Rapid plasticity of motor corticospinal system with robotic reach training

Goal-directed reaching is important for the activities of daily living. Populations of neurons in the primary motor cortex that project to spinal motor circuits are known to represent the kinematics of reaching movements. We investigated whether repetitive practice of goal-directed reaching movements induces use-dependent plasticity of those kinematic characteristics, in a manner similar to finger movements, as had been shown previously. Transcranial magnetic stimulation (TMS) was used to evoke upper extremity movements while the forearm was resting in a robotic cradle. Plasticity was measured by the change in kinematics of these evoked movements following goal-directed reaching practice. Baseline direction of TMS-evoked arm movements was determined for each subject. Subjects then practiced three blocks of 160 goal-directed reaching movements in a direction opposite to the baseline direction (14 cm reach 180° from baseline direction) against a 75-Nm spring field. Changes in TMS-evoked whole arm movements were assessed after each practice block and after 5 min following the end of practice. Direction and the position of the point of peak velocity of TMS-evoked movements were significantly altered following training and at a 5-min interval following training, while amplitude did not show significant changes. This was accompanied by changes in the motor-evoked potentials (MEPs) of the shoulder and elbow agonist muscles that partly explained the change in direction, mainly by increase in agonist MEP, without significant changes in antagonists. These findings demonstrate that the arm representation accessible by motor cortical stimulation under goes rapid plasticity induced by goal-directed robotic reach training in healthy subjects.

Arm movement maps evoked by cortical magnetic stimulation in a robotic environment

Many neurological diseases result in a severe inability to reach for which there is no proven therapy. Promising new interventions to address reaching rehabilitation using robotic training devices are currently under investigation in clinical trials but the neural mechanisms that underlie these interventions are not understood. Transcranial magnetic stimulation (TMS) may be used to probe such mechanisms quickly and non-invasively, by mapping muscle and movement representations in the primary motor cortex (M1). Here we investigate movement maps in healthy young subjects at rest using TMS in the robotic environment, with the goal of determining the range of TMS accessible movements, as a starting point for the study of cortical plasticity in combination with robotic therapy. We systematically stimulated the left motor cortex of 14 normal volunteers while the right hand and forearm rested in the cradle of a two degree-of-freedom planar rehabilitation robot (IMT). Maps were created by applying 10 stimuli at each of nine locations (3x3 cm(2) grid) centered on the M1 movement hotspot for each subject, defined as the stimulation location that elicited robot cradle movements of the greatest distance. TMS-evoked movement kinematics were measured by the robotic encoders and ranged in magnitude from 0 to 3 cm. Movement maps varied by subject and by location within a subject. However, movements were very consistent within a single stimulation location for a given subject. Movement vectors remained relatively constant (limited to <90 degrees section of the planar field) within some subjects across the entire map, while others covered a wider range of directions. This may be due to individual differences in cortical physiology or anatomy, resulting in a practical limit to the areas that are TMS-accessible. This study provides a baseline inventory of possible TMS-evoked arm movements in the robotic reaching trainer, and thus may provide a real-time, non-invasive platform for neurophysiology based evaluation and therapy in motor rehabilitation settings.