The Influence of Hand Posture on Corticospinal Excitability during Motor Imagery: A Transcranial Magnetic Stimulation Study

Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery

BACKGROUND

Persistent weakness of the quadriceps muscles and extension deficit after knee injuries are due to specific alterations in neural excitability - a process known as arthrogenic muscle inhibition (AMI). The effects of a novel neuromotor reprogramming (NR) treatment based on the use of proprioceptive sensations associated with motor imagery and low frequency sounds have not been studied in AMI after knee injuries.

HYPOTHESIS

This study aimed to assess quadriceps electromyographic (EMG) activity and the effects on extension deficits in persons with AMI who completed 1 session of NR treatment. We hypothesized that the NR session would activate the quadriceps and improve extension deficits.

STUDY DESIGN

Case series.

LEVEL OF EVIDENCE

Level 4.

METHODS

Between May 1, 2021 and February 28, 2022, patients who underwent knee ligament surgery or sustained a knee sprain with a deficit of >30% of the vastus medialis oblique (VMO) on EMG testing in comparison with the contralateral limb after their initial rehabilitation were included in the study. The maximal voluntary isometric contraction of the VMO measured on EMG, the knee extension deficit (distance between the heel and the table during contraction), and the simple knee value (SKV) were assessed before and immediately after completion of 1 session of NR treatment.

RESULTS

A total of 30 patients with a mean age of 34.6 ± 10.1 years (range, 14-50 years) were included in the study. After the NR session, VMO activation increased significantly, with a mean increase of 45% (P < 0.01). Similarly, the knee extension deficit significantly improved from 4.03 ± 0.69 cm before the treatment to 1.93 ± 0.68 after the treatment (P < 0.01). The SKV was 50 ± 5.43% before the treatment, and this increased to 67.5 ± 4.09% after the treatment (P < 0.01).

CONCLUSION

Our study indicates that this innovative NR method can improve VMO activation and extension deficits in patients with AMI. Therefore, this method could be considered a safe and reliable treatment modality in patients with AMI after knee injury or surgery.

CLINICAL RELEVANCE

This multidisciplinary treatment modality for AMI can enhance outcomes through the restoration of quadriceps neuromuscular function and subsequent reduction of extension deficits after knee trauma.

Observing an expert's action swapped with an observer's face increases corticospinal excitability during combined action observation and motor imagery

This study aimed to examine whether observing an expert's action swapped with an observer's face increases corticospinal excitability during combined action observation and motor imagery (AOMI). Twelve young males performed motor imagery of motor tasks with different difficulties while observing the actions of an expert performer and an expert performer with a swapped face. Motor tasks included bilateral wrist dorsiflexion (EASY) and unilateral two-ball rotating motions (DIFF). During the AOMI of EASY and DIFF, single-pulse transcranial magnetic stimulation was delivered to the left primary motor cortex, and motor-evoked potentials (MEPs) were obtained from the extensor carpi ulnaris and first dorsal interosseous muscles of the right upper limb, respectively. Visual analogue scale (VAS) assessed the subjective similarity of the expert performer with the swapped face in the EASY and DIFF to the participants themselves. The MEP amplitude in DIFF was larger in the observation of the expert performer with the swapped face than that of the expert performer (P = 0.012); however, the corresponding difference was not observed in EASY (P = 1.000). The relative change in the MEP amplitude from observing the action of the expert performer to that of the expert performer with the swapped face was positively correlated with VAS only in DIFF (r = 0.644, P = 0.024). These results indicate that observing the action of an expert performer with the observer's face enhances corticospinal excitability during AOMI, depending on the task difficulty and subjective similarity between the expert performer being observed and the observer.

Neural underpinnings of the interplay between actual touch and action imagination in social contexts

While there is established evidence supporting the involvement of the sense of touch in various actions, the neural underpinnings of touch and action interplay in a social context remain poorly understood. To prospectively investigate this phenomenon and offer further insights, we employed a combination of motor and sensory components by asking participants to imagine exerting force with the index finger while experiencing their own touch, the touch of one another individual, the touch of a surface, and no touch. Based on the assumption that the patterns of activation in the motor system are similar when action is imagined or actually performed, we proceeded to apply a single-pulse transcranial magnetic stimulation over the primary motor cortex (M1) while participants engaged in the act of imagination. Touch experience was associated with higher M1 excitability in the presence and in the absence of force production imagination, but only during force production imagination M1 excitability differed among the types of touch: both biological sources, the self-touch and the touch of one other individual, elicited a significant increase in motor system activity when compared to touching a non-living surface or in the absence of touch. A strong correlation between individual touch avoidance questionnaire values and facilitation in the motor system was present while touching another person, indicating a social aspect for touch in action. The present study unveils the motor system correlates when the sensory/motor components of touch are considered in social contexts.

How Posture and Previous Sensorimotor Experience Influence Muscle Activity during Gait Imagery in Young Healthy Individuals

This study explores how gait imagery (GI) influences lower-limb muscle activity with respect to posture and previous walking experience. We utilized surface electromyography (sEMG) in 36 healthy young individuals aged 24 (±1.1) years to identify muscle activity during a non-gait imagery task (non-GI), as well as GI tasks before (GI-1) and after the execution of walking (GI-2), with assessments performed in both sitting and standing postures. The sEMG was recorded on both lower limbs on the tibialis anterior (TA) and on the gastrocnemius medialis (GM) for all tested tasks. As a result, a significant muscle activity decrease was found in the right TA for GI-1 compared to GI-2 in both sitting (p = 0.008) and standing (p = 0.01) positions. In the left TA, the activity decreased in the sitting posture during non-GI (p = 0.004) and GI-1 (p = 0.009) in comparison to GI-2. No differences were found for GM. The subjective level of imagination difficulty improved for GI-2 in comparison to GI-1 in both postures (p < 0.001). Previous sensorimotor experience with real gait execution and sitting posture potentiate TA activity decrease during GI. These findings contribute to the understanding of neural mechanisms beyond GI.

Enhanced motor imagery of digits within the same hand via vibrotactile stimulation

Purpose

The aim of the present study is to evaluate the effect of vibrotactile stimulation prior to repeated complex motor imagery of finger movements using the non-dominant hand on motor imagery (MI) performance.

Methods

Ten healthy right-handed adults (4 females and 6 males) participated in the study. The subjects performed motor imagery tasks with and without a brief vibrotactile sensory stimulation prior to performing motor imagery using either their left-hand index, middle, or thumb digits. Mu- and beta-band event-related desynchronization (ERD) at the sensorimotor cortex and an artificial neural network-based digit classification was evaluated.

Results

The ERD and digit discrimination results from our study showed that ERD was significantly different between the vibration conditions for the index, middle, and thumb. It was also found that digit classification accuracy with-vibration (mean ± SD = 66.31 ± 3.79%) was significantly higher than without-vibration (mean ± SD = 62.68 ± 6.58%).

Conclusion

The results showed that a brief vibration was more effective at improving MI-based brain-computer interface classification of digits within a single limb through increased ERD compared to performing MI without vibrotactile stimulation.

Differences in Cortical Area Activity and Motor Imagery Vivid-Ness during Evaluation of Motor Imagery Tasks in Right and Left Hemiplegics

The ability to develop vivid motor imagery (MI) is important for effective mental practice. Therefore, we aimed to determine differences in the MI clarity and cortical area activity between patients with right hemiplegia and left hemiplegia after stroke in an MI task. In total, 11 participants with right hemiplegia and 14 with left hemiplegia were categorized into two groups. The MI task required the flexion and extension of the finger on the paralyzed side. Considering that MI vividness changes with MI practice, we measured the MI vividness and cortical area activity during the task before and after MI practice. MI vividness was evaluated subjectively using the visual analog scale, and cerebral hemodynamics during the task were measured using near-infrared spectroscopy in cortical regions during the MI task. The MI sharpness and cortical area activity in the MI task were significantly lower in the right hemiplegia group than in the left hemiplegia group. Therefore, when practicing mental practices with right hemiplegia, it is necessary to devise ways by which to increase MI vividness.

A Method for Using Video Presentation to Increase Cortical Region Activity during Motor Imagery Tasks in Stroke Patients

Previous studies have reported that stroke patients have difficulty recalling the motor imagery (MI) of a task, also known as MI vividness. Research on combining MI with action observation is gaining importance as a method to improve MI vividness. We enrolled 10 right-handed stroke patients and compared MI vividness and cortical activity under different presentation methods (no inverted image, inverted image of another individual’s hand, and an inverted image of the patient’s nonparalyzed hand) using near-infrared spectroscopy. Images of the nonparalyzed upper limb were inverted to make the paralyzed upper limb appear as if it were moving. Three tasks (non inverted image, AO + MI (other hand), AO + MI (own hand)) were randomly performed on 10 stroke patients. MI vividness was significantly higher when the inverted image of the nonparalyzed upper limb was presented compared to the other conditions (p < 0.01). The activity of the cortical regions was also significantly enhanced (p < 0.01). Our study highlights the potential application of inverted images of a stroke patient’s own nonparalyzed hand in mental practice to promote the motor recovery of stroke patients. This technique achieved higher levels of MI vividness and cortical activity when performing motor tasks.

The multisensory nature of human action imagery

Imagination can appeal to all our senses and may, therefore, manifest in very different qualities (e.g., visual, tactile, proprioceptive, or kinesthetic). One line of research addresses action imagery that refers to a process by which people imagine the execution of an action without actual body movements. In action imagery, visual and kinesthetic aspects of the imagined action are particularly important. However, other sensory modalities may also play a role. The purpose of the paper will be to address issues that include: (i) the creation of an action image, (ii) how the brain generates images of movements and actions, (iii) the richness and vividness of action images. We will further address possible causes that determine the sensory impression of an action image, like task specificity, instruction and experience. In the end, we will outline open questions and future directions.

Effects of motor imagery training on skeletal muscle contractile properties in sports science students

Background

Studies on motor imagery (MI) practice based on different designs and training protocols have reported changes in maximal voluntary contraction (MVC) strength. However, to date, there is a lack of information on the effects of MI training on contractile properties of the trained muscle.

Methods

Forty-five physically active sport science students (21 female) were investigated who trained three times per week over a 4-week period in one of three groups: An MI group conducted MI practice of maximal isometric contraction of the biceps brachii; a physical exercise (PE) group physically practiced maximal isometric contractions of the biceps brachii in a biceps curling machine; and a visual imagery (VI) group performed VI training of a landscape. A MVC test of the arm flexors was performed in a biceps curling machine before and after 4 weeks of training. The muscular properties of the biceps brachii were also tested with tensiomyography measurements (TMG).

Results

Results showed an interaction effect between time and group for MVC (p = 0.027, η ² = 0.17), with a higher MVC value in the PE group (Δ5.9%) compared to the VI group (Δ -1.3%) (p = 0.013). MVC did not change significantly in the MI group (Δ2.1%). Analysis of muscle contractility via TMG did not show any interaction effects neither for maximal radial displacement (p = 0.394, η ² = 0.05), delay time (p = 0.79, η ² = 0.01) nor contraction velocity (p = 0.71, η ² = 0.02).

Conclusion

In spite of MVC-related changes in the PE group due to the interventions, TMG measurements were not sensitive enough to detect concomitant neuronal changes related to contractile properties.

Hand constraint reduces brain activity and affects the speed of verbal responses on semantic tasks

According to the theory of embodied cognition, semantic processing is closely coupled with body movements. For example, constraining hand movements inhibits memory for objects that can be manipulated with the hands. However, it has not been confirmed whether body constraint reduces brain activity related to semantics. We measured the effect of hand constraint on semantic processing in the parietal lobe using functional near-infrared spectroscopy. A pair of words representing the names of hand-manipulable (e.g., cup or pencil) or nonmanipulable (e.g., windmill or fountain) objects were presented, and participants were asked to identify which object was larger. The reaction time (RT) in the judgment task and the activation of the left intraparietal sulcus (LIPS) and left inferior parietal lobule (LIPL), including the supramarginal gyrus and angular gyrus, were analyzed. We found that constraint of hand movement suppressed brain activity in the LIPS toward hand-manipulable objects and affected RT in the size judgment task. These results indicate that body constraint reduces the activity of brain regions involved in semantics. Hand constraint might inhibit motor simulation, which, in turn, would inhibit body-related semantic processing.

Age-related asymmetry in anticipatory postural movements during unilateral arm movement and imagery

Reaching movements of the arms are accompanied by anticipatory (APM) and compensatory postural motion (CPM) that counteract the resulting perturbations to body stability. Recent research has shown that these postural actions are also observable in the context of imagined arm movements. As motor imagery (MI) shares many neurophysiological and behavioral characteristics with physical movements, and MI training can affect subsequent performance, MI tasks provide a good setting for studying the anticipatory aspects of postural control. This study investigated APMs and CPMs of the head and hip of healthy young and older adults in the temporal vicinity of physical and imagined forward raises of the dominant and non-dominant arm. When MI of the dominant arm was self-initiated, both age groups showed APM in the anteroposterior plane. When the self-initiated MI was of the non-dominant arm, only the older group showed anteroposterior APM. The older group did not show APM when an expected arm movement (or MI) was made to an external signal. This suggests an age-related deficit in coordinating postural preparation with external events. Only the older group showed mediolateral APM, and only for dominant arm MI, indicating sensitivity to potential perturbation to the weaker, non-dominant side of the body. Overall, the older group showed more anticipatory postural motion at the head. Systematic APM for manual MI suggests that MI training may be an effective intervention for anticipatory postural control. An integrated model of postural support for executed and imagined limb movements is suggested.

Channel selection from source localization: A review of four EEG-based brain-computer interfaces paradigms

Channel selection is a critical part of the classification procedure for multichannel electroencephalogram (EEG)-based brain-computer interfaces (BCI). An optimized subset of electrodes reduces computational complexity and optimizes accuracy. Different tasks activate different sources in the brain and are characterized by distinctive channels. The goal of the current review is to define a subset of electrodes for each of four popular BCI paradigms: motor imagery, motor execution, steady-state visual evoked potentials and P300. Twenty-one studies have been reviewed to identify the most significant activations of cortical sources. The relevant EEG sensors are determined from the reported 3D Talairach coordinates. They are scored by their weighted mean Cohen's d and its confidence interval, providing the magnitude of the corresponding effect size and its statistical significance. Our goal is to create a knowledge-based channel selection framework with a sufficient statistical power. The core channel selection (CCS) could be used as a reference by EEG researchers and would have the advantages of practicality and rapidity, allowing for an easy implementation of semiparametric algorithms.

Imagined paralysis reduces motor cortex excitability

Mental imagery is a powerful capability that engages similar neurophysiological processes that underlie real sensory and motor experiences. Previous studies show that motor cortical excitability can increase during mental imagery of actions. In this study, we focused on possible inhibitory effects of mental imagery on motor functions. We assessed whether imagined arm paralysis modulates motor cortical excitability in healthy participants, as measured by motor evoked potentials (MEPs) of the hand induced by near-threshold transcranial magnetic stimulation (TMS) over the primary motor cortex hand area. We found lower MEP amplitudes during imagined arm paralysis when compared to imagined leg paralysis or baseline stimulation without paralysis imagery. These results show that purely imagined bodily constraints can selectively inhibit basic motor corticospinal functions. The results are discussed in the context of motoric embodiment/disembodiment.

EXPRESS: Is Implicit Level-2 Visual perspective taking embodied? Spontaneous perceptual simulation of others' perspectives is not impaired by motor restriction

Visual perspective taking may rely on the ability to mentally rotate one's own body into that of another. Here we test whether participants' ability to make active body movements plays a causal role in visual perspective taking. We utilized our recent task that measures whether participants spontaneously represent another's visual perspective in a (quasi-)perceptual format that can drive own perceptual decision making. Participants reported whether alphanumeric characters, presented in different orientations, are shown in their normal or mirror-inverted form (e.g., "R" vs. "Я"). Between trials, we manipulated whether another person was sitting either left or right of the character and whether participants' movement was restricted with a chin rest or they could move freely. As in our previous research, participants spontaneously took the visual perspective of the other person, recognizing rotated letters more rapidly when they appeared upright to the other person in the scene, compared to when they faced away from that person, and these effects increased with age but were (weakly) negatively related to Schizotypy and not to autistic traits or social skills. Restricting participants' ability to make active body movements did not influence these effects. The results therefore rule out that active physical movement plays a causal role in computing another's visual perspective, either to create alignment between own and other's perspective or to trigger perspective-taking processes. The postural adjustments people sometimes make when making judgements from another's perspective may instead be a bodily consequence of mentally transforming one's actual to an imagined position in space.

A sensorimotor representation impairment in dyslexic adults: A specific profile of comorbidy

Sensorimotor disorders have been frequently reported in children and adults with dyslexia over the past 30 years. The present study aimed to determine the impact of sensorimotor comorbidity risks in dyslexia by investigating the functional links between phonological and sensorimotor representations in young dyslexic adults. Using 52 dyslexic participants and 58 normo-readers, we investigated whether the underlying phonological deficit, which is reported in the literature, was associated with a general impairment of sensorimotor representations of articulatory and bodily actions. Internal action representations were explored through motor imagery tasks, consisting of measuring and comparing the durations of performed or imagined actions chosen from their current repertoire of daily life activities. To detect sensorimotor deficits, all participants completed the extended version of the M-ABC 2, as a reference test. We found sensorimotor impairments in 27% of the young adult dyslexics, then considered as sensorimotor comorbid, as opposed to much less in the normo-reader group (5%). While motor slowdown, reflecting motor difficulty, was present in all dyslexic adults, motor imagery performance was impacted only in the specific dyslexic subgroup with sensorimotor impairments. Moreover, in contrast with slowness, only the comorbid subgroup showed an increased variability in execution durations. The present study highlights the importance of the quality of perception-action coupling, questions the relevance of investigating sensorimotor impairment profiles beyond phonological deficits and provides new arguments supporting the perspective of multiple deficits approaches in dyslexia.

Imagine Your Crossed Hands as Uncrossed: Visual Imagery Impacts the Crossed-Hands Deficit

Successful interaction with our environment requires accurate tactile localization. Although we seem to localize tactile stimuli effortlessly, the processes underlying this ability are complex. This is evidenced by the crossed-hands deficit, in which tactile localization performance suffers when the hands are crossed. The deficit results from the conflict between an internal reference frame, based in somatotopic coordinates, and an external reference frame, based in external spatial coordinates. Previous evidence in favour of the integration model employed manipulations to the external reference frame (e.g., blindfolding participants), which reduced the deficit by reducing conflict between the two reference frames. The present study extends this finding by asking blindfolded participants to visually imagine their crossed arms as uncrossed. This imagery manipulation further decreased the magnitude of the crossed-hands deficit by bringing information in the two reference frames into alignment. This imagery manipulation differentially affected males and females, which was consistent with the previously observed sex difference in this effect: females tend to show a larger crossed-hands deficit than males and females were more impacted by the imagery manipulation. Results are discussed in terms of the integration model of the crossed-hands deficit.

Familiarity with a Tool Influences Peripersonal Space and Primary Motor Cortex Excitability of Muscles Involved in Haptic Contact

Long-term experience with a tool stably enlarges peripersonal space (PPS). Also, gained experience with a tool modulates internal models of action. The aim of this work was to understand whether the familiarity with a tool influences both PPS and motor representation. Toward this goal, we tested in 13 expert fencers through a multisensory integration paradigm the embodiment in their PPS of a personal (pE) or a common (cE) épée. Then, we evaluated the primary motor cortex excitability of proximal (ECR) and distal (APB) muscles during a motor imagery (MI) task of an athletic gesture when athletes handled these tools. Results showed that pE enlarges subjects' PPS, while cE does not. Moreover, during MI, handling tools increased cortical excitability of ECR muscle. Notably, APB's cortical excitability during MI only increased with pE as a function of its embodiment in PPS. These findings indicate that the familiarity with a tool specifically enlarges PPS and modulates the cortical motor representation of those muscles involved in the haptic contact with it.

The effects of body position and actual execution on motor imagery of locomotor tasks in people with a lower-limb amputation

Motor imagery (MI) is usually facilitated when performed in a congruent body position to the imagined movement, as well as after actual execution (AE). A lower-limb amputation (LLA) results in important structural and functional changes in the sensorimotor system, which can alter MI. In this study, we investigated the effects of body position and AE on the temporal characteristics of MI in people with LLA. Ten participants with LLA (mean age = 59.6 ± 13.9 years, four females) and ten gender- and age-matched healthy control participants (mean age = 60.1 ± 15.4 years, four females) were included. They performed two locomotor-related tasks (a walking task and the Timed Up and Go task) while MI times were measured in different conditions (in congruent/incongruent positions and before/after AE). We showed that MI times were significantly shorter when participants imagined walking in a congruent-standing position compared to an incongruent-sitting position, and when performing MI after actual walking compared to before, in both groups. Shorter MI times in the congruent position and after AE suggest an improvement of MI’s temporal accuracy (i.e. the ability to match AE time during MI) in healthy individuals but not in the LLA group.

Revisiting the acute effects of resistance exercise on motor imagery ability

Motor imagery (MI) shares psychological and physiological similarities with the physical practice of the same action. Yet, it remains unclear whether fatigue elicited by exercise impairs MI ability. Fourteen participants performed MI of a self-paced walking sequence of 22 m before and after a resistance exercise eliciting muscle fatigue from upper and lower limbs, selectively. We indexed MI ability using psychometric and behavioral methods. Electromyography of the quadriceps was also recorded during physical practice trials of the walking sequence. For both experimental conditions, we recorded improved temporal congruence between MI and physical practice of the walking sequence (9.89 %, 95 % CI [7.03, 12.75], p < 0.01). Vividness decreased immediately after the fatiguing exercise (6.35 %, 95 % CI [5.18, 7.51], p < 0.05), before rapidly returning to pre-fatigue values during recovery trials. The results challenge the hypothesis of an effect of acute fatigue elicited by a resistance exercise on MI ability, i.e. restricted to MI tasks focusing fatigued effectors. The beneficial effects of fatigue conditions on the psychometric and behavioral indexes of MI ability are discussed in the broader context of psychobiological fatigue models linking perceived exertion with the reallocation of attentional resources. The general perception of fatigue, rather than local muscle fatigue, appeared linked to the acute effects of resistance exercise on MI ability.

Sonification of combined action observation and motor imagery: Effects on corticospinal excitability

Action observation and motor imagery are valuable strategies for motor learning. Their simultaneous use (AOMI) increases neural activity, with related benefits for motor learning, compared to the two strategies alone. In this study, we explored how sonification influences AOMI. Twenty-five participants completed a practice block based on AOMI, motor imagery and physical execution of the same action. Participants were divided into two groups: An experimental group that practiced with sonification during AOMI (sAOMI), and a control group, which did not receive any extrinsic feedback. Corticospinal excitability at rest and during action observation and AOMI was assessed before and after practice, with and without sonification sound, to test the development of an audiomotor association. The practice block increased corticospinal excitability in all testing conditions, but sonification did not affect this. In addition, we found no differences in action observation and AOMI, irrespective of sonification. These results suggest that, at least for simple tasks, sonification of AOMI does not influence corticospinal excitability; In these conditions, sonification may have acted as a distractor. Future studies should further explore the relationship between task complexity, value of auditory information and action, to establish whether sAOMI is a valuable for motor learning.

Confounding effects of caffeine on neuroplasticity induced by transcranial alternating current stimulation and paired associative stimulation

OBJECTIVE

We examined the effects of caffeine, time of day, and alertness fluctuation on plasticity effects after transcranial alternating current stimulation (tACS) or 25 ms paired associative stimulation (PAS25) in caffeine-naïve and caffeine-adapted subjects.

METHODS

In two randomised, double-blinded, cross-over or placebo-controlled (caffeine) studies, we measured sixty subjects in eight sessions (n = 30, Male: Female = 1:1 in each study).

RESULTS

We found caffeine increased motor cortex excitability in caffeine naïve subjects. The aftereffects in caffeine naïve subjects were enhanced and prolonged when combined with PAS 25. Caffeine also increased alertness and the motor evoked potentials (MEPs) were reduced under light deprivation in caffeine consumers both with and without caffeine. In caffeine consumers, the time of day had no effect on tACS-induced plasticity.

CONCLUSIONS

We conclude that caffeine should be avoided or controlled as confounding factor for brain stimulation protocols. It is also important to keep the brightness constant in all sessions and study groups should not be mixed with caffeine-naïve and caffeine consuming participants.

SIGNIFICANCE

Caffeine is one of the confounding factors in the plasticity induction studies and it induces different excitability effects in caffeine-naïve and caffeine-adapted subjects. This study was registered in the ClinicalTrials.gov with these registration IDs: 1) NCT03720665 https://clinicaltrials.gov/ct2/results?cond=NCT03720665&term=&cntry=&state=&city=&dist= 2) NCT04011670 https://clinicaltrials.gov/ct2/results?cond=&term=NCT04011670&cntry=&state=&city=&dist=.

Navigated TMS in the ICU: Introducing Motor Mapping to the Critical Care Setting

Navigated transcranial magnetic stimulation (nTMS) is a modality for noninvasive cortical mapping. Specifically, nTMS motor mapping is an objective measure of motor function, offering quantitative diagnostic information regardless of subject cooperation or consciousness. Thus far, it has mostly been restricted to the outpatient setting. This study evaluates the feasibility of nTMS motor mapping in the intensive care unit (ICU) setting and solves the challenges encountered in this special environment. We compared neuronavigation based on computed tomography (CT) and magnetic resonance imaging (MRI). We performed motor mappings in neurocritical patients under varying conditions (e.g., sedation or hemicraniectomy). Furthermore, we identified ways of minimizing electromyography (EMG) noise in the interference-rich ICU environment. Motor mapping was performed in 21 patients (six females, median age: 69 years). In 18 patients, motor evoked potentials (MEPs) were obtained. In three patients, MEPs could not be evoked. No adverse reactions occurred. We found CT to offer a comparable neuronavigation to MRI (CT maximum e-field 52 ± 14 V/m vs. MRI maximum e-field 52 ± 11 V/m; p = 0.6574). We detailed EMG noise reduction methods and found that propofol sedation of up to 80 mcg/kg/h did not inhibit MEPs. Yet, nTMS equipment interfered with exposed pulse oximetry. nTMS motor mapping application and use was illustrated in three clinical cases. In conclusion, we present an approach for the safe and reliable use of nTMS motor mapping in the ICU setting and outline possible benefits. Our findings support further studies regarding the clinical value of nTMS in critical care settings.

Imagining handwriting movements in a usual or unusual position: effect of posture congruency on visual and kinesthetic motor imagery

Motor imagery has been used in training programs to improve the performance of motor skills. Handwriting movement may benefit from motor imagery training. To optimize the efficacy of this kind of training, it is important to identify the factors that facilitate the motor imagery process for handwriting movements. Several studies have shown that motor imagery is more easily achieved when there is maximum compatibility between the actual posture and the imagined movement. We, therefore, examined the effect of posture congruency on visual and kinesthetic motor imagery for handwriting movements. Adult participants had to write and imagine writing a sentence by focusing on the evocation of either the kinesthetic or visual consequences of the motion. Half the participants performed the motor imagery task in a congruent posture (sitting with a hand ready for writing), and half in an incongruent one (standing with arms crossed behind the back and fingers spread wide). The temporal similarity between actual and imagined movement times and the vividness of the motor imagery were evaluated. Results revealed that temporal similarity was stronger in the congruent posture condition than in the incongruent one. Furthermore, in the incongruent posture condition, participants reported greater difficulty forming a precise kinesthetic motor image of themselves writing than a visual image, whereas no difference was observed in the congruent posture condition. Taken together, our results show that postural information is taken into account during the mental simulation of handwriting movements. The implications of these findings for guiding the design of motor imagery training are discussed.

The Role of Primary Motor Cortex: More Than Movement Execution

The predominant role of the primary motor cortex (M1) in motor execution is well acknowledged. However, additional roles of M1 are getting evident in humans owing to advances in noninvasive brain stimulation (NIBS) techniques. This review collates such studies in humans and proposes that M1 also plays a key role in higher cognitive processes. The review commences with the studies that have investigated the nature of connectivity of M1 with other cortical regions in light of studies based on NIBS. The review then moves on to discuss the studies that have demonstrated the role of M1 in higher cognitive processes such as attention, motor learning, motor consolidation, movement inhibition, somatomotor response, and movement imagery. Overall, the purpose of the review is to highlight the additional role of M1 in motor cognition besides motor control, which remains unexplored.

Age-related differences in postural adjustments during limb movement and motor imagery in young and older adults

Recent research has shown that systematic postural adjustments occur during periods of manual motor imagery (MI), but the timing (anticipatory or reactive) and directionality (against or in the direction of arm extension) of these postural motions relative to individual manual actions or imagery are not well understood. This study analyzed the anteroposterior hip and head motion of healthy young and older participants, while they imagined bilateral arm raises under self-initiated or environmentally triggered performance conditions. When MI was self-initiated, both age groups showed significant forward postural motion during the second prior to MI initiation. When MI (or physical arm movement) was environmentally triggered, however, older people did not show anticipatory forward postural motion, but did show compensatory backward head motion. These results suggest that manual MI is indeed accompanied by anticipatory postural motion, but this anticipation is attenuated in older people when they do not have control over the timing of manual movement onset.

Brain-computer interfaces in neurologic rehabilitation practice

The brain-computer interfaces (BCIs) for neurologic rehabilitation are based on the assumption that by retraining the brain to specific activities, an ultimate improvement of function can be expected. In this chapter, we review the present status, key determinants, and future directions of the clinical use of BCI in neurorehabilitation. The recent advancements in noninvasive BCIs as a therapeutic tool to promote functional motor recovery by inducing neuroplasticity are described, focusing on stroke as it represents the major cause of long-term motor disability. The relevance of recent findings on BCI use in spinal cord injury beyond the control of neuroprosthetic devices to restore motor function is briefly discussed. In a dedicated section, we examine the potential role of BCI technology in the domain of cognitive function recovery by instantiating BCIs in the long history of neurofeedback and some emerging BCI paradigms to address cognitive rehabilitation are highlighted. Despite the knowledge acquired over the last decade and the growing number of studies providing evidence for clinical efficacy of BCI in motor rehabilitation, an exhaustive deployment of this technology in clinical practice is still on its way. The pipeline to translate BCI to clinical practice in neurorehabilitation is the subject of this chapter.

Motor Imagery Development in Children: Changes in Speed and Accuracy With Increasing Age

Although motor imagery has been pointed as a promising strategy for the rehabilitation of children with neurological disorders, information on their development throughout childhood and adolescence is still scarce. For instance, it is still unclear at what age they reach a development comparable to the motor imagery performance observed in adults. Herein we used a mental rotation task to assess motor imagery in 164 typically developing children and adolescents, which were divided into four age groups (6-7, 8-9, 10-11, and 12-13 years) and 30 adults. The effects of biomechanical constraints, accuracy, and reaction time of the mental rotation task were considered. ANOVA showed that all groups had the effect of biomechanical restrictions of the mental rotation task. We found a group effect for accuracy [F _{(4, 180)} = 17,560; p < 0.00; η² = 3.79] and reaction time [F _{(4, 180)} = 17.5; p < 0.001, η² = 0.615], with the results of children groups 6-7 and 8-9 years being significantly lower than the other groups (p < 0.05). In all the analyses, there were no differences regarding accuracy and reaction time among the participants of the age groups 10-11 and 12-13 years and adults (p > 0.05). Concluding, children aged 6-7 years were able to perform motor imagery, motor imagery ability improved as the participants' ages increased, and children aged 10 and over-performed similarly to adults.

Aging and posture in the memory of manipulable objects

Thirty healthy elderly participants (mean age = 77.3) learned the names of manipulable and nonmanipulable objects while adopting a control posture (hands in front of them) or an interfering posture (holding their hands behind their back). Results on a recall task showed a postural interference (PI) effect, with the interfering posture reducing the memory of manipulable objects, but not of nonmanipulable ones. The effect was similar to the Postural Interference effect previously observed in young adults, although with a lower performance. These results call into question the embodied theory hypothesis that the deterioration of memory in aging is related to the decline of the sensorimotor system.

Predictive coding of action intentions in dorsal and ventral visual stream is based on visual anticipations, memory-based information and motor preparation

Predictions of upcoming movements are based on several types of neural signals that span the visual, somatosensory, motor and cognitive system. Thus far, pre-movement signals have been investigated while participants viewed the object to be acted upon. Here, we studied the contribution of information other than vision to the classification of preparatory signals for action, even in the absence of online visual information. We used functional magnetic resonance imaging (fMRI) and multivoxel pattern analysis (MVPA) to test whether the neural signals evoked by visual, memory-based and somato-motor information can be reliably used to predict upcoming actions in areas of the dorsal and ventral visual stream during the preparatory phase preceding the action, while participants were lying still. Nineteen human participants (nine women) performed one of two actions towards an object with their eyes open or closed. Despite the well-known role of ventral stream areas in visual recognition tasks and the specialization of dorsal stream areas in somato-motor processes, we decoded action intention in areas of both streams based on visual, memory-based and somato-motor signals. Interestingly, we could reliably decode action intention in absence of visual information based on neural activity evoked when visual information was available and vice versa. Our results show a similar visual, memory and somato-motor representation of action planning in dorsal and ventral visual stream areas that allows predicting action intention across domains, regardless of the availability of visual information.

Electrocorticographic dissociation of alpha and beta rhythmic activity in the human sensorimotor system

This study uses electrocorticography in humans to assess how alpha- and beta-band rhythms modulate excitability of the sensorimotor cortex during psychophysically-controlled movement imagery. Both rhythms displayed effector-specific modulations, tracked spectral markers of action potentials in the local neuronal population, and showed spatially systematic phase relationships (traveling waves). Yet, alpha- and beta-band rhythms differed in their anatomical and functional properties, were weakly correlated, and traveled along opposite directions across the sensorimotor cortex. Increased alpha-band power in the somatosensory cortex ipsilateral to the selected arm was associated with spatially-unspecific inhibition. Decreased beta-band power over contralateral motor cortex was associated with a focal shift from relative inhibition to excitation. These observations indicate the relevance of both inhibition and disinhibition mechanisms for precise spatiotemporal coordination of movement-related neuronal populations, and illustrate how those mechanisms are implemented through the substantially different neurophysiological properties of sensorimotor alpha- and beta-band rhythms.

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.

Postural Effects on the Mental Rotation of Body-Related Pictures: An fMRI Study

This study investigated the embodied effects involved in the mental rotation of pictures of body parts (hands and feet). Blood oxygen level-dependent (BOLD) signals were collected from 18 healthy volunteers who performed mental rotation tasks of rotated drawings of hands under different arm postures. Congruent drawings of hands (those congruent with left-hand posture) evoked stronger activation in the left supplementary motor area (SMA), left precentral gyrus, and left superior parietal lobule (SPL) than did incongruent drawings of hands. Congruent drawings of hands (those congruent with right-hand posture) evoked significant activation in the left inferior parietal lobule (IPL), right SMA, bilateral middle frontal gyrus (MFG), left inferior frontal gyrus (IFG), and bilateral superior frontal gyrus (SFG) compared to that evoked by the incongruent drawings of hands. Similar methodology was implemented with drawings of feet. However, no significant differences in brain activation were observed between congruent and incongruent drawings of feet. This finding suggests that body posture influences body part-related mental rotation in an effector-specific manner. A direct comparison between the medially and laterally rotated drawings revealed activation in the right IPL, left precentral gyrus, bilateral IFG, and bilateral SFG. These results suggest that biomechanical constraints affect the cognitive process of mental rotation.

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.

Dynamic Changes in Upper-Limb Corticospinal Excitability during a 'Pro-/Anti-saccade' Double-Choice Task

Under natural behavioral conditions, visually guided eye movements are linked to direction-specific modulations of cortico-spinal system (CSS) excitability in upper-limb muscles, even in absence of a manual response. These excitability changes have been shown to be compatible with a covert motor program encoding a manual movement toward the same target of the eyes. The aim of this study is to investigate whether this implicit oculo-manual coupling is enforced following every saccade execution or it depends on the behavioral context. Twenty-two healthy young adults participated in the study. Single-pulse transcranial magnetic stimulation was applied to the motor cortex at nine different time epochs during a double-choice eye task, in which the decision to execute a prosaccade or an antisaccade was made on the color of a peripheral visual cue. By analyzing the amplitude of the motor evoked potentials (MEP) in three distal muscles of the resting upper-limb, a facilitation peak of CSS excitability was found in two of them at 120 ms before the eyes begin to move. Furthermore, a long-lasting, generalized reduced corticomotor excitability develops following the eye response. Finally, a quite large modulation of MEP amplitude, depending on the direction of the saccade, is observed only in the first dorsal interosseous muscle, in a narrow time window at about 150 ms before the eye movement, irrespective of the type of the ocular response (pro-/anti-saccade). This change in CSS excitability is not tied up to the timing of the occurrence of the visual cue but, instead, appears to be tightly time-related to the saccade onset. Observed excitability changes differ in many respects from those previously reported with different behavioral paradigms. A main finding of our study is that the implicit coupling between eye and hand motor systems is contingent upon the particular motor set determined by the cognitive aspects of the performed oculomotor task. In particular, the direction-specific modulation in CSS excitability described in this study appears to be related to perceptual and decision-making processes rather than representing an implicit upper-limb motor program, coupled to the saccade execution.

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.

Learning Is Better with the Hands Free: The Role of Posture in the Memory of Manipulable Objects

Grounded cognition proposes that memory shares processing resources with sensorimotor systems. The aim of the present study was to show that motor simulation participates in the conceptual representation of manipulable objects in long-term memory. In two experiments, lists of manipulable and nonmanipulable objects were presented. Participants were instructed to memorize the items while adopting different postures. In the control condition, they had to keep their hands at rest in front of them. In the interference condition, participants had to keep their hands crossed behind their back to make their hands less free for action. After each list, participants had to perform first a distractive task, and then an oral free recall. The results showed that the interfering posture produced a specific decrease in the recall of manipulable objects, but not of nonmanipulable ones. This decrease was similar when the items were presented as pictures (Experiment 1) or as words (Experiment 2), thus excluding a purely visual effect. These results provide strong evidence that the motor simulation plays a role in the memory trace of the object.

Effect of Gait Imagery Tasks on Lower Limb Muscle Activity With Respect to Body Posture

The objective of this study was to evaluate the effect of gait imagery tasks on lower limb muscle activity with respect to body posture. The sitting and standing position and lower limb muscle activity were evaluated in 27 healthy female students (24.4 ± 1.3 years, 167.2 ± 5.2 cm, 60.10 ± 6.4 kg). Surface electromyography was assessed during rest and in three different experimental conditions using mental imagery. These included a rhythmic gait, rhythmic gait simultaneously with observation of a model, and rhythmic gait after performing rhythmic gait. The normalized root mean square EMG values with respect to corresponding rest position were compared using non-parametric statistics. Standing gait imagery tasks had facilitatory effect on proximal lower limb muscle activity. However, electromyography activity of distal leg muscles decreased for all gait imagery tasks in the sitting position, when the proprioceptive feedback was less appropriate. For subsequent gait motor imagery tasks, the muscle activity decreased, probably as result of habituation. In conclusion, the effect of motor imagery on muscle activity appears to depend on relative strength of facilitatory and inhibitory inputs.

Quantifying the role of motor imagery in brain-machine interfaces

Despite technical advances in brain machine interfaces (BMI), for as-yet unknown reasons the ability to control a BMI remains limited to a subset of users. We investigate whether individual differences in BMI control based on motor imagery (MI) are related to differences in MI ability. We assessed whether differences in kinesthetic and visual MI, in the behavioral accuracy of MI, and in electroencephalographic variables, were able to differentiate between high- versus low-aptitude BMI users. High-aptitude BMI users showed higher MI accuracy as captured by subjective and behavioral measurements, pointing to a prominent role of kinesthetic rather than visual imagery. Additionally, for the first time, we applied mental chronometry, a measure quantifying the degree to which imagined and executed movements share a similar temporal profile. We also identified enhanced lateralized μ-band oscillations over sensorimotor cortices during MI in high- versus low-aptitude BMI users. These findings reveal that subjective, behavioral, and EEG measurements of MI are intimately linked to BMI control. We propose that poor BMI control cannot be ascribed only to intrinsic limitations of EEG recordings and that specific questionnaires and mental chronometry can be used as predictors of BMI performance (without the need to record EEG activity).

Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation

A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb.

Upper Limb Immobilisation: A Neural Plasticity Model with Relevance to Poststroke Motor Rehabilitation

Advances in our understanding of the neural plasticity that occurs after hemiparetic stroke have contributed to the formulation of theories of poststroke motor recovery. These theories, in turn, have underpinned contemporary motor rehabilitation strategies for treating motor deficits after stroke, such as upper limb hemiparesis. However, a relative drawback has been that, in general, these strategies are most compatible with the recovery profiles of relatively high-functioning stroke survivors and therefore do not easily translate into benefit to those individuals sustaining low-functioning upper limb hemiparesis, who otherwise have poorer residual function. For these individuals, alternative motor rehabilitation strategies are currently needed. In this paper, we will review upper limb immobilisation studies that have been conducted with healthy adult humans and animals. Then, we will discuss how the findings from these studies could inspire the creation of a neural plasticity model that is likely to be of particular relevance to the context of motor rehabilitation after stroke. For instance, as will be elaborated, such model could contribute to the development of alternative motor rehabilitation strategies for treating poststroke upper limb hemiparesis. The implications of the findings from those immobilisation studies for contemporary motor rehabilitation strategies will also be discussed and perspectives for future research in this arena will be provided as well.