Remodelling of hand representation in adult cortex determined by timing of tactile stimulation

Transfer of Tactile Learning to Untrained Body Parts: Emerging Cortical Mechanisms

Pioneering investigations in the mid-19th century revealed that the perception of tactile cues presented to the surface of the skin improves with training, which is referred to as tactile learning. Surprisingly, tactile learning also occurs for body parts and skin locations that are not physically involved in the training. For example, after training of a finger, tactile learning transfers to adjacent untrained fingers. This suggests that the transfer of tactile learning follows a somatotopic pattern and involves brain regions such as the primary somatosensory cortex (S1), in which the trained and untrained body parts and skin locations are represented close to each other. However, other results showed that transfer occurs between body parts that are not represented close to each other in S1-for example, between the hand and the foot. These and similar findings have led to the suggestion of additional cortical mechanisms to explain the transfer of tactile learning. Here, different mechanisms are reviewed, and the extent to which they can explain the transfer of tactile learning is discussed. What all of these mechanisms have in common is that they assume a representational or functional relationship between the trained and untrained body parts and skin locations. However, none of these mechanisms alone can explain the complex pattern of transfer results, and it is likely that different mechanisms interact to enable transfer, perhaps in concert with higher somatosensory and decision-making areas.

Against cortical reorganisation

Neurological insults, such as congenital blindness, deafness, amputation, and stroke, often result in surprising and impressive behavioural changes. Cortical reorganisation, which refers to preserved brain tissue taking on a new functional role, is often invoked to account for these behavioural changes. Here, we revisit many of the classical animal and patient cortical remapping studies that spawned this notion of reorganisation. We highlight empirical, methodological, and conceptual problems that call this notion into doubt. We argue that appeal to the idea of reorganisation is attributable in part to the way that cortical maps are empirically derived. Specifically, cortical maps are often defined based on oversimplified assumptions of 'winner-takes-all', which in turn leads to an erroneous interpretation of what it means when these maps appear to change. Conceptually, remapping is interpreted as a circuit receiving novel input and processing it in a way unrelated to its original function. This implies that neurons are either pluripotent enough to change what they are tuned to or that a circuit can change what it computes. Instead of reorganisation, we argue that remapping is more likely to occur due to potentiation of pre-existing architecture that already has the requisite representational and computational capacity pre-injury. This architecture can be facilitated via Hebbian and homeostatic plasticity mechanisms. Crucially, our revised framework proposes that opportunities for functional change are constrained throughout the lifespan by the underlying structural 'blueprint'. At no period, including early in development, does the cortex offer structural opportunities for functional pluripotency. We conclude that reorganisation as a distinct form of cortical plasticity, ubiquitously evoked with words such as 'take-over'' and 'rewiring', does not exist.

Biological constraints on stereotaxic targeting of functionally-defined cortical areas

Understanding computational principles in hierarchically organized sensory systems requires functional parcellation of brain structures and their precise targeting for manipulations. Although brain atlases are widely used to infer area locations in the mouse neocortex, it has been unclear whether stereotaxic coordinates based on standardized brain morphology accurately represent functional domains in individual animals. Here, we used intrinsic signal imaging to evaluate the accuracy of area delineation in the atlas by mapping functionally-identified auditory cortices onto bregma-based stereotaxic coordinates. We found that auditory cortices in the brain atlas correlated poorly with the true complexity of functional area boundaries. Inter-animal variability in functional area locations predicted surprisingly high error rates in stereotaxic targeting with atlas coordinates. This variability was not simply attributed to brain sizes or suture irregularities but instead reflected differences in cortical geography across animals. Our data thus indicate that functional mapping in individual animals is essential for dissecting cortical area-specific roles with high precision.

Multi-finger receptive field properties in primary somatosensory cortex: A revised account of the spatiotemporal integration functions of area 3b

The leading view in the somatosensory system indicates that area 3b serves as a cortical relay site that primarily encodes (cutaneous) tactile features limited to individual digits. Our recent work argues against this model by showing that area 3b cells can integrate both cutaneous and proprioceptive information from the hand. Here, we further test the validity of this model by studying multi-digit (MD) integration properties in area 3b. In contrast to the prevailing view, we show that most cells in area 3b have a receptive field (RF) that extends to multiple digits, with the size of the RF (i.e., the number of responsive digits) increasing across time. Further, we show that MD cells' orientation angle preference is highly correlated across digits. Taken together, these data show that area 3b plays a larger role in generating neural representations of tactile objects, as opposed to just being a "feature detector" relay site.

Complex pattern of facial remapping in somatosensory cortex following congenital but not acquired hand loss

Cortical remapping after hand loss in the primary somatosensory cortex (S1) is thought to be predominantly dictated by cortical proximity, with adjacent body parts remapping into the deprived area. Traditionally, this remapping has been characterised by changes in the lip representation, which is assumed to be the immediate neighbour of the hand based on electrophysiological research in non-human primates. However, the orientation of facial somatotopy in humans is debated, with contrasting work reporting both an inverted and upright topography. We aimed to fill this gap in the S1 homunculus by investigating the topographic organisation of the face. Using both univariate and multivariate approaches we examined the extent of face-to-hand remapping in individuals with a congenital and acquired missing hand (hereafter one-handers and amputees, respectively), relative to two-handed controls. Participants were asked to move different facial parts (forehead, nose, lips, tongue) during functional MRI (fMRI) scanning. We first confirmed an upright face organisation in all three groups, with the upper-face and not the lips bordering the hand area. We further found little evidence for remapping of both forehead and lips in amputees, with no significant relationship to the chronicity of their phantom limb pain (PLP). In contrast, we found converging evidence for a complex pattern of face remapping in congenital one-handers across multiple facial parts, where relative to controls, the location of the cortical neighbour - the forehead - is shown to shift away from the deprived hand area, which is subsequently more activated by the lips and the tongue. Together, our findings demonstrate that the face representation in humans is highly plastic, but that this plasticity is restricted by the developmental stage of input deprivation, rather than cortical proximity.

Beyond language: The unspoken sensory-motor representation of the tongue in non-primates, non-human and human primates

The English idiom "on the tip of my tongue" commonly acknowledges that something is known, but it cannot be immediately brought to mind. This phrase accurately describes sensorimotor functions of the tongue, which are fundamental for many tongue-related behaviors (e.g., speech), but often neglected by scientific research. Here, we review a wide range of studies conducted on non-primates, non-human and human primates with the aim of providing a comprehensive description of the cortical representation of the tongue's somatosensory inputs and motor outputs across different phylogenetic domains. First, we summarize how the properties of passive non-noxious mechanical stimuli are encoded in the putative somatosensory tongue area, which has a conserved location in the ventral portion of the somatosensory cortex across mammals. Second, we review how complex self-generated actions involving the tongue are represented in more anterior regions of the putative somato-motor tongue area. Finally, we describe multisensory response properties of the primate and non-primate tongue area by also defining how the cytoarchitecture of this area is affected by experience and deafferentation.

Unilateral vestibular neurectomy induces a remodeling of somatosensory cortical maps

Unilateral Vestibular Neurectomy (UVN) induces a postural syndrome whose compensation over time is underpinned by multimodal sensory substitution processes. However, at a chronic stage of compensation, UVN rats exhibit an enduring postural asymmetry expressed by an increase in the body weight on the ipsilesional paws. Given the anatomo-functional links between the vestibular nuclei and the primary somatosensory cortex (S1), we explored the interplay of vestibular and somatosensory cortical inputs following acute and chronic UVN. We determined whether the enduring imbalance in tactilo-plantar inputs impacts response properties of S1 cortical neurons and organizational features of somatotopic maps. We performed electrophysiological mapping of the hindpaw cutaneous representations in S1, immediately and one month after UVN. In parallel, we assessed the posturo-locomotor imbalance during the compensation process. UVN immediately induces an expansion of the cortical neuron cutaneous receptive fields (RFs) leading to a partial dedifferentiation of somatotopic maps. This effect was demonstrated for the ventral skin surface representations and was greater on the contralesional hindpaw for which the neuronal threshold to skin pressure strongly decreased. The RF enlargement was amplified for the representation of the ipsilesional hindpaw in relation to persistent postural asymmetries, but was transitory for the contralesional one. Our study shows, for the first time, that vestibular inputs exert a modulatory influence on S1 neuron's cutaneous responses. The lesion-induced cortical malleability highlights the influence of vestibular inputs on tactile processing related to postural control.

Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain with Percutaneous Peripheral Nerve Stimulation

Peripheral nerve stimulation (PNS) is an effective tool for the treatment of chronic pain, although its efficacy and utilization have previously been significantly limited by technology. In recent years, purpose-built percutaneous PNS devices have been developed to overcome the limitations of conventional permanently implanted neurostimulation devices. Recent clinical evidence suggests clinically significant and sustained reductions in pain can persist well beyond the PNS treatment period, outcomes that have not previously been observed with conventional permanently implanted neurostimulation devices. This narrative review summarizes mechanistic processes that contribute to chronic pain, and the potential mechanisms by which selective large diameter afferent fiber activation may reverse these changes to induce a prolonged reduction in pain. The interplay of these mechanisms, supported by data in chronic pain states that have been effectively treated with percutaneous PNS, will also be discussed in support of a new theory of pain management in neuromodulation: Peripherally Induced Reconditioning of the Central Nervous System (CNS).

Experience-driven remodeling of S1 digit representation in awake monkeys: the challenge of comparing active and passive touch

Many studies have compared active and passive touch to understand how motor action shapes touch perception. Current views emphasize the difficulties in making such a comparison and promote investigating how motor strategies enable the filtering out of sensory inputs to reshape touch perception. Cybulska-Klosowicz et al. (Cybulska-Klosowicz A, Tremblay F, Jiang W, Bourgeon S, Meftah E-M, Chapman CE. J Neurophysiol 123: 1072-1089, 2020) suggest that primary somatosensory (S1) cortical remodeling of digit representation occurs during active touch. Here, alternative interpretations are proposed, and the relevance of studying multidigit scanning is emphasized.

Themes of advanced information processing in the primate brain

Here is a review of several empirical examples of information processing that occur in the primate cerebral cortex. These include visual processing, object identification and perception, information encoding, and memory. Also, there is a discussion of the higher scale neural organization, mainly theoretical, which suggests hypotheses on how the brain internally represents objects. Altogether they support the general attributes of the mechanisms of brain computation, such as efficiency, resiliency, data compression, and a modularization of neural function and their pathways. Moreover, the specific neural encoding schemes are expectedly stochastic, abstract and not easily decoded by theoretical or empirical approaches.

Musical practice and BDNF plasma levels as a potential marker of synaptic plasticity: an instrument of rehabilitative processes

Background and objectives

The aim of the study was to investigate the influence of musical practice on brain plasticity. BDNF (brain-derived neurotrophic factor) is a neurotrophin involved in neuroplasticity and synaptic function.

Materials and methods

We recruited 48 healthy subjects of equal age and sex (21 musicians and 27 non-musicians). All subjects were administered the AQ (Autism-Spectrum Questionnaire) and plasma levels (PLs) of BDNF, oxytocin (OT), and vasopressin (VP) were measured in the blood sample of every participant.

Results.

The difference between BDNF PLs in the two groups was found to be statistically significant (t = − 2.214, p = 0.03). Furthermore, oxytocin (OT) PLs and musical practice were found to be independent positive predictors of BDNF PLs (p < 0.04). We also found a negative correlation between BDNF PLs and AD (attention to detail) sub-scale score of AQ throughout the whole sample. Assuming BDNF PLs to be a marker of synaptic plasticity, higher PLs could be associated with the activation of alternative neural pathways: a lower score in the “attention to detail” sub-scale could imply greater flexibility of higher cerebral functions among musicians.

Further researches should be conducted to assess the rehabilitative usefulness of these findings among patients affected by psychiatric disorders.

Organized Toe Maps in Extreme Foot Users

Although the fine-grained features of topographic maps in the somatosensory cortex can be shaped by everyday experience, it is unknown whether behavior can support the expression of somatotopic maps where they do not typically occur. Unlike the fingers, represented in all primates, individuated toe maps have only been found in non-human primates. Using 1-mm resolution fMRI, we identify organized toe maps in two individuals born without either upper limb who use their feet to substitute missing hand function and even support their profession as foot artists. We demonstrate that the ordering and structure of the artists’ toe representation mimics typical hand representation. We further reveal “hand-like” features of activity patterns, not only in the foot area but also similarly in the missing hand area. We suggest humans may have an innate capacity for forming additional topographic maps that can be expressed with appropriate experience.

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We ask if extreme behavior can cause the (re)emergence of somatotopic maps

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We investigated two foot artists, born without arms

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7T fMRI shows individuated maps of up to 5 toes in the artists but not controls

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Activity in artists’ foot and hand areas was more “hand-like” than in controls

Brain (re)organisation following amputation: Implications for phantom limb pain

Following arm amputation the region that represented the missing hand in primary somatosensory cortex (S1) becomes deprived of its primary input, resulting in changed boundaries of the S1 body map. This remapping process has been termed 'reorganisation' and has been attributed to multiple mechanisms, including increased expression of previously masked inputs. In a maladaptive plasticity model, such reorganisation has been associated with phantom limb pain (PLP). Brain activity associated with phantom hand movements is also correlated with PLP, suggesting that preserved limb functional representation may serve as a complementary process. Here we review some of the most recent evidence for the potential drivers and consequences of brain (re)organisation following amputation, based on human neuroimaging. We emphasise other perceptual and behavioural factors consequential to arm amputation, such as non-painful phantom sensations, perceived limb ownership, intact hand compensatory behaviour or prosthesis use, which have also been related to both cortical changes and PLP. We also discuss new findings based on interventions designed to alter the brain representation of the phantom limb, including augmented/virtual reality applications and brain computer interfaces. These studies point to a close interaction of sensory changes and alterations in brain regions involved in body representation, pain processing and motor control. Finally, we review recent evidence based on methodological advances such as high field neuroimaging and multivariate techniques that provide new opportunities to interrogate somatosensory representations in the missing hand cortical territory. Collectively, this research highlights the need to consider potential contributions of additional brain mechanisms, beyond S1 remapping, and the dynamic interplay of contextual factors with brain changes for understanding and alleviating PLP.

Global enhancement of cortical excitability following coactivation of large neuronal populations

Correlated activation of cortical neurons often occurs in the brain and repetitive correlated neuronal firing could cause long-term modifications of synaptic efficacy and intrinsic excitability. We found that repetitive optogenetic activation of neuronal populations in the mouse cortex caused enhancement of optogenetically evoked firing of local coactivated neurons as well as distant cortical neurons in both ipsilateral and contralateral hemispheres. This global enhancement of evoked responses required coactivation of a sufficiently large population of neurons either within one cortical area or distributed in several areas. Enhancement of neuronal firing was saturable after repeated episodes of coactivation, diminished by inhibition of N-methyl-d-aspartic acid receptors, and accompanied by elevated excitatory postsynaptic potentials, all consistent with activity-induced synaptic potentiation. Chemogenetic inhibition of neuronal activity of the thalamus decreased the enhancement effect, suggesting thalamic involvement. Thus, correlated excitation of large neuronal populations leads to global enhancement of neuronal excitability.

Differential effects of the mode of touch, active and passive, on experience-driven plasticity in the S1 cutaneous digit representation of adult macaque monkeys

This study compared the receptive field (RF) properties and firing rates of neurons in the cutaneous hand representation of primary somatosensory cortex (areas 3b, 1, and 2) of 9 awake, adult macaques that were intensively trained in a texture discrimination task using active touch (fingertips scanned over the surfaces using a single voluntary movement), passive touch (surfaces displaced under the immobile fingertips), or both active and passive touch. Two control monkeys received passive exposure to the same textures in the context of a visual discrimination task. Training and recording extended over 1–2 yr per animal. All neurons had a cutaneous receptive field (RF) that included the tips of the stimulated digits (D3 and/or D4). In area 3b, RFs were largest in monkeys trained with active touch, smallest in those trained with passive touch, and intermediate in those trained with both; i.e., the mode of touch differentially modified the cortical representation of the stimulated fingers. The same trends were seen in areas 1 and 2, but the changes were not significant, possibly because a second experience-driven influence was seen in areas 1 and 2, but not in area 3b: smaller RFs with passive exposure to irrelevant tactile inputs compared with recordings from one naive hemisphere. We suggest that added feedback during active touch and higher cortical firing rates were responsible for the larger RFs with behavioral training; this influence was tempered by periods of more restricted sensory feedback during passive touch training in the active + passive monkeys.

NEW & NOTEWORTHY We studied experience-dependent sensory cortical plasticity in relation to tactile discrimination of texture using active and/or passive touch. We showed that neuronal receptive fields in primary somatosensory cortex, especially area 3b, are largest in monkeys trained with active touch, smallest in those trained with passive touch, and intermediate in those trained using both modes of touch. Prolonged, irrelevant tactile input had the opposite influence in areas 1 and 2, favoring smaller receptive fields.

Tactile angle discriminability improvement: roles of training time intervals and different types of training tasks

Perceptual learning, which is not limited to sensory modalities such as vision and touch, emerges within a training session and between training sessions and is accompanied by the remodeling of neural connections in the cortex. However, limited knowledge exists regarding perceptual learning between training sessions. Although tactile studies have paid attention to between-session learning effects, there have been few studies asking fundamental questions regarding whether the time interval between training sessions affects tactile perceptual learning and generalization across tactile tasks. We investigated the effects of different training time intervals on the consecutive performance of a tactile angle discrimination (AD) task and a tactile orientation discrimination (OD) task training on tactile angle discriminability. The results indicated that in the short-interval training group, AD task performance significantly improved in the early stage of learning and nearly plateaued in the later stage, whereas in the long-interval training group, significant improvement was delayed and then also nearly plateaued in the later stage; additionally, improved OD task performance resulted in improved AD task performance. These findings suggest that training time interval affects the early stage of learning but not the later stage and that generalization occurs between different types of tactile tasks.

NEW & NOTEWORTHY Perceptual learning, which constitutes important foundations of complicated cognitive processes, is learning better perception skills. We demonstrate that training time interval can affect the early stage of learning but not the later stage. Moreover, a tactile orientation discrimination training task can also improve tactile angle discrimination performance. These findings may expand the characteristics of between-session learning and help understand the mechanism of the generalization across tactile tasks.

Large-scale changes in cortical dynamics triggered by repetitive somatosensory electrical stimulation

Background

Repetitive somatosensory electrical stimulation (SES) of forelimb peripheral nerves is a promising therapy; studies have shown that SES can improve motor function in stroke subjects with chronic deficits. However, little is known about how SES can directly modulate neural dynamics. Past studies using SES have primarily used noninvasive methods in human subjects. Here we used electrophysiological recordings from the rodent primary motor cortex (M1) to assess how SES affects neural dynamics at the level of single neurons as well as at the level of mesoscale dynamics.

Methods

We performed acute extracellular recordings in 7 intact adult Long Evans rats under ketamine-xylazine anesthesia while they received transcutaneous SES. We recorded single unit spiking and local field potentials (LFP) in the M1 contralateral to the stimulated arm. We then compared neural firing rate, spike-field coherence (SFC), and power spectral density (PSD) before and after stimulation.

Results

Following SES, the firing rate of a majority of neurons changed significantly from their respective baseline values. There was, however, a diversity of responses; some neurons increased while others decreased their firing rates. Interestingly, SFC, a measure of how a neuron’s firing is coupled to mesoscale oscillatory dynamics, increased specifically in the δ-band, also known as the low frequency band (0.3- 4 Hz). This increase appeared to be driven by a change in the phase-locking of broad-spiking, putative pyramidal neurons. These changes in the low frequency range occurred without a significant change in the overall PSD.

Conclusions

Repetitive SES significantly and persistently altered the local cortical dynamics of M1 neurons, changing both firing rates as well as the SFC magnitude in the δ-band. Thus, SES altered the neural firing and coupling to ongoing mesoscale dynamics. Our study provides evidence that SES can directly modulate cortical dynamics.

Obtaining and maintaining cortical hand representation as evidenced from acquired and congenital handlessness

A key question in neuroscience is how cortical organisation relates to experience. Previously we showed that amputees experiencing highly vivid phantom sensations maintain cortical representation of their missing hand (Kikkert et al., 2016). Here, we examined the role of sensory hand experience on persistent hand representation by studying individuals with acquired and congenital hand loss. We used representational similarity analysis in primary somatosensory and motor cortex during missing and intact hand movements. We found that key aspects of acquired amputees’ missing hand representation persisted, despite varying vividness of phantom sensations. In contrast, missing hand representation of congenital one-handers, who do not experience phantom sensations, was significantly reduced. Across acquired amputees, individuals’ reported motor control over their phantom hand positively correlated with the extent to which their somatosensory hand representation was normally organised. We conclude that once cortical organisation is formed, it is remarkably persistent, despite long-term attenuation of peripheral signals.

Young children's neural processing of their mother's voice: An fMRI study

In addition to semantic content, human speech carries paralinguistic information that conveys important social cues such as a speaker's identity. For young children, their own mothers' voice is one of the most salient vocal inputs in their daily environment. Indeed, qualities of mothers' voices are shown to contribute to children's social development. Our knowledge of how the mother's voice is processed at the neural level, however, is limited. This study investigated whether the voice of a mother modulates activation in the network of regions activated by the human voice in young children differently than the voice of an unfamiliar mother. We collected fMRI data from 32 typically developing 7- and 8-year-olds as they listened to natural speech produced by their mother and another child's mother. We used emotionally-varied natural speech stimuli to approximate the range of children's day-to-day experience. We individually-defined functional ROIs in children's voice-sensitive neural network and then independently investigated the extent to which activation in these regions is modulated by speaker identity. The bilateral posterior auditory cortex, superior temporal gyrus (STG), and inferior frontal gyrus (IFG) exhibit enhanced activation in response to the voice of one's own mother versus that of an unfamiliar mother. The findings indicate that children process the voice of their own mother uniquely, and pave the way for future studies of how social information processing contributes to the trajectory of child social development.

Decreased Distance between Representation Sites of Distinct Facial Movements in Facial Synkinesis-A Task fMRI Study

This study aimed to investigate the cortical functional alterations in patients with unilateral facial synkinesis using the task-designed functional magnetic resonance imaging. Fourteen unilateral synkinesis followed by peripheral facial nerve palsy patients and eighteen healthy adults were recruited in this study. Four facial motor tasks, i.e. left/right blinking and left/right smiling, were performed by each subject during the scans. Based on the activation maps, the spatial distance between the representation sites in the contralateral pre-/post-central gyrus of left or right blinking and smiling tasks (i.e. left/right B-S-distance) were calculated. Patients with unilateral facial synkinesis showed decreased B-S-distances during blinking and smiling tasks on the affected half face (9.68 ± 3.92 mm) compared to both average distances in healthy controls (14.95 ± 5.55 mm; p = 0.002) and unaffected half face tasks in patients (16.19 ± 7.87 mm; p = 0.011). These findings demonstrated cortical reorganization in facial synkinesis and suggested a conceivable mechanism corresponding to the simultaneous facial movement. This potentially provides a new modulation target for preventive, therapeutic and rehabilitative maneuver of this disease.

Early movement restriction leads to maladaptive plasticity in the sensorimotor cortex and to movement disorders

Motor control and body representations in the central nervous system are built, i.e., patterned, during development by sensorimotor experience and somatosensory feedback/reafference. Yet, early emergence of locomotor disorders remains a matter of debate, especially in the absence of brain damage. For instance, children with developmental coordination disorders (DCD) display deficits in planning, executing and controlling movements, concomitant with deficits in executive functions. Thus, are early sensorimotor atypicalities at the origin of long-lasting abnormal development of brain anatomy and functions? We hypothesize that degraded locomotor outcomes in adulthood originate as a consequence of early atypical sensorimotor experiences that induce developmental disorganization of sensorimotor circuitry. We showed recently that postnatal sensorimotor restriction (SMR), through hind limb immobilization from birth to one month, led to enduring digitigrade locomotion with ankle-knee overextension, degraded musculoskeletal tissues (e.g., gastrocnemius atrophy), and clear signs of spinal hyperreflexia in adult rats, suggestive of spasticity; each individual disorder likely interplaying in self-perpetuating cycles. In the present study, we investigated the impact of postnatal SMR on the anatomical and functional organization of hind limb representations in the sensorimotor cortex and processes representative of maladaptive neuroplasticity. We found that 28 days of daily SMR degraded the topographical organization of somatosensory hind limb maps, reduced both somatosensory and motor map areas devoted to the hind limb representation and altered neuronal response properties in the sensorimotor cortex several weeks after the cessation of SMR. We found no neuroanatomical histopathology in hind limb sensorimotor cortex, yet increased glutamatergic neurotransmission that matched clear signs of spasticity and hyperexcitability in the adult lumbar spinal network. Thus, even in the absence of a brain insult, movement disorders and brain dysfunction can emerge as a consequence of reduced and atypical patterns of motor outputs and somatosensory feedback that induce maladaptive neuroplasticity. Our results may contribute to understanding the inception and mechanisms underlying neurodevelopmental disorders, such as DCD.

Tomographic optical imaging of cortical responses after crossing nerve transfer in mice

To understand the neural mechanisms underlying the therapeutic effects of crossing nerve transfer for brachial plexus injuries in human patients, we investigated the cortical responses after crossing nerve transfer in mice using conventional and tomographic optical imaging. The distal cut ends of the left median and ulnar nerves were connected to the central cut ends of the right median and ulnar nerves with a sciatic nerve graft at 8 weeks of age. Eight weeks after the operation, the responses in the primary somatosensory cortex (S1) elicited by vibratory stimulation applied to the left forepaw were visualized based on activity-dependent flavoprotein fluorescence changes. In untreated mice, the cortical responses to left forepaw stimulation were mainly observed in the right S1. In mice with nerve crossing transfer, cortical responses to left forepaw stimulation were observed in the left S1 together with clear cortical responses in the right S1. We expected that the right S1 responses in the untreated mice were produced by thalamic inputs to layer IV, whereas those in the operated mice were mediated by callosal inputs from the left S1 to layer II/III of the right S1. To confirm this hypothesis, we performed tomographic imaging of flavoprotein fluorescence responses by macroconfocal microscopy. Flavoprotein fluorescence responses in layer IV were dominant compared to those in layer II/III in untreated mice. In contrast, responses in layer II/III were dominant compared to those in layer IV in operated mice. The peak latency of the cortical responses in the operated mice was longer than that in the untreated mice. These results confirmed our expectation that drastic reorganization in the cortical circuits was induced after crossing nerve transfer in mice.

Cortical Merging in S1 as a Substrate for Tactile Input Grouping

Perception is a reconstruction process guided by rules based on knowledge about the world. Little is known about the neural implementation of the rules of object formation in the tactile sensory system. When two close tactile stimuli are delivered simultaneously on the skin, subjects feel a unique sensation, spatially centered between the two stimuli. Voltage-sensitive dye imaging (VSDi) and electrophysiological recordings [local field potentials (LFPs) and single units] were used to extract the cortical representation of two-point tactile stimuli in the primary somatosensory cortex of anesthetized Long-Evans rats. Although layer 4 LFP responses to brief costimulation of the distal region of two digits resembled the sum of individual responses, approximately one-third of single units demonstrated merging-compatible changes. In contrast to previous intrinsic optical imaging studies, VSD activations reflecting layer 2/3 activity were centered between the representations of the digits stimulated alone. This merging was found for every tested distance between the stimulated digits. We discuss this laminar difference as evidence that merging occurs through a buildup stream and depends on the superposition of inputs, which increases with successive stages of sensory processing. These findings show that layers 2/3 are involved in the grouping of sensory inputs. This process that could be inscribed in the cortical computing routine and network organization is likely to promote object formation and implement perception rules.

Effects of pharyngeal electrical stimulation on swallowing performance

Pharyngeal electrical stimulation (PEStim) has been found to facilitate voluntary swallowing. This study investigated how PEStim contributed to modulation of swallowing function in 15 healthy humans. In the involuntary swallowing test, water was injected onto the pharynx at 0.05 ml/s and the onset latency of the first swallow was measured. In the voluntary swallowing test, subjects swallowed their own saliva as quickly as possible for 30 s and the number of swallows was counted. Voluntary and involuntary swallowing was evaluated before (baseline), immediately after, and every 10 min after 10-min PEStim for 60 min. A voluntary swallowing test with simultaneous 30-s PEStim was also conducted before and 60 min after 10-min PEStim. The number of voluntary swallows with simultaneous PEStim significantly increased over 60 min after 10-min PEStim compared with the baseline. The onset latency of the first swallow in the involuntary swallowing test was not affected by 10-min PEStim. The results suggest that PEStim may have a long-term facilitatory effect on the initiation of voluntary swallowing in healthy humans, but not on peripherally-evoked swallowing. The physiological implications of this modulation are discussed.

Somatosensory maps

Somatosensory areas containing topographic maps of the body surface are a major feature of parietal cortex. In primates, parietal cortex contains four somatosensory areas, each with its own map, with the primary cutaneous map in area 3b. Rodents have at least three parietal somatosensory areas. Maps are not isomorphic to the body surface, but magnify behaviorally important skin regions, which include the hands and face in primates, and the whiskers in rodents. Within each map, intracortical circuits process tactile information, mediate spatial integration, and support active sensation. Maps may also contain fine-scale representations of touch submodalities, or direction of tactile motion. Functional representations are more overlapping than suggested by textbook depictions of map topography. The whisker map in rodent somatosensory cortex is a canonic system for studying cortical microcircuits, sensory coding, and map plasticity. Somatosensory maps are plastic throughout life in response to altered use or injury. This chapter reviews basic principles and recent findings in primate, human, and rodent somatosensory maps.

Evidence for frequency-dependent cortical plasticity in the human brain

Frequency-dependent plasticity (FDP) describes adaptation at the synapse in response to stimulation at different frequencies. Its consequence on the structure and function of cortical networks is unknown. We tested whether cortical "resonance," favorable stimulation frequencies at which the sensory cortices respond maximally, influenced the impact of FDP on perception, functional topography, and connectivity of the primary somatosensory cortex using psychophysics and functional imaging (fMRI). We costimulated two digits on the hand synchronously at, above, or below the resonance frequency of the somatosensory cortex, and tested subjects' accuracy and speed on tactile localization before and after costimulation. More errors and slower response times followed costimulation at above- or below-resonance, respectively. Response times were faster after at-resonance costimulation. In the fMRI, the cortical representations of the two digits costimulated above-resonance shifted closer, potentially accounting for the poorer performance. Costimulation at-resonance did not shift the digit regions, but increased the functional coupling between them, potentially accounting for the improved response time. To relate these results to synaptic plasticity, we simulated a network of oscillators incorporating Hebbian learning. Two neighboring patches embedded in a cortical sheet, mimicking the two digit regions, were costimulated at different frequencies. Network activation outside the stimulated patches was greatest at above-resonance frequencies, reproducing the spread of digit representations seen with fMRI. Connection strengths within the patches increased following at-resonance costimulation, reproducing the increased fMRI connectivity. We show that FDP extends to the cortical level and is influenced by cortical resonance.

Neural plasticity and network remodeling: From concepts to pathology

Neuroplasticity has been subject to a great deal of research in the last century. Recently, significant emphasis has been placed on the global effect of localized plastic changes throughout the central nervous system, and on how these changes integrate in a pathological context. Specifically, alterations of network functionality have been described in various pathological contexts to which corresponding structural alterations have been proposed. However, considering the amount of literature and the different pathological contexts, an integration of this information is still lacking. In this paper we will review the concepts of neural plasticity as well as their repercussions on network remodeling and provide a possible explanation to how these two concepts relate to each other. We will further examine how alterations in different pathological contexts may relate to each other and will discuss the concept of plasticity diseases, its models and implications.

Focal Hand Dystonia Affecting Musicians. Part I: An Overview Of Epidemiology, PathoPhysiology And Medical Treatments

In 1911, Oppenheim coined the term ‘dystonia’ to describe disordered motor control, characterised by an association of hypotonia and tonic muscle spasm. Focal hand dystonia is one form of this disorder, in which symptoms are often task-specific and occur during skilled movements such as writing (writer's cramp) or playing a musical instrument (musician's cramp). Much research has been conducted on the pathophysiology of dystonia, but the underlying mechanisms still remain unclear. Hypotheseses about functional central nervous system alterations continue to gain more support. Scientific treatment-based publications on focal dystonia are sparse, and progress in evidence-based treatment options are necessary in order to assist this patient group. This paper will review the literature, documenting dystonia classification criteria, manifestations, pathophysiology and medical treatment techniques for musicians affected by focal hand dystonia.

Functional consequences of experience-dependent plasticity on tactile perception following perceptual learning

Continuous training enhances perceptual discrimination and promotes neural changes in areas encoding the experienced stimuli. This type of experience-dependent plasticity has been demonstrated in several sensory and motor systems. Particularly, non-human primates trained to detect consecutive tactile bar indentations across multiple digits showed expanded excitatory receptive fields (RFs) in somatosensory cortex. However, the perceptual implications of these anatomical changes remain undetermined. Here, we trained human participants for 9 days on a tactile task that promoted expansion of multi-digit RFs. Participants were required to detect consecutive indentations of bar stimuli spanning multiple digits. Throughout the training regime we tracked participants' discrimination thresholds on spatial (grating orientation) and temporal tasks on the trained and untrained hands in separate sessions. We hypothesized that training on the multi-digit task would decrease perceptual thresholds on tasks that require stimulus processing across multiple digits, while also increasing thresholds on tasks requiring discrimination on single digits. We observed an increase in orientation thresholds on a single digit. Importantly, this effect was selective for the stimulus orientation and hand used during multi-digit training. We also found that temporal acuity between digits improved across trained digits, suggesting that discriminating the temporal order of multi-digit stimuli can transfer to temporal discrimination of other tactile stimuli. These results suggest that experience-dependent plasticity following perceptual learning improves and interferes with tactile abilities in manners predictive of the task and stimulus features used during training.

Effect of high-frequency repetitive transcranial magnetic stimulation on motor cortical excitability and sensory nerve conduction velocity in subacute-stage incomplete spinal cord injury patients

[Purpose] The aim of the present study was to determine whether repetitive transcranial magnetic stimulation can improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients. [Subjects and Methods] This study was conducted on 20 subjects with diagnosed paraplegia due to spinal cord injury. These 20 subjects were allocated to an experimental group of 10 subjects that underwent active repetitive transcranial magnetic stimulation or to a control group of 10 subjects that underwent sham repetitive transcranial magnetic stimulation. The SCI patients in the experimental group underwent active repetitive transcranial magnetic stimulation and conventional rehabilitation therapy, whereas the spinal cord injury patients in the control group underwent sham repetitive transcranial magnetic stimulation and conventional rehabilitation therapy. Participants in both groups received therapy five days per week for six-weeks. Latency, amplitude, and sensory nerve conduction velocity were assessed before and after the six week therapy period. [Results] A significant intergroup difference was observed for posttreatment velocity gains, but no significant intergroup difference was observed for amplitude or latency. [Conclusion] repetitive transcranial magnetic stimulation may be improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients.

Review : The Neurobiology of Stroke Rehabilitation

Cerebrovascular disease plays a paramount role in mortality and morbidity, and the clinical and basic sci entific study of acute stroke has blossomed, leading both to increased survival and to increasing numbers of people with disabilities from stroke. Neurobiological study of the chronic form of this prevalent neurological disease has lagged behind investigation of the acute illness. This article reviews how and why this situation will change. Four major points are addressed: 1) The anatomical organizations of functional brain systems are less topographically precise than commonly believed. 2) Cortical plasticity exists in adults and takes a number of forms, including unmasking of existing circuits, growth of new synapses via axonal sprouting or dendritic proliferation, and development of compensatory processes. 3) It is possible to manipulate this plasticity with behavioral and pharmacological interventions, and such manipulations can have a beneficial effect on recovery. 4) Functional neuroimaging, particularly the noninvasive method of fMRI, can be used to study in vivo both cerebral plasticity after stroke and the interventions that might influence recovery by affecting this plasticity. Although there is much to be accomplished, the prognosis is extremely good for a neuroscience of stroke rehabilitation. NEUROSCIENTIST 4:426-434, 1998

■ REVIEW : Computer Models of Stroke Recovery: Implications for Neurorehabilitation

The persistence of cortical plasticity in the adult can help explain functional recovery after stroke. Computer modeling tools developed to explain the process of early development of sensory systems can be extended to help us relate cortical plasticity to both behavior and to underlying molecular and cellular mechanisms. Computer modeling results suggest a two-phase recovery process, involving immediate alterations in activity patterns caused by the loss of the infarcted neurons ("dynamic plasticity"), followed by true plastic changes as the new activity alters synaptic weights between neurons. Recognition of these two phases suggests that timing of physiotherapy and pharmacotherapy may play an important role in their efficacy. NEURO SCIENTIST 5:100-111, 1999

The Ying and Yang of Auditory Nerve Damage

Chambers et al. investigate consequences in the central auditory system after profound cochlear denervation. They observed gains in firing rate in auditory cortex despite nearly absent auditory nerve and brainstem responses, suggesting an important role of central plasticity and its clinical implications.

Neural circuits underlying mother's voice perception predict social communication abilities in children

The human voice is a critical social cue, and listeners are extremely sensitive to the voices in their environment. One of the most salient voices in a child's life is mother's voice: Infants discriminate their mother's voice from the first days of life, and this stimulus is associated with guiding emotional and social function during development. Little is known regarding the functional circuits that are selectively engaged in children by biologically salient voices such as mother's voice or whether this brain activity is related to children's social communication abilities. We used functional MRI to measure brain activity in 24 healthy children (mean age, 10.2 y) while they attended to brief (<1 s) nonsense words produced by their biological mother and two female control voices and explored relationships between speech-evoked neural activity and social function. Compared to female control voices, mother's voice elicited greater activity in primary auditory regions in the midbrain and cortex; voice-selective superior temporal sulcus (STS); the amygdala, which is crucial for processing of affect; nucleus accumbens and orbitofrontal cortex of the reward circuit; anterior insula and cingulate of the salience network; and a subregion of fusiform gyrus associated with face perception. The strength of brain connectivity between voice-selective STS and reward, affective, salience, memory, and face-processing regions during mother's voice perception predicted social communication skills. Our findings provide a novel neurobiological template for investigation of typical social development as well as clinical disorders, such as autism, in which perception of biologically and socially salient voices may be impaired.

Hypergravity within a critical period impacts on the maturation of somatosensory cortical maps and their potential for use-dependent plasticity in the adult

We investigated experience-dependent plasticity of somatosensory maps in rat S1 cortex during early development. We analyzed both short- and long-term effects of exposure to 2G hypergravity (HG) during the first 3 postnatal weeks on forepaw representations. We also examined the potential of adult somatosensory maps for experience-dependent plasticity after early HG rearing. At postnatal day 22, HG was found to induce an enlargement of cortical zones driven by nail displacements and a contraction of skin sectors of the forepaw map. In these remaining zones serving the skin, neurons displayed expanded glabrous skin receptive fields (RFs). HG also induced a bias in the directional sensitivity of neuronal responses to nail displacement. HG-induced map changes were still found after 16 wk of housing in normogravity (NG). However, the glabrous skin RFs recorded in HG rats decreased to values similar to that of NG rats, as early as the end of the first week of housing in NG. Moreover, the expansion of the glabrous skin area and decrease in RF size normally induced in adults by an enriched environment (EE) did not occur in the HG rats, even after 16 wk of EE housing in NG. Our findings reveal that early postnatal experience critically and durably shapes S1 forepaw maps and limits their potential to be modified by novel experience in adulthood.

Somatotopic mismatch of hand representation following stroke: is recovery possible?

Well-organized somatotopic representation of the hand is required to interpret input from cutaneous mechanoreceptors. Previous reports have identified patients with various distortions of somatotopic representation after stroke. Importantly, those patients were investigated years after the stroke, indicating that afferent signal regained access to the cortical circuits; however, further plastic changes, which would re-establish somatotopic order and ability to correctly localize tactile stimuli, did not follow. Thus, it was not known whether somatotopic organization could be restored in such patients and whether there is a potential for new rehabilitation strategies. This is the first case report demonstrating normalization of somatotopic representation.

Learning-Dependent Plasticity of the Barrel Cortex Is Impaired by Restricting GABA-Ergic Transmission

Experience-induced plastic changes in the cerebral cortex are accompanied by alterations in excitatory and inhibitory transmission. Increased excitatory drive, necessary for plasticity, precedes the occurrence of plastic change, while decreased inhibitory signaling often facilitates plasticity. However, an increase of inhibitory interactions was noted in some instances of experience-dependent changes. We previously reported an increase in the number of inhibitory markers in the barrel cortex of mice after fear conditioning engaging vibrissae, observed concurrently with enlargement of the cortical representational area of the row of vibrissae receiving conditioned stimulus (CS). We also observed that an increase of GABA level accompanied the conditioning. Here, to find whether unaltered GABAergic signaling is necessary for learning-dependent rewiring in the murine barrel cortex, we locally decreased GABA production in the barrel cortex or reduced transmission through GABAA receptors (GABAARs) at the time of the conditioning. Injections of 3-mercaptopropionic acid (3-MPA), an inhibitor of glutamic acid decarboxylase (GAD), into the barrel cortex prevented learning-induced enlargement of the conditioned vibrissae representation. A similar effect was observed after injection of gabazine, an antagonist of GABAARs. At the behavioral level, consistent conditioned response (cessation of head movements in response to CS) was impaired. These results show that appropriate functioning of the GABAergic system is required for both manifestation of functional cortical representation plasticity and for the development of a conditioned response.

The most sensitive inputs to cutaneous representing regions of primary somatosensory cortex do not change with behavioral training

Learning a sensory detection task leads to an increased primary sensory cortex response to the detected stimulus, while learning a sensory discrimination task additionally leads to a decreased sensory cortex response to the distractor stimulus. Neural responses are scaled up, and down, in strength, along with concomitant changes in receptive field size. The present work considers neural response properties that are invariant to learning. Data are drawn from two animals that were trained to detect and discriminate spatially separate taps delivered to positions on the skin of their fingers. Each animal was implanted with electrodes positioned in area 3b, and responses were derived on a near daily basis over 84 days in animal 1 and 202 days in animal 2. Responses to taps delivered in the receptive field were quantitatively measured each day, and receptive fields were audiomanually mapped each day. In the subset of responses that had light cutaneous receptive fields, a preponderance of the days, the most sensitive region of the field was invariant to training. This skin region was present in the receptive field on all, or nearly all, occasions in which the receptive field was mapped, and this region constituted roughly half of the most sensitive region. These results suggest that maintaining the most sensitive inputs as dominant in cortical receptive fields provide a measure of stability that may be transformationally useful for minimizing reconstruction errors and perceptual constancy.

Transfer of tactile perceptual learning to untrained neighboring fingers reflects natural use relationships

Tactile learning transfers from trained to untrained fingers in a pattern that reflects overlap between the representations of fingers in the somatosensory system (e.g., neurons with multifinger receptive fields). While physical proximity on the body is known to determine the topography of somatosensory representations, tactile coactivation is also an established organizing principle of somatosensory topography. In this study we investigated whether tactile coactivation, induced by habitual inter-finger cooperative use (use pattern), shapes inter-finger overlap. To this end, we used psychophysics to compare the transfer of tactile learning from the middle finger to its adjacent fingers. This allowed us to compare transfer to two fingers that are both physically and cortically adjacent to the middle finger but have differing use patterns. Specifically, the middle finger is used more frequently with the ring than with the index finger. We predicted this should lead to greater representational overlap between the former than the latter pair. Furthermore, this difference in overlap should be reflected in differential learning transfer from the middle to index vs. ring fingers. Subsequently, we predicted temporary learning-related changes in the middle finger's representation (e.g., cortical magnification) would cause transient interference in perceptual thresholds of the ring, but not the index, finger. Supporting this, longitudinal analysis revealed a divergence where learning transfer was fast to the index finger but relatively delayed to the ring finger. Our results support the theory that tactile coactivation patterns between digits affect their topographic relationships. Our findings emphasize how action shapes perception and somatosensory organization.

Tactile representation in somatosensory thalamus (VPL) and cortex (S1) of awake primate and the plasticity induced by VPL neuroprosthetic stimulation

To further understand how tactile information is carried in somatosensory cortex (S1) and the thalamus (VPL), and how neuronal plasticity after neuroprosthetic stimulation affects sensory encoding, we chronically implanted microelectrode arrays across hand areas in both S1 and VPL, where neuronal activities were simultaneously recorded during tactile stimulation on the finger pad of awake monkeys. Tactile information encoded in the firing rate of individual units (rate coding) or in the synchrony of unit pairs (synchrony coding) was quantitatively assessed within the information theoretic-framework. We found that tactile information encoded in VPL was higher than that encoded in S1 for both rate coding and synchrony coding; rate coding carried greater information than synchrony coding for the same recording area. With the aim for neuroprosthetic stimulation, plasticity of the circuit was tested after 30 min of VPL electrical stimulation, where stimuli were delivered either randomly or contingent on the spiking of an S1 unit. We showed that neural encoding in VPL was more stable than in S1, which depends not only on the thalamic input but also on recurrent feedback. The percent change of mutual-information after stimulation was increased with closed-loop stimulation, but decreased with random stimulation. The underlying mechanisms during closed-loop stimulation might be spike-timing-dependent plasticity, while frequency-dependent synaptic plasticity might play a role in random stimulation. Our results suggest that VPL could be a promising target region for somatosensory stimulation with closed-loop brain-machine-interface applications.

Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles

The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This relearning is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality-based simulations, can be used to provide meaningful, repetitive practice together with salient feedback, thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control, and sensory feedback-based learning mechanisms. The objectives of this article are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments, and to provide evidence concerning current applications for upper limb motor recovery. The limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks also are discussed.

Stress and the dynamic genome: Steroids, epigenetics, and the transposome

Stress plays a substantial role in shaping behavior and brain function, often with lasting effects. How these lasting effects occur in the context of a fixed postmitotic neuronal genome has been an enduring question for the field. Synaptic plasticity and neurogenesis have provided some of the answers to this question, and more recently epigenetic mechanisms have come to the fore. The exploration of epigenetic mechanisms recently led us to discover that a single acute stress can regulate the expression of retrotransposons in the rat hippocampus via an epigenetic mechanism. We propose that this response may represent a genomic stress response aimed at maintaining genomic and transcriptional stability in vulnerable brain regions such as the hippocampus. This finding and those of other researchers have made clear that retrotransposons and the genomic plasticity they permit play a significant role in brain function during stress and disease. These observations also raise the possibility that the transposome might have adaptive functions at the level of both evolution and the individual organism.

Computational anatomy for studying use-dependant brain plasticity

In this article we provide a comprehensive literature review on the in vivo assessment of use-dependant brain structure changes in humans using magnetic resonance imaging (MRI) and computational anatomy. We highlight the recent findings in this field that allow the uncovering of the basic principles behind brain plasticity in light of the existing theoretical models at various scales of observation. Given the current lack of in-depth understanding of the neurobiological basis of brain structure changes we emphasize the necessity of a paradigm shift in the investigation and interpretation of use-dependent brain plasticity. Novel quantitative MRI acquisition techniques provide access to brain tissue microstructural properties (e.g., myelin, iron, and water content) in-vivo, thereby allowing unprecedented specific insights into the mechanisms underlying brain plasticity. These quantitative MRI techniques require novel methods for image processing and analysis of longitudinal data allowing for straightforward interpretation and causality inferences.

The functional significance of cortical reorganization and the parallel development of CI therapy

For the nineteenth and the better part of the twentieth centuries two correlative beliefs were strongly held by almost all neuroscientists and practitioners in the field of neurorehabilitation. The first was that after maturity the adult CNS was hardwired and fixed, and second that in the chronic phase after CNS injury no substantial recovery of function could take place no matter what intervention was employed. However, in the last part of the twentieth century evidence began to accumulate that neither belief was correct. First, in the 1960s and 1970s, in research with primates given a surgical abolition of somatic sensation from a single forelimb, which rendered the extremity useless, it was found that behavioral techniques could convert the limb into an extremity that could be used extensively. Beginning in the late 1980s, the techniques employed with deafferented monkeys were translated into a rehabilitation treatment, termed Constraint Induced Movement therapy or CI therapy, for substantially improving the motor deficit in humans of the upper and lower extremities in the chronic phase after stroke. CI therapy has been applied successfully to other types of damage to the CNS such as traumatic brain injury, cerebral palsy, multiple sclerosis, and spinal cord injury, and it has also been used to improve function in focal hand dystonia and for aphasia after stroke. As this work was proceeding, it was being shown during the 1980s and 1990s that sustained modulation of afferent input could alter the structure of the CNS and that this topographic reorganization could have relevance to the function of the individual. The alteration in these once fundamental beliefs has given rise to important recent developments in neuroscience and neurorehabilitation and holds promise for further increasing our understanding of CNS function and extending the boundaries of what is possible in neurorehabilitation.

Cognitive training in mental disorders: update and future directions

OBJECTIVE

This article reviews the conceptual basis, definitions, and evolution of cognitive training approaches for the treatment of mental disorders.

METHOD

The authors review the current state of the knowledge on cognitive training in psychiatric illnesses, and its neural and behavioral targets, and summarize the factors that appear to relate to a successful response, including learner characteristics that influence clinical outcome. They also discuss methodological issues relevant to the development and testing of cognitive training approaches, with the goal of creating maximally efficient and effective approaches to training. Finally, they identify gaps in existing knowledge and outline key research directions for the future.

RESULTS

While much of the early research has been conducted in schizophrenia, cognitive training has more recently been applied to a widening range of neuropsychiatric illnesses, including attention deficit hyperactivity disorder, mood disorders, and substance use disorders. Cognitive training harnesses the inherent neuroplastic capacities of the brain, targeting neural system function across psychiatric disorders, thus improving the cognitive processes that play a role in emotion regulation, clinical symptoms, and adaptive community functioning.

CONCLUSIONS

Cognitive training offers considerable promise, especially given the limited efficacy of pharmacological interventions in ameliorating cognitive deficits. However, more research is needed to understand the mechanisms underlying cognitive training, predictors of response, generalization and real-world applicability, and approaches to dissemination in practice settings.

Functional deficits in carpal tunnel syndrome reflect reorganization of primary somatosensory cortex

Carpal tunnel syndrome, a median nerve entrapment neuropathy, is characterized by sensorimotor deficits. Recent reports have shown that this syndrome is also characterized by functional and structural neuroplasticity in the primary somatosensory cortex of the brain. However, the linkage between this neuroplasticity and the functional deficits in carpal tunnel syndrome is unknown. Sixty-three subjects with carpal tunnel syndrome aged 20-60 years and 28 age- and sex-matched healthy control subjects were evaluated with event-related functional magnetic resonance imaging at 3 T while vibrotactile stimulation was delivered to median nerve innervated (second and third) and ulnar nerve innervated (fifth) digits. For each subject, the interdigit cortical separation distance for each digit's contralateral primary somatosensory cortex representation was assessed. We also evaluated fine motor skill performance using a previously validated psychomotor performance test (maximum voluntary contraction and visuomotor pinch/release testing) and tactile discrimination capacity using a four-finger forced choice response test. These biobehavioural and clinical metrics were evaluated and correlated with the second/third interdigit cortical separation distance. Compared with healthy control subjects, subjects with carpal tunnel syndrome demonstrated reduced second/third interdigit cortical separation distance (P < 0.05) in contralateral primary somatosensory cortex, corroborating our previous preliminary multi-modal neuroimaging findings. For psychomotor performance testing, subjects with carpal tunnel syndrome demonstrated reduced maximum voluntary contraction pinch strength (P < 0.01) and a reduced number of pinch/release cycles per second (P < 0.05). Additionally, for four-finger forced-choice testing, subjects with carpal tunnel syndrome demonstrated greater response time (P < 0.05), and reduced sensory discrimination accuracy (P < 0.001) for median nerve, but not ulnar nerve, innervated digits. Moreover, the second/third interdigit cortical separation distance was negatively correlated with paraesthesia severity (r = -0.31, P < 0.05), and number of pinch/release cycles (r = -0.31, P < 0.05), and positively correlated with the second and third digit sensory discrimination accuracy (r = 0.50, P < 0.05). Therefore, reduced second/third interdigit cortical separation distance in contralateral primary somatosensory cortex was associated with worse symptomatology (particularly paraesthesia), reduced fine motor skill performance, and worse sensory discrimination accuracy for median nerve innervated digits. In conclusion, primary somatosensory cortex neuroplasticity for median nerve innervated digits in carpal tunnel syndrome is indeed maladaptive and underlies the functional deficits seen in these patients.