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

Using mechanistic knowledge to appraise contemporary approaches to the rehabilitation of upper limb function following stroke

It is a paradox of neurological rehabilitation that, in an era in which preclinical models have produced significant advances in our mechanistic understanding of neural plasticity, there is inadequate support for many therapies recommended for use in clinical practice. When the goal is to estimate the probability that a specific form of therapy will have a positive clinical effect, the integration of mechanistic knowledge (concerning 'the structure or way of working of the parts in a natural system') may improve the quality of inference. This is illustrated by analysis of three contemporary approaches to the rehabilitation of lateralized dysfunction affecting people living with stroke: constraint-induced movement therapy; mental practice; and mirror therapy. Damage to 'cross-road' regions of the structural (white matter) brain connectome generates deficits that span multiple domains (motor, language, attention and verbal/spatial memory). The structural integrity of these regions determines not only the initial functional status, but also the response to therapy. As structural disconnection constrains the recovery of functional capability, 'disconnectome' modelling provides a basis for personalized prognosis and precision rehabilitation. It is now feasible to refer a lesion delineated using a standard clinical scan to a (dis)connectivity atlas derived from the brains of other stroke survivors. As the individual disconnection pattern thus obtained suggests the functional domains most likely be compromised, a therapeutic regimen can be tailored accordingly. Stroke is a complex disorder that burdens individuals with distinct constellations of brain damage. Mechanistic knowledge is indispensable when seeking to ameliorate the behavioural impairments to which such damage gives rise.

Tactile imagery affects cortical responses to vibrotactile stimulation of the fingertip

Mental imagery is a crucial cognitive process, yet its underlying neural mechanisms remain less understood compared to perception. Furthermore, within the realm of mental imagery, the somatosensory domain is particularly underexplored compared to other sensory modalities. This study aims to investigate the influence of tactile imagery (TI) on cortical somatosensory processing. We explored the cortical manifestations of TI by recording EEG activity in healthy human subjects. We investigated event-related somatosensory oscillatory dynamics during TI compared to actual tactile stimulation, as well as somatosensory evoked potentials (SEPs) in response to short vibrational stimuli, examining their amplitude-temporal characteristics and spatial distribution across the scalp. EEG activity exhibited significant changes during TI compared to the no-imagery baseline. TI caused event-related desynchronization (ERD) of the contralateral μ-rhythm, with a notable correlation between ERD during imagery and real stimulation across subjects. TI also modulated several SEP components in sensorimotor and frontal areas, showing increases in the contralateral P100 and P300, contra- and ipsilateral P300, frontal P200, and parietal P600 components. The results clearly indicate that TI affects cortical processing of somatosensory stimuli, impacting EEG responses in various cortical areas. The assessment of SEPs in EEG could serve as a versatile marker of tactile imagery in practical applications. We propose incorporating TI in imagery-based brain-computer interfaces (BCIs) to enhance sensorimotor restoration and sensory substitution. This approach underscores the importance of somatosensory mental imagery in cognitive neuroscience and its potential applications in neurorehabilitation and assistive technologies.

Differential Hemodynamic Responses to Motor and Tactile Imagery: Insights from Multichannel fNIRS Mapping

Tactile and motor imagery are crucial components of sensorimotor functioning and cognitive neuroscience research, yet the neural mechanisms of tactile imagery remain underexplored compared to motor imagery. This study employs multichannel functional near-infrared spectroscopy (fNIRS) combined with image reconstruction techniques to investigate the neural hemodynamics associated with tactile (TI) and motor imagery (MI). In a study of 15 healthy participants, we found that MI elicited significantly greater hemodynamic responses (HRs) in the precentral area compared to TI, suggesting the involvement of different cortical areas involved in two different types of sensorimotor mental imagery. Concurrently, the HRs in S1 and parietal areas exhibited comparable patterns in both TI and MI. During MI, both motor and somatosensory areas demonstrated comparable HRs. However, in TI, somatosensory activation was observed to be more pronounced. Our results highlight the distinctive neural profiles of motor versus tactile imagery and indicate fNIRS technique to be sensitive for this. This distinction is significant for fundamental understanding of sensorimotor integration and for developing advanced neurotechnologies, including imagery-based brain-computer interfaces (BCIs) that can differentiate between different types of mental imagery.

Tactile versus motor imagery: differences in corticospinal excitability assessed with single-pulse TMS

Tactile Imagery (TI) remains a fairly understudied phenomenon despite growing attention to this topic in recent years. Here, we investigated the effects of TI on corticospinal excitability by measuring motor evoked potentials (MEPs) induced by single-pulse transcranial magnetic stimulation (TMS). The effects of TI were compared with those of tactile stimulation (TS) and kinesthetic motor imagery (kMI). Twenty-two participants performed three tasks in randomly assigned order: imagine finger tapping (kMI); experience vibratory sensations in the middle finger (TS); and mentally reproduce the sensation of vibration (TI). MEPs increased during both kMI and TI, with a stronger increase for kMI. No statistically significant change in MEP was observed during TS. The demonstrated differential effects of kMI, TI and TS on corticospinal excitability have practical implications for devising the imagery-based and TS-based brain-computer interfaces (BCIs), particularly the ones intended to improve neurorehabilitation by evoking plasticity changes in sensorimotor circuitry.

Changes in spinal motoneuron excitability during the improvement of fingertip dexterity by actual execution combined with motor imagery practice

Since there is an upper limit to skill improvement through the repetition of actual execution, we examined whether motor imagery could be used in combination with actual execution to maximize motor skill improvement. Fingertip dexterity was evaluated in 25 healthy participants performing a force adjustment task using a pinch movement with the left thumb and index finger. In the intervention condition, six sets of repetitions of combined actual execution and motor imagery were performed, while in the control condition, the same flow was performed, but with motor imagery replaced by rest. Changes in the excitability of spinal motoneurons during motor imagery compared to rest were compared in terms of the F/M amplitude ratio. Motor skill changes were compared before and after repeated practice and between the conditions, respectively, using the absolute amount of adjustment error between the target pinch force value and the delivered pinch force value (absolute error) as an index. The results showed that the repetition of exercise practice and motor imagery decreased the absolute error, which was greater than that of exercise practice alone in terms of motor skill improvement. The F/M amplitude ratio for motor imagery compared to rest did not increase. This suggests that motor imagery is involved in the degree of the increase of spinal motoneuron excitability based on the real-time prediction of motor execution and that there may be no need for an increase in excitability during motor skill control.

Differences in motor imagery strategy change behavioral outcome

Kinesthetic motor imagery (KMI) involves imagining the feeling and experience of movements. We examined the effects of KMI, number visualizing, and KMI with number visualizing on the excitability of spinal motor neurons and a behavioral outcome measure in a pinch force task. Healthy participants (13 men and 8 women; mean age: 24.8 ± 5.5 years) were recruited. We compared the F-waves of the left thenar muscles after stimulating the left median nerve at the wrist during each motor imagery condition after a practice session. The KMI condition consisted of imagining muscle contraction, the number visualizing condition consisted of imagining the pinch force increasing numerically, and the KMI with number visualizing consisted of alternating between the KMI and imagining the pinch force increasing numerically. Before and after motor imagery, the time required to adjust to the target pinch force was compared. The time required to adjust the pinch force was shorter in the KMI with number visualizing condition than in the KMI and number visualizing conditions. There was no difference in the F/M amplitude ratio between each MI strategy condition, indicating the excitability of spinal motor neurons. Numerical information helped to improve the ability of participants to perform KMI.

Effectiveness of Tai Chi Yunshou motor imagery training for hemiplegic upper extremity motor function in poststroke patients: study protocol for a randomized clinical trial

Background

Evidence concerning the effect of Tai Chi Yunshou motor imagery training (TCY-MIT) on upper extremity motor function (UE-MF) recovery in poststroke patients is lacking, and few studies have examined the neural mechanisms of MIT. The study was designed to assess the effectiveness of TCY-MIT and its possible neural mechanisms.

Methods/design

The study is an assessor-blinded, parallel, superiority, randomized clinical trial. A total of 78 eligible participants will be randomly assigned to 2 groups in a 1:1 ratio. Participants in the control group will receive (conventional rehabilitation therapies) CRTs for 40 min per day, 6 days per week, for 3 weeks. Participants in the intervention group will receive CRTs combined with TCY-MIT (30 min per day, 6 days per week, for 3 weeks). The primary outcome measure is the Fugl-Meyer Assessment of Upper Extremity. Secondary outcome measures are the Box and Block Test, muscle strength test, modified Barthel index, and Pearson correlation coefficients. All outcomes will be assessed at baseline, after completion of the intervention (1, 2, and 3 weeks), and at the end of follow-up (2 months). The outcome assessor will be blinded to the group allocation of the participants.

Discussion

We expect this assessor-blinded, parallel, superiority, randomized clinical trial to explore the effectiveness of TCY-MIT combined with CRTs compared with CRTs alone for UE-MF in poststroke patients.

Trial registration

Chinese Clinical Trial Registry ID: ChiCTR2100048868. Registered on 19 July 2021

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06283-z.

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

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

Unpleasant visual stimuli increase the excitability of spinal motor neurons

Purpose: In physical therapy for post-stroke patients, we often experience cases in which unpleasant emotions cause abnormal muscle tonus. Previously, we suggested that the magnitude of spinal motor neuron excitability was correlated with the grade of muscle tonus. Therefore, spinal motor neuron excitability was considered to be a useful index to evaluate the influence of unpleasant emotions on muscle tonus. In this study, we investigated whether unpleasant emotions evoked by visual stimuli affected the excitability of spinal motor neurons.Materials and Methods: The F-waves, an indicator of spinal motor neuron excitability, were measured in 19 healthy adult volunteers. Firstly, for the rest trial, F-waves were measured during relaxation to determine the baseline of spinal motor neuron excitability. Following the rest trial, the unpleasant trial was conducted in which F-waves were measured while the subjects viewed an unpleasant picture for 1 min. After the unpleasant trial, F-waves were measured during relaxation. For the control condition, F-waves were measured while the subjects viewed a neutral picture instead of the unpleasant picture. The recorded F-wave data were analysed for persistence and the F/M amplitude ratio.Results: Persistence and the F/M amplitude ratio were significantly greater during the unpleasant trial than during the rest trial. In the control condition, there was no significant difference in persistence and the F/M amplitude ratio compared with the three trials.Conclusions: Our findings indicate that unpleasant emotions may affect spinal motor neuron excitability. Therefore, learning how to control emotions should be important aspect of physical therapy.