significantly increased compared with those at rest. However, oxy-Hb levels during MI were not increased. There was a significant correlation between right oxy-Hb levels and mental chronometry (MC) during MI (r = -0.3, p < 0.05). HR and LF/HF were not correlated with MC. VAS was not correlated with oxy-Hb levels, HR, or LF/HF. The results of this study confirm an association between MI performance and frontal oxy-Hb changes and that brain activity is not necessarily elevated during MI. HR were significantly increased but did not show any association with MC.

Thenar Muscle Motor Imagery Increases Spinal Motor Neuron Excitability of the Abductor Digiti Minimi Muscle

When a person attempts intended finger movements, unintended finger movement also occur, a phenomenon called “enslaving”. Given that motor imagery (MI) and motor execution (ME) share a common neural foundation, we hypothesized that the enslaving effect on the spinal motor neuron excitability occurs during MI. To investigate this hypothesis, electromyography (EMG) and F-wave analysis were conducted in 11 healthy male volunteers. Initially, the EMG activity of the left abductor digiti minimi (ADM) muscle during isometric opposition pinch movement by the left thumb and index finger at 50% maximal effort was compared with EMG activity during the Rest condition. Next, the F-wave and background EMG recordings were performed under the Rest condition, followed by the MI condition. Specifically, in the Rest condition, subjects maintained relaxation. In the MI condition, they imagined isometric left thenar muscle activity at 50% maximal voluntary contraction (MVC). During ME, ADM muscle activity was confirmed. During the MI condition, both F-wave persistence and the F-wave/M-wave amplitude ratio obtained from the ADM muscle were significantly increased compared with that obtained during the Rest condition. No difference was observed in the background EMG between the Rest and MI conditions. These results suggest that MI of isometric intended finger muscle activity at 50% MVC facilitates spinal motor neuron excitability corresponding to unintended finger muscle. Furthermore, MI may induce similar modulation of spinal motor neuron excitability as actual movement.

Time course effect of corticospinal excitability for motor imagery

This study examined the effect of temporal changes in corticospinal excitability in motor imagery (MI) and the effect of real-time guides for MI on excitability changes. The MI task involved wrist flexion and motor evoked potentials using transcranial magnetic stimulation were recorded and examined from the flexor carpi radialis. Ballistic (momentary MI) and tonic (continuous MI) conditions were used, and the duration of each MI was different. In Experiment 1, each MI task was performed using an acoustic trigger. In Experiment 2, a real-time guide was presented on a computer screen, which provided a visual indication of the onset and duration of the MI task through via moving dots on the screen. The results indicate that the corticospinal excitability changed differently, depending on the duration of MI. Additionally, with real-time guides, the change in corticospinal excitability became clearer. Thus, corticospinal excitability changes due to the temporal specificities of MI, as well as with actual motor output. Moreover, if MI is actively performed without a guide, it is likely to show an unintended change in corticospinal excitability. It is suggested that when MI is performed with visual guide, the excitatory changes of the corticospinal tract might be different from the actual motor output. Therefore, when using MI for mental practices, it is possible to improve the effect of a guide for MI, such as a visual indicator for motor output. Additionally, when examining neural activities in MI, it may be necessary to consider the characteristics of motion performed by MI.

Modulation of intracortical inhibition during physically performed and mentally simulated balance tasks

PURPOSE

Action observation (AO) during motor imagery (MI), so-called AO + MI, has been proposed as a new form of non-physical training, but the neural mechanisms involved remains largely unknown. Therefore, this study aimed to explore whether there were similarities in the modulation of short-interval intracortical inhibition (SICI) during execution and mental simulation of postural tasks, and if there was a difference in modulation of SICI between AO + MI and AO alone.

METHOD

21 young adults (mean ± SD = 24 ± 6.3 years) were asked to either passively observe (AO) or imagine while observing (AO + MI) or physically perform a stable and an unstable standing task, while motor evoked potentials and SICI were assessed in the soleus muscle.

RESULT

SICI results showed a modulation by condition (F2,40 = 6.42, p = 0.009) with less SICI in the execution condition compared to the AO + MI (p = 0.009) and AO (p = 0.002) condition. Moreover, switching from the stable to the unstable stance condition reduced significantly SICI (F1,20 = 8.34, p = 0.009) during both, physically performed (- 38.5%; p = 0.03) and mentally simulated balance (- 10%, p < 0.001, AO + MI and AO taken together).

CONCLUSION

The data demonstrate that SICI is reduced when switching from a stable to a more unstable standing task during both real task execution and mental simulation. Therefore, our results strengthen and further support the existence of similarities between executed and mentally simulated actions by showing that not only corticospinal excitability is similarly modulated but also SICI. This proposes that the activity of the inhibitory cortical network during mental simulation of balance tasks resembles the one during physical postural task execution.

Probing the Effect of Block Duration on Corticospinal Excitability during Motor Imagery Performance

Considerable evidence exists related to the behavioral outcomes of motor imagery-based training (MI). Comparatively, there is a relative gap in the literature on how corticospinal excitability, a precursor for experience-dependent plasticity, changes over the course of an MI session, and more specifically if there is an effect of varying the duration of the blocks in which MI is performed. As such, we probed corticospinal excitability during MI, whereby the duration of MI blocks within the session were manipulated yet total exposure to MI was kept constant. Participants performed a total of 24 min of MI of common motor tasks in blocks of 2, 4 or 6 min. Transcranial magnetic stimulation was used to assess corticospinal excitability throughout MI performance. All groups demonstrated increased corticospinal excitability over the session. Owing to a decrease in corticospinal excitability when engaging in 6 min blocks and the variability noted when engaging in 2 min blocks, findings suggest that MI performed in 4 min blocks may be preferable for the generation and maintenance of corticospinal excitability, at least relative to 2 and 6 min blocks. Overall, our findings provide physiological evidence that informs the structure of MI training sessions to optimize their effectiveness.

Dissociation between cortical and spinal excitability of the antagonist muscle during combined motor imagery and action observation

Inhibitory neural control of antagonist muscle is one of the fundamental neural mechanism of coordinated human limb movement. Previous studies have revealed that motor execution (ME) and motor imagery (MI) share many common neural substrates; however, whether inhibitory neural activity occurs during MI remains unknown. In addition, recent studies have demonstrated that a combined MI and action observation (MI + AO) produces strong neurophysiological changes compared with MI or AO alone. Therefore, we investigated inhibitory changes in cortical and spinal excitability of the antagonist muscle during MI + AO and ME. Single-pulse transcranial magnetic stimulation (TMS) experiments revealed that corticospinal excitability of the antagonist muscle was decreased during MI + AO. Conversely, F-wave experiments showed that F-wave persistence of the antagonist muscle increased. Paired-pulse TMS experiment also demonstrated that short-interval intracortical inhibition (SICI) did not contribute to this inhibition. Therefore, cortical mediated inhibition, except for SICI, may be related to this inhibition. Conversely, such clear inhibition of the antagonist muscle was not observed during ME, presumably owing to the effects of muscle contraction to decelerate the movements and/or sensory input accompanying the joint movements. These findings provide important insights into the neurophysiological differences between MI + AO and ME.

Imagery strategy affects spinal motor neuron excitability: using kinesthetic and somatosensory imagery

Motor imagery is the mental rehearsal of a movement within working memory. Reduction of spinal motor neuron excitability has been demonstrated after stroke, and motor imagery may increase spinal motor neuron excitability in patients with a motor deficit. However, spinal motor neuron excitability varies depending on the imagery strategy used. In this study, we examined spinal motor neuron excitability during kinesthetic, somatosensory, and combined imagery. Healthy adult volunteers (n=14) were recruited for F-wave recording. The F-wave was measured during relaxation to determine baseline levels, followed by measurement during the three imagery trials performed in a random order. In the somatosensory imagery (SI) trial, participants imagined tactile and pressure perception of the thumb finger pulp during holding a pinch meter. In the kinesthetic imagery (KI) trial, participants imagined muscle contraction during isometric thenar muscle activity at 50% maximal voluntary contraction. In the combined KI and SI trial, participants performed the KI and SI simultaneously. After F-wave recording, participants evaluated the difficulty of each imagery trial using a five-point Likert scale. Persistence during SI and KI was significantly higher than that at rest. The F/M amplitude ratio during KI was significantly higher than that at rest. The five-point Likert scale score of the combined KI and SI was significantly lower than that of KI. KI may increase spinal motor neuron excitability over that of SI. Thus, it is important to consider the sensory modality chosen for imagery during rehabilitation.

Combined endogenous and exogenous disinhibition of intracortical circuits augments plasticity induction in the human motor cortex

BACKGROUND

Motor imagery (MI) engages cortical areas in the human brain similar to motor practice. Corticospinal excitability (CSE) is facilitated during but not after MI practice. We hypothesized that lasting CSE changes could be achieved by associatively pairing this endogenous modulation with exogenous stimulation of the same intracortical circuits.

METHODS

We combined MI with a disinhibition protocol (DIS) targeting intracortical circuits by paired-pulse repetitive transcranial magnetic stimulation in one main and three subsequent experiments. The follow-up experiments were applied to increase effects, e.g., by individualizing inter-stimulus intervals, adding neuromuscular stimulation and expanding the intervention period. CSE was captured during (online) and after (offline) the interventions via input-output changes and cortical maps of motor evoked potentials. A total of 35 healthy subjects (mean age 26.1 ± 2.6 years, 20 females) participated in this study.

RESULTS

A short intervention (48 stimuli within ∼90s) increased CSE. This plasticity developed rapidly, was associative (with MI_on, but not MI_off or REST) and persisted beyond the intervention period. Follow-up experiments revealed the relevance of individualizing inter-stimulus intervals and of consistent inter-burst periods for online and offline effects, respectively. Expanding this combined MI/DIS intervention to 480 stimuli amplified the sustainability of CSE changes. When concurrent neuromuscular electrical stimulation was applied, the plasticity induction was cancelled.

CONCLUSIONS

This novel associative stimulation protocol augmented plasticity induction in the human motor cortex within a remarkably short period of time and in the absence of active movements. The combination of endogenous and exogenous disinhibition of intracortical circuits may provide a therapeutic backdoor when active movements are no longer possible, e.g., for hand paralysis after stroke.

Somatosensory and transcranial direct current stimulation effects on manual dexterity and motor cortex function: A metaplasticity study

BACKGROUND

Non-invasive neuromodulation may provide treatment strategies for neurological deficits affecting movement, such as stroke. For example, weak electrical stimulation applied to the hand by wearing a "mesh glove" (MGS) can transiently increase primary motor cortex (M1) excitability. Conversely, transcranial direct current stimulation with the cathode over M1 (c-tDCS) can decrease corticomotor excitability.

OBJECTIVE/HYPOTHESIS

We applied M1 c-tDCS as a priming adjuvant to MGS and hypothesised metaplastic effects would be apparent in improved motor performance and modulation of M1 inhibitory and facilitatory circuits.

METHODS

Sixteen right-handed neurologically healthy individuals participated in a repeated measures cross-over study; nine minutes of sham- or c-tDCS followed by 30 min of suprasensory threshold MGS. Dexterity of the non-dominant (left) hand was assessed using the grooved pegboard task, and measures of corticomotor excitability, intracortical facilitation, short-latency afferent inhibition (SAI), short-interval intracortical inhibition (SICI), and SAI in the presence of SICI (SAIxSICI), were obtained at baseline, post-tDCS, and 0, 30 and 60 min post-MGS.

RESULTS

There was a greater improvement in grooved pegboard completion times with c-tDCS primed MGS than sham + MGS. There was also more pronounced disinhibition of SAI. However, disinhibition of SAI in the presence of SICI was less and rest motor threshold higher compared to sham + MGS.

CONCLUSIONS

The results indicate a metaplastic modulation of corticomotor excitability with c-tDCS primed MGS. Further studies are warranted to determine how various stimulation approaches can induce metaplastic effects on M1 neuronal circuits to boost functional gains obtained with motor practice.

Short Intracortical Inhibition During Voluntary Movement Reveals Persistent Impairment Post-stroke

Objective: Short intracortical inhibition (SICI) is a GABA_A-mediated phenomenon, argued to mediate selective muscle activation during coordinated motor activity. Markedly reduced SICI has been observed in the acute period following stroke and, based on findings in animal models, it has been posited this disinhibitory phenomenon may facilitate neural plasticity and contribute to early motor recovery. However, it remains unresolved whether SICI normalizes over time, as part of the natural course of stroke recovery. Whether intracortical inhibition contributes to motor recovery in chronic stroke also remains unclear. Notably, SICI is typically measured at rest, which may not fully reveal its role in motor control. Here we investigated SICI at rest and during voluntary motor activity to determine: (1) whether GABA_A-mediated inhibition recovers, and (2) how GABA_A-mediated inhibition is related to motor function, in the chronic phase post-stroke.

Methods: We studied 16 chronic stroke survivors (age: 64.6 ± 9.3 years; chronicity: 74.3 ± 52.9 months) and 12 age-matched healthy controls. We used paired-pulse transcranial magnetic stimulation (TMS) to induce SICI during three conditions: rest, submaximal grip, and performance of box-and-blocks. Upper-extremity Fugl-Meyer Assessment and Box-and-Blocks tests were used to evaluate motor impairment in stroke survivors and manual dexterity in all participants, respectively.

Results: At rest, SICI revealed no differences between ipsilesional and contralesional hemispheres of either cortical or subcortical stroke survivors, or healthy controls (P's > 0.05). During box-and-blocks, however, ipsilesional hemisphere SICI was significantly reduced (P = 0.025), especially following cortical stroke (P < 0.001). SICI in the ipsilesional hemisphere during box-and-blocks task was significantly related to paretic hand dexterity (r = 0.56, P = 0.039) and motor impairment (r = 0.56, P = 0.037).

Conclusions: SICI during motor activity, but not rest, reveals persistent impairment in chronic stroke survivors indicating that inhibitory brain circuits responsible for motor coordination do not fully normalize as part of the natural history of stroke recovery. Observation that reduced SICI (i.e., disinhibition) is associated with greater motor impairment and worse dexterity in chronic hemiparetic individuals suggests the response considered to promote neuroplasticity and recovery in the acute phase could be maladaptive in the chronic phase post-stroke.

Does the duration of motor imagery affect the excitability of spinal anterior horn cells?

PURPOSE

Motor imagery, the process of imagining a physical action, has been shown to facilitate the excitability of spinal anterior horn cells. In the acute phase after a stroke, the excitability of spinal anterior horn cells is significantly reduced, which leads to motor deficits. This loss of movement can be prevented by increasing the excitability of spinal anterior horn cells immediately following an injury. Motor imagery is an effective method for facilitating the excitability of spinal anterior horn cells in patients with impaired movement; however, the optimal duration for motor imagery is unclear.

MATERIALS AND METHODS

To investigate time-dependent changes in spinal anterior horn cell excitability during motor imagery, healthy adult participants were recruited to measure the F-wave, an indicator of anterior horn cell excitability. F-waves were measured from participants at baseline, during motor imagery, and post-motor imagery. During motor imagery, participants imagined isometric thenar muscle activity at 50% maximum voluntary contraction for 5 min. F-waves were measured at 1, 3, and 5 min after beginning motor imagery and analysed for persistence and F/M amplitude ratio.

RESULTS

Persistence and F/M amplitude ratios at 1- and 3-min after motor imagery initiation were significantly greater than at baseline. The persistence and F/M amplitude ratio at 5-min after motor imagery initiation, however, was comparable to baseline levels.

CONCLUSION

Therefore, 1 to 3 min of motor imagery is likely sufficient to facilitate the excitability of spinal anterior horn cells.

Effect of the combination of motor imagery and electrical stimulation on upper extremity motor function in patients with chronic stroke: preliminary results

Background

The combination of motor imagery (MI) and afferent input with electrical stimulation (ES) enhances the excitability of the corticospinal tract compared with motor imagery alone or electrical stimulation alone. However, its therapeutic effect is unknown in patients with hemiparetic stroke. We performed a preliminary examination of the therapeutic effects of MI + ES on upper extremity (UE) motor function in patients with chronic stroke.

Methods

A total of 10 patients with chronic stroke demonstrating severe hemiparesis participated. The imagined task was extension of the affected finger. Peripheral nerve electrical stimulation was applied to the radial nerve at the spiral groove. MI + ES intervention was conducted for 10 days. UE motor function as assessed with the Fugl-Meyer assessment UE motor score (FMA-UE), the amount of the affected UE use in daily life as assessed with a Motor Activity Log (MAL-AOU), and the degree of hypertonia in flexor muscles as assessed with the Modified Ashworth Scale (MAS) were evaluated before and after intervention. To assess the change in spinal neural circuits, reciprocal inhibition between forearm extensor and flexor muscles with the H reflex conditioning-test paradigm at interstimulus intervals (ISIs) of 0, 20, and 100 ms were measured before and after intervention.

Results

UE motor function, the amount of the affected UE use, and muscle hypertonia in flexor muscles were significantly improved after MI + ES intervention (FMA-UE: p < 0.01, MAL-AOU: p < 0.01, MAS: p = 0.02). Neurophysiologically, the intervention induced restoration of reciprocal inhibition from the forearm extensor to the flexor muscles (ISI at 0 ms: p = 0.03, ISI at 20 ms: p = 0.03, ISI at 100 ms: p = 0.01).

Conclusion

MI + ES intervention was effective for improving UE motor function in patients with severe paralysis.

Differences between motor execution and motor imagery of grasping movements in the motor cortical excitatory circuit

Background

Both motor imagery (MI) and motor execution (ME) can facilitate motor cortical excitability. Although cortical excitability is modulated by intracortical inhibitory and excitatory circuits in the human primary motor cortex, it is not clear which intracortical circuits determine the differences in corticospinal excitability between ME and MI.

Methods

We recruited 10 young healthy subjects aged 18-28 years (mean age: 22.1 ± 3.14 years; five women and five men) for this study. The experiment consisted of two sets of tasks involving grasp actions of the right hand: imagining and executing them. Corticospinal excitability and short-interval intracortical inhibition (SICI) were measured before the interventional protocol using transcranial magnetic stimulation (baseline), as well as at 0, 20, and 40 min (T0, T20, and T40) thereafter.

Results

Facilitation of corticospinal excitability was significantly greater after ME than after MI in the right abductor pollicis brevis (APB) at T0 and T20 (p < 0.01 for T0, and p < 0.05 for T20), but not in the first dorsal interosseous (FDI) muscle. On the other hand, no significant differences in SICI between ME and MI were found in the APB and FDI muscles. The facilitation of corticospinal excitability at T20 after MI correlated with the Movement Imagery Questionnaire (MIQ) scores for kinesthetic items (Rho = -0.646, p = 0.044) but did not correlate with the MIQ scores for visual items (Rho = -0.265, p = 0.458).

Discussion

The present results revealed significant differences between ME and MI on intracortical excitatory circuits of the human motor cortex, suggesting that cortical excitability differences between ME and MI may be attributed to the activation differences of the excitatory circuits in the primary motor cortex.

Effects of Sensorimotor Rhythm Modulation on the Human Flexor Carpi Radialis H-Reflex

People can learn over training sessions to increase or decrease sensorimotor rhythms (SMRs) in the electroencephalogram (EEG). Activity-dependent brain plasticity is thought to guide spinal plasticity during motor skill learning; thus, SMR training may affect spinal reflexes and thereby influence motor control. To test this hypothesis, we investigated the effects of learned mu (8–13 Hz) SMR modulation on the flexor carpi radialis (FCR) H-reflex in 6 subjects with no known neurological conditions and 2 subjects with chronic incomplete spinal cord injury (SCI). All subjects had learned and practiced over more than 10 < 30-min training sessions to increase (SMR-up trials) and decrease (SMR-down trials) mu-rhythm amplitude over the hand/arm area of left sensorimotor cortex with ≥80% accuracy. Right FCR H-reflexes were elicited at random times during SMR-up and SMR-down trials, and in between trials. SMR modulation affected H-reflex size. In all the neurologically normal subjects, the H-reflex was significantly larger [116% ± 6 (mean ± SE)] during SMR-up trials than between trials, and significantly smaller (92% ± 1) during SMR-down trials than between trials (p < 0.05 for both, paired t-test). One subject with SCI showed similar H-reflex size dependence (high for SMR-up trials, low for SMR-down trials): the other subject with SCI showed no dependence. These results support the hypothesis that SMR modulation has predictable effects on spinal reflex excitability in people who are neurologically normal; they also suggest that it might be used to enhance therapies that seek to improve functional recovery in some individuals with SCI or other CNS disorders.

Modulation of corticospinal excitability during positive and negative motor imageries

We investigated corticospinal excitability during positive (execution) and negative (suppression) imageries for the right and left upper and lower limbs. In the Positive Imagery tasks, sixteen subjects were instructed to repeatedly imagine rotation of the index finger of the right or left hand, or the ankle of the right or left foot. In the Negative Imagery tasks, they were asked to imagine the suppression of movements for the index finger of the right or left hand, or the ankle of the right or left foot. A single-pulse transcranial magnetic stimulation was delivered over the left hand primary motor cortex, and motor evoked potentials (MEPs) were recorded from the right first dorsal interosseous (FDI) muscle under all conditions. The MEP amplitudes of the FDI were significantly larger in the Positive and Negative Imagery tasks than in the resting control task during motor imagery of the right hand, left hand, and left foot, but not during that of right foot. Our results indicate that imageries of suppressing hand and foot movements enhanced corticospinal excitability.

Inhibition or facilitation? Modulation of corticospinal excitability during motor imagery

Motor imagery (MI) is the mental simulation of an action without any overt movement. Functional evidences show that brain activity during MI and motor execution (ME) largely overlaps. However, the role of the primary motor cortex (M1) during MI is controversial. Effective connectivity techniques show a facilitation on M1 during ME and an inhibition during MI, depending on whether an action should be performed or suppressed. Conversely, Transcranial Magnetic Stimulation (TMS) studies report facilitatory effects during both ME and MI. The present TMS study shed light on MI mechanisms, by manipulating the instructions given to the participants. In both Experimental and Control groups, participants were asked to mentally simulate a finger-thumb opposition task, but only the Experimental group received the explicit instruction to avoid any unwanted fingers movements. The amplitude of motor evoked potentials (MEPs) to TMS during MI was compared between the two groups. If the M1 facilitation actually pertains to MI per se, we should have expected to find it, irrespective of the instructions. Contrariwise, we found opposite results, showing facilitatory effects (increased MEPs amplitude) in the Control group and inhibitory effects (decreased MEPs amplitude) in the Experimental group. Control experiments demonstrated that the inhibitory effect was specific for the M1 contralateral to the hand performing the MI task and that the given instructions did not compromise the subjects' MI abilities. The present findings suggest a crucial role of motor inhibition when a "pure" MI task is performed and the subjects are explicitly instructed to avoid overt movements.

Recruitment of Additional Corticospinal Pathways in the Human Brain with State-Dependent Paired Associative Stimulation

Standard brain stimulation protocols modify human motor cortex excitability by modulating the gain of the activated corticospinal pathways. However, the restoration of motor function following lesions of the corticospinal tract requires also the recruitment of additional neurons to increase the net corticospinal output. For this purpose, we investigated a novel protocol based on brain state-dependent paired associative stimulation.Motor imagery (MI)-related electroencephalography was recorded in healthy males and females for brain state-dependent control of both cortical and peripheral stimulation in a brain-machine interface environment. State-dependency was investigated with concurrent, delayed, and independent stimulation relative to the MI task. Specifically, sensorimotor event-related desynchronization (ERD) in the β-band (16-22 Hz) triggered peripheral stimulation through passive hand opening by a robotic orthosis and transcranial magnetic stimulation to the respective cortical motor representation, either synchronously or subsequently. These MI-related paradigms were compared with paired cortical and peripheral input applied independent of the brain state. Cortical stimulation resulted in a significant increase in corticospinal excitability only when applied brain state-dependently and synchronously to peripheral input. These gains were resistant to a depotentiation task, revealed a nonlinear evolution of plasticity, and were mediated via the recruitment of additional corticospinal neurons rather than via synchronization of neuronal firing. Recruitment of additional corticospinal pathways may be achieved when cortical and peripheral inputs are applied concurrently, and during β-ERD. These findings resemble a gating mechanism and are potentially important for developing closed-loop brain stimulation for the treatment of hand paralysis following lesions of the corticospinal tract.SIGNIFICANCE STATEMENT The activity state of the motor system influences the excitability of corticospinal pathways to external input. State-dependent interventions harness this property to increase the connectivity between motor cortex and muscles. These stimulation protocols modulate the gain of the activated pathways, but not the overall corticospinal recruitment. In this study, a brain-machine interface paired peripheral stimulation through passive hand opening with transcranial magnetic stimulation to the respective cortical motor representation during volitional β-band desynchronization. Cortical stimulation resulted in the recruitment of additional corticospinal pathways, but only when applied brain state-dependently and synchronously to peripheral input. These effects resemble a gating mechanism and may be important for the restoration of motor function following lesions of the corticospinal tract.

Influence of motor imagery on spinal reflex excitability of multiple muscles

The effects of motor imagery on spinal reflexes such as the H-reflex are unclear. One reason for this is that the muscles that can be used to record spinal reflexes are limited to traditional evoking methods Recently, transcutaneous spinal cord stimulation has been used for inducing spinal reflexes from multiple muscles and we aimed to examine the effect of motor imagery on spinal reflexes from multiple muscles. Spinal reflexes evoked by transcutaneous spinal cord stimulation were recorded from six muscles from lower limbs during motor imagery of right wrist extension and ankle plantarflexion with maximum isometric contraction. During both imaginary tasks, facilitation of spinal reflexes was detected in the ankle ipsilateral plantarflexor and dorsiflexor muscles, but not in thigh, toe or contralateral lower limb muscles. These results suggest that motor imagery of isometric contraction facilitates spinal reflex excitability in muscles of the ipsilateral lower leg and the facilitation does not correspond to the imaginary involved muscles.

Motor imagery of voluntary muscle relaxation of the foot induces a temporal reduction of corticospinal excitability in the hand

The object of this study was to clarify how the motor imagery of foot muscle relaxation influences corticospinal excitability for the ipsilateral hand. Twelve participants volitionally relaxed their right foot from a dorsiflexed position (actual relaxation), or imaged the same movement (imagery relaxation) in response to an auditory cue. Transcranial magnetic stimulation (TMS) was delivered to the hand area of the left primary motor cortex at different time intervals after an auditory cue. Motor evoked potentials (MEPs) were recorded from the right extensor carpi radialis (ECR) and flexor carpi radialis (FCR). MEP amplitudes of ECR and FCR caused by single-pulse TMS temporarily decreased during both actual relaxation and imagery relaxation as compared with those of the resting control. A correlation of MEP amplitude between actual relaxation and imagery relaxation was observed. Our findings indicate that motor imagery of muscle relaxation of the foot induced a reduction of corticospinal excitability in the ipsilateral hand muscles. This effect is likely produced via the same mechanism that functions during actual muscle relaxation.

Corticospinal excitability for hand muscles during motor imagery of foot changes with imagined force level

The object of this study was to clarify whether corticospinal excitability controlling hand muscles changes concurrently with increases in the imagined contraction level of foot dorsiflexion. Twelve participants performed actual and imagined dorsiflexion of their right foot at three different EMG levels (10, 40 or 80% of the maximum voluntary contraction). During isometric actual- or imagined- dorsiflexion, transcranial magnetic stimulation (TMS) was delivered to the right hand area of the left primary motor cortex. Motor evoked potentials (MEPs) were recorded from the right extensor carpi radialis (ECR) and flexor carpi radialis (FCR). During actual contraction, MEP amplitudes of ECR and FCR increased with an increased EMG level of dorsiflexion. Similarly, during imagery contraction, MEP amplitudes of ECR and FCR increased with the intensity of imagery contraction. Furthermore, a correlation between MEP amplitude during actual contraction and imagery contraction was observed for both ECR and FCR. Motor imagery of foot contraction induced an enhancement of corticospinal excitability for hand muscles that was dependent on the imagined contraction levels, just as what was observed when there was an actual contraction.

Modulation of motor cortex inhibition during motor imagery

Motor imagery (MI) is similar to overt movement, engaging common neural substrates and facilitating the corticomotor pathway; however, it does not result in excitatory descending motor output. Transcranial magnetic stimulation (TMS) can be used to assess inhibitory networks in the primary motor cortex via measures of 1-ms short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI), and late cortical disinhibition (LCD). These measures are thought to reflect extrasynaptic GABA_A tonic inhibition, postsynaptic GABA_B inhibition, and presynaptic GABA_B disinhibition, respectively. The behavior of 1-ms SICI, LICI, and LCD during MI has not yet been explored. This study aimed to investigate how 1-ms SICI, LICI, and LCD are modulated during MI and voluntary relaxation (VR) of a target muscle. Twenty-five healthy young adults participated. TMS was used to assess nonconditioned motor evoked potential (MEP) amplitude, 1-ms SICI, 100- (LICI₁₀₀) and 150-ms LICI, and LCD in the right abductor pollicis brevis (APB) and right abductor digiti minimi during rest, MI, and VR of the hand. Compared with rest, MEP amplitudes were facilitated in APB during MI. SICI was not affected by task or muscle. LICI₁₀₀ decreased in both muscles during VR but not MI, whereas LCD was recruited in both muscles during both tasks. This indicates that VR modulates postsynaptic GABA_B inhibition, whereas both tasks modulate presynaptic GABA_B inhibition in a non-muscle-specific way. This study highlights further neurophysiological parallels between actual and imagined movement, which may extend to voluntary relaxation.NEW & NOTEWORTHY This is the first study to investigate how 1-ms short-interval intracortical inhibition, long-interval intracortical inhibition, and late cortical disinhibition are modulated during motor imagery and voluntary muscle relaxation. We present novel findings of decreased 100-ms long-interval intracortical inhibition during voluntary muscle relaxation and increased late cortical disinhibition during both motor imagery and voluntary muscle relaxation.

Neural plasticity during motor learning with motor imagery practice: Review and perspectives

In the last decade, many studies confirmed the benefits of mental practice with motor imagery. In this review we first aimed to compile data issued from fundamental and clinical investigations and to provide the key-components for the optimization of motor imagery strategy. We focused on transcranial magnetic stimulation studies, supported by brain imaging research, that sustain the current hypothesis of a functional link between cortical reorganization and behavioral improvement. As perspectives, we suggest a model of neural adaptation following mental practice, in which synapse conductivity and inhibitory mechanisms at the spinal level may also play an important role.

Virtual Reality-Guided Motor Imagery Increases Corticomotor Excitability in Healthy Volunteers and Stroke Patients

Objective

To investigate the effects of using motor imagery (MI) in combination with a virtual reality (VR) program on healthy volunteers and stroke patients. In addition, this study investigated whether task variability within the VR-guided MI programs would influence corticomotor excitability.

Methods

The present study included 15 stroke patients and 15 healthy right-handed volunteers who were presented with four different conditions in a random order: rest, MI alone, VR-guided MI, and VR-guided MI with task variability. The corticomotor excitability of each participant was assessed before, during, and after each condition by measuring changes in the various parameters of motor-evoked potentials (MEPs) of the extensor carpi radials (ECR). Changes in intracortical inhibition (ICI) and intracortical facilitation (ICF) were calculated after each condition as percentages of inhibition (%INH) and facilitation (%FAC) at rest.

Results

In both groups, the increases in MEP amplitudes were greater during the two VR-guided MI conditions than during MI alone. Additionally, the reductions in ECR %INH in both groups were greater under the condition involving VR-guided MI with task variability than under that involving VR-guided MI with regular interval.

Conclusion

The corticomotor excitability elicited by MI using a VR avatar representation was greater than that elicited by MI with real body observations. Furthermore, the use of task variability in a VR program may enhance neural regeneration after stroke by reducing ICI. The present findings support the use of various VR programs as well as the concept of combining MI with VR programs for neurorehabilitation.

Brain State-Dependent Closed-Loop Modulation of Paired Associative Stimulation Controlled by Sensorimotor Desynchronization

BACKGROUND

Pairing peripheral electrical stimulation (ES) and transcranial magnetic stimulation (TMS) increases corticospinal excitability when applied with a specific temporal pattern. When the two stimulation techniques are applied separately, motor imagery (MI)-related oscillatory modulation amplifies both ES-related cortical effects-sensorimotor event-related desynchronization (ERD), and TMS-induced peripheral responses-motor-evoked potentials (MEP). However, the influence of brain self-regulation on the associative pairing of these stimulation techniques is still unclear.

OBJECTIVE

The aim of this pilot study was to investigate the effects of MI-related ERD during associative ES and TMS on subsequent corticospinal excitability.

METHOD

The paired application of functional electrical stimulation (FES) of the extensor digitorum communis (EDC) muscle and subsequent single-pulse TMS (110% resting motor threshold (RMT)) of the contralateral primary motor cortex (M1) was controlled by beta-band (16-22 Hz) ERD during MI of finger extension and applied within a brain-machine interface environment in six healthy subjects. Neural correlates were probed by acquiring the stimulus-response curve (SRC) of both MEP peak-to-peak amplitude and area under the curve (AUC) before and after the intervention.

RESULT

The application of approximately 150 pairs of associative FES and TMS resulted in a significant increase of MEP amplitudes and AUC, indicating that the induced increase of corticospinal excitability was mediated by the recruitment of additional neuronal pools. MEP increases were brain state-dependent and correlated with beta-band ERD, but not with the background EDC muscle activity; this finding was independent of the FES intensity applied.

CONCLUSION

These results could be relevant for developing closed-loop therapeutic approaches such as the application of brain state-dependent, paired associative stimulation (PAS) in the context of neurorehabilitation.

Cortical inhibition is reduced following short-term training in young and older adults

The purpose of this study was to investigate age-related differences in short-term training adaptations in cortical excitability and inhibition. Thirty young (21.9 ± 3.1 years) and 30 older (72.9 ± 4.6 years) individuals participated in the study. Each participant was randomly assigned to a control (n = 30) or a resistance training (n = 30) group, with equal numbers of young and older subjects in each group. Participants completed 2 days of testing, separated by 2 weeks during which time the training group participated in resistance training of the ankle dorsiflexor muscles three times per week. During each testing session, transcranial magnetic stimulation was used to generate motor evoked potentials (MEPs) and silent periods in the tibialis anterior. Hoffmann reflexes (H-reflexes) and compound muscle action potentials (M-waves) were also evoked via electrical stimulation of the peroneal nerve. At baseline, young subjects had higher maximum voluntary contraction (MVC) force (p = 0.002), larger M-wave amplitude (p < 0.001), and longer duration silent periods (p = 0.01) than older individuals, with no differences in the maximal amplitude of the MEP (p = 0.23) or H-reflex (p = 0.57). In the trained group, MVC increased in both young (17.4 %) and older (19.8 %) participants (p < 0.001), and the duration of the silent period decreased by ~15 and 12 ms, respectively (p < 0.001). Training did not significantly impact MEP (p = 0.69) or H-reflex amplitudes (p = 0.38). There were no significant changes in any measures in the control group (p ≥ 0.19) across the two testing sessions. These results indicate that a reduction in cortical inhibition may be an important neural adaptation in response to training in both young and older adults.

Unilateral imagined movement increases interhemispheric inhibition from the contralateral to ipsilateral motor cortex

Whether a cortical drive to one limb modulates interhemispheric inhibition (IHI) from the active targeting to the non-active motor cortex (M1) remained unclear. The present study using a conditioning-test transcranial magnetic stimulation (TMS) paradigm aimed to directly demonstrate the modulation of IHI during unilateral voluntary or imagined movement in humans. Subjects were asked to actually perform right index-finger abduction (10-70% of the maximum voluntary contraction) or to imagine the movement. Conditioning and test TMS with an interstimulus interval of 5, 10, and 15 ms were applied over the left and right M1, respectively, and the test motor evoked potential (MEP) was recorded from the left first dorsal interosseous (FDI) muscle. The conditioning TMS intensity was adjusted ranging from 0.6 to 1.4 (in 0.2 steps) times the resting motor threshold (rMT). With test TMS alone, MEP in the left FDI muscle significantly increased during voluntary or imagined movement of the right index-finger. MEP amplitude was significantly reduced in proportion to increments of the conditioning TMS intensity at rest (1.2 and 1.4 times the rMT, P < 0.05, respectively). Importantly, the MEP inhibition was markedly enhanced during voluntary or imagined movement in comparison with that at rest. The regression analysis revealed that IHI varied depending on the intensity of the impulses conveyed from left to right M1, but not on the corticospinal excitability of the active right hand. Our results suggest that IHI from the active to non-active M1 is enhanced during unilateral volitional motor activity.

Dominant vs. nondominant arm advantage in mentally simulated actions in right handers

Although plentiful data are available regarding mental states involving the dominant-right arm, the evidence for the nondominant-left arm is sparse. Here, we investigated whether right-handers can generate accurate predictions with either the right or the left arm. Fifteen adults carried out actual and mental arm movements in two directions with varying inertial resistance (inertial anisotropy phenomenon). We recorded actual and mental movement times and used the degree of their similarity as an indicator for the accuracy of motor imagery/prediction process. We found timing correspondences (isochrony) between actual and mental right arm movements in both rightward (low inertia resistance) and leftward (high inertia resistance) directions. Timing similarities between actual and mental left arm movements existed for the leftward direction (low inertia resistance) but not for the rightward direction (high inertia resistance). We found similar results when participants reaching towards the midline of the workspace, a result that excludes a hemispace effect. Electromyographic analysis during mental movements showed that arm muscles remained inactivate, thus eliminating a muscle activation strategy that could explain intermanual differences. Furthermore, motor-evoked potentials enhancement in both right and left biceps brachii during mental actions indicated that subjects were actively engaged in mental movement simulation and that the disadvantage of the left arm cannot be attributed to the nonactivation of the right motor cortex. Our findings suggest that predictive mechanisms are more robust for the right than the left arm in right-handers. We discussed these findings from the perspective of the internal models theory and the dynamic-dominance hypothesis of laterality.

Motor imagery in bipolar depression with slowed movement

We hypothesized that motor retardation in bipolar depression is mediated by disruption of the pre-executive stages of motor production. We used functional magnetic resonance imaging to investigate neural activity during motor imagery and motor execution to elucidate whether brain regions that mediate planning, preparation, and control of movement are activated differently in subjects with bipolar depression (n = 9) compared with healthy controls (n = 12). We found significant between-group differences. During motor imagery, the patients activated the posterior medial parietal cortex, the posterior cingulate cortex, the premotor cortex, the prefrontal cortex, and the frontal poles more than the controls did. Activation in the brain areas involved in motor selection, planning, and preparation was altered. In addition, limbic and prefrontal regions associated with self-reference and the default mode network were altered during motor imagery in bipolar depression with motor retardation.

Interhemispheric inhibition during mental actions of different complexity

Several investigations suggest that actual and mental actions trigger similar neural substrates. Yet, neurophysiological evidences on the nature of interhemispheric interactions during mental movements are still meagre. Here, we asked whether the content of mental images, investigated by task complexity, is finely represented in the inhibitory interactions between the two primary motor cortices (M1s). Subjects' left M1 was stimulated by means of transcranial magnetic stimulation (TMS) while they were performing actual or mental movements of increasing complexity with their right hand and exerting a maximum isometric force with their left thumb and index. Thus, we simultaneously assessed the corticospinal excitability in the right opponent pollicis muscle (OP) and the ipsilateral silent period (iSP) in the left OP during actual and mental movements. Corticospinal excitability in right OP increased during actual and mental movements, but task complexity-dependent changes were only observed during actual movements. Interhemispheric motor inhibition in the left OP was similarly modulated by task complexity in both mental and actual movements. Precisely, the duration and the area of the iSP increased with task complexity in both movement conditions. Our findings suggest that mental and actual movements share similar inhibitory neural circuits between the two homologous primary motor cortex areas.

Imagining is Not Doing but Involves Specific Motor Commands: A Review of Experimental Data Related to Motor Inhibition

There is now compelling evidence that motor imagery (MI) and actual movement share common neural substrate. However, the question of how MI inhibits the transmission of motor commands into the efferent pathways in order to prevent any movement is largely unresolved. Similarly, little is known about the nature of the electromyographic activity that is apparent during MI. In addressing these gaps in the literature, the present paper argues that MI includes motor execution commands for muscle contractions which are blocked at some level of the motor system by inhibitory mechanisms. We first assemble data from neuroimaging studies that demonstrate that the neural networks mediating MI and motor performance are not totally overlapping, thereby highlighting potential differences between MI and actual motor execution. We then review MI data indicating the presence of subliminal muscular activity reflecting the intrinsic characteristics of the motor command as well as increased corticomotor excitability. The third section not only considers the inhibitory mechanisms involved during MI but also examines how the brain resolves the problem of issuing the motor command for action while supervising motor inhibition when people engage in voluntary movement during MI. The last part of the paper draws on imagery research in clinical contexts to suggest that some patients move while imagining an action, although they are not aware of such movements. In particular, experimental data from amputees as well as from patients with Parkinson’s disease are discussed. We also review recent studies based on comparing brain activity in tetraplegic patients with that from healthy matched controls that provide insights into inhibitory processes during MI. We conclude by arguing that based on available evidence, a multifactorial explanation of motor inhibition during MI is warranted.

The impact of mental practice on stroke patients' postural balance

INTRODUCTION

The most common problem in stroke patients is reduced balance and derangements of postural control that lead to increase the chance of falling and instability during walking. Since physical practice improves balance and postural control, it is assumed also that the application of mental practice would be useful in enhancing such balance. Mental practice is defined as the cognitive rehearsal of a physical skill in the absence of overt physical movements. Factors such as similar time between actual execution and mental performance of a task, the increase of regional cerebral blood flow and also the vegetative activation, all suggest that mental practice imitates physical performance of a task. Thus, the main purpose of this study was to investigate the effect of such mental practice on postural balance among stroke survivors.

METHOD AND MATERIALS

This study was implemented as an experimental (interventional), case-control, double blind and randomized trial design. A total of 30 subjects (16 males and 14 females) with necessary arousal, attention and memory functions as their major components of mental practice, participated. Subjects' mean ages were 48.1 ± 10.5 years. They were divided randomly in two control and experimental groups. Timed Get up and Go (TUG) test was used to evaluate the balance of all participants. They were assessed before-after treatment and two weeks post-treatment as research's follow up. The two groups received the same method of occupational therapy services, but the experimental group in addition to aforementioned occupational therapy, was requested to participate in mental practice sessions.

RESULTS

Mental practice had a significant effect on postural balance in stroke survivors (P=<0.001).

CONCLUSION

Mental practice may improve postural balance in stroke patients and can be considered for them as a beneficial rehabilitative technique.

Task-dependent interaction between parietal and contralateral primary motor cortex during explicit versus implicit motor imagery

Both mental rotation (MR) and motor imagery (MI) involve an internalization of movement within motor and parietal cortex. Transcranial magnetic stimulation (TMS) techniques allow for a task-dependent investigation of the interhemispheric interaction between these areas. We used image-guided dual-coil TMS to investigate interactions between right inferior parietal lobe (rIPL) and left primary motor cortex (M1) in 11 healthy participants. They performed MI (right index-thumb pinching in time with a 1 Hz metronome) or hand MR tasks, while motor evoked potentials (MEPs) were recorded from right first dorsal interosseous. At rest, rIPL conditioning 6 ms prior to M1 stimulation facilitated MEPs in all participants, whereas this facilitation was abolished during MR. While rIPL conditioning 12 ms prior to M1 stimulation had no effect on MEPs at rest, it suppressed corticomotor excitability during MI. These results support the idea that rIPL forms part of a distinct inhibitory network that may prevent unwanted movement during imagery tasks.