Long-term limb immobilization modulates inhibition-related electrophysiological brain activity

Therapeutic benefits of lower limb prostheses: a systematic review

BACKGROUND

Enhancing the quality of life of people with a lower limb amputation is critical in prosthetic development and rehabilitation. Yet, no overview is available concerning the impact of passive, quasi-passive and active ankle-foot prostheses on quality of life.

OBJECTIVE

To systematically review the therapeutic benefits of performing daily activities with passive, quasi-passive and active ankle-foot prostheses in people with a lower limb amputation.

METHODS

We searched the Pubmed, Web of Science, Scopus and Pedro databases, and backward citations until November 3, 2021. Only English-written randomised controlled trials, cross-sectional, cross-over and cohort studies were included when the population comprised individuals with a unilateral transfemoral or transtibial amputation, wearing passive, quasi-passive or active ankle-foot prostheses. The intervention and outcome measures had to include any aspect of quality of life assessed while performing daily activities. We synthesised the participants' characteristics, type of prosthesis, intervention, outcome and main results, and conducted risk of bias assessment using the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021290189.

RESULTS

We identified 4281 records and included 34 studies in total. Results indicate that quasi-passive and active prostheses are favoured over passive prostheses based on biomechanical, physiological, performance and subjective measures in the short-term. All studies had a moderate or high risk of bias.

CONCLUSION

Compared to passive ankle-foot prostheses, quasi-passive and active prostheses significantly enhance the quality of life. Future research should investigate the long-term therapeutic benefits of prosthetics devices.

Spatial proximity to others induces plastic changes in the neural representation of the peripersonal space

Peripersonal space (PPS) is a highly plastic "invisible bubble" surrounding the body whose boundaries are mapped through multisensory integration. Yet, it is unclear how the spatial proximity to others alters PPS boundaries. Across five experiments (N = 80), by recording behavioral and electrophysiological responses to visuo-tactile stimuli, we demonstrate that the proximity to others induces plastic changes in the neural PPS representation. The spatial proximity to someone else's hand shrinks the portion of space within which multisensory responses occur, thus reducing the PPS boundaries. This suggests that PPS representation, built from bodily and multisensory signals, plastically adapts to the presence of conspecifics to define the self-other boundaries, so that what is usually coded as "my space" is recoded as "your space". When the space is shared with conspecifics, it seems adaptive to move the other-space away from the self-space to discriminate whether external events pertain to the self-body or to other-bodies.

Effects of short-term arm immobilization on motor skill acquisition

Learning to sequence movements is necessary for skillful interaction with the environment. Neuroplasticity, particularly long-term potentiation (LTP), within sensorimotor networks underlies the acquisition of motor skill. Short-term immobilization of the arm, even less than 12 hours, can reduce corticospinal excitability and increase the capacity for LTP-like plasticity within the contralateral primary motor cortex. However, it is still unclear whether short-term immobilization influences motor skill acquisition. The current study aimed to evaluate the effect of short-term arm immobilization on implicit, sequence-specific motor skill acquisition using a modified Serial Reaction Time Task (SRTT). Twenty young, neurotypical adults underwent a single SRTT training session after six hours of immobilization of the non-dominant arm or an equivalent period of no immobilization. Our results demonstrated that participants improved SRTT performance overall after training, but there was no evidence of an effect of immobilization prior to task training on performance improvement. Further, improvements on the SRTT were not sequence-specific. Taken together, motor skill acquisition for sequential, individuated finger movements improved following training but the effect of six hours of immobilization was difficult to discern.

Post-arthrolysis rehabilitation in a patient with wrist stiffness secondary to distal radio-ulnar fracture: A case report

BACKGROUND

Arthrolysis is usually performed when stiffness has a disabling effect on quality of life and in cases where physiotherapy has not been effective. This report describes one patient with a chronic stiff wrist who underwent open arthrolysis. The purpose of this case report is to describe the rehabilitation following arthrolysis, in order to illustrate the effects of intensive physiotherapy for this patient.

CASE DESCRIPTION

A 54-year-old woman with chronic wrist stiffness secondary to a radio-ulnar fracture was described. The patient presented severe pain and unsatisfactory wrist range of motion and muscle strength almost 2 years after the traumatic event.

INTERVENTION

Post-arthrolysis rehabilitation was based on edema control, manual therapy, transcutaneous electrical nerve stimulation (TENS), static splinting and strengthening exercises. In addition, graded motor imagery and proprioceptive rehabilitation were included to address impaired motor control. Outcome measures of passive range of motion (PROM), active range of motion (AROM), grip and pinch strength, numeric rating scale (NRS), disability of the arm, shoulder and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) were recorded.

CONCLUSIONS

The outcomes of this case report suggest that arthrolysis combined with immediate and intensive physiotherapy were a suitable option for the treatment of post-traumatic wrist stiffness in this patient. The passive motion measured intraoperatively was maintained, while pain, functional active motion and strength were improved allowing for social reintegration.

Preferred music listening is associated with perceptual learning enhancement at the expense of self-focused attention

Can preferred music listening improve following attentional and learning performances? Here we suggest that this may be the case. In Experiment 1, following preferred and non-preferred musical-piece listening, we recorded electrophysiological responses to an auditory roving-paradigm. We computed the mismatch negativity (MMN - the difference between responses to novel and repeated stimulation), as an index of perceptual learning, and we measured the correlation between trial-by-trial EEG responses and the fluctuations in Bayesian Surprise, as a quantification of the neural attunement with stimulus informational value. Furthermore, during music listening, we recorded oscillatory cortical activity. MMN and trial-by-trial correlation with Bayesian surprise were significantly larger after subjectively preferred versus non-preferred music, indicating the enhancement of perceptual learning. The analysis on oscillatory activity during music listening showed a selective alpha power increased in response to preferred music, an effect often related to cognitive enhancements. In Experiment 2, we explored whether this learning improvement was realized at the expense of self-focused attention. Therefore, after preferred versus non-preferred music listening, we collected Heart-Beat Detection (HBD) accuracy, as a measure of the attentional focus toward the self. HBD was significantly lowered following preferred music listening. Overall, our results suggest the presence of a specific neural mechanism that, in response to aesthetically pleasing stimuli, and through the modulation of alpha oscillatory activity, redirects neural resources away from the self and toward the environment. This attentional up-weighting of external stimuli might be fruitfully exploited in a wide area of human learning activities, including education, neurorehabilitation and therapy.

Effects of motor restrictions on preparatory brain activity

Modifying established motor skills is a challenging endeavor due to proactive interference from undesired old to desired new actions, calling for high levels of cognitive control. Motor restrictions may facilitate the modification of motor skills by rendering undesired responses physically impossible, thus reducing demands to response inhibition. Here we studied behavioral and EEG effects of rule changes to typing in skilled touch-typists. The respective rule change—typing without using the left index finger—was either implemented per instruction only or with an additional motor restriction. In both groups, the rule change elicited delays and more errors in typing, indicating the occurrence of proactive interference. While stimulus-locked ERPs did not exhibit prominent effects of rule change or group, response-locked ERPs revealed that the time courses of preparatory brain activity preceding typing responses depended on the presence of motor restriction. Although further research is necessary to corroborate our findings, they indicate a novel brain correlate that represents changes in inhibitory response preparation induced by short-term motor restrictions.

Modality-specific improvements in sensory processing among baseball players

Long-term skills training is known to induce neuroplastic alterations, but it is still debated whether these changes are always modality-specific or can be supramodal components. To address this issue, we compared finger-targeted somatosensory-evoked and auditory-evoked potentials under both Go (response) and Nogo (response inhibition) conditions between 10 baseball players, who require fine hand/digit skills and response inhibition, to 12 matched track and field (T&F) athletes. Electroencephalograms were obtained at nine cortical electrode positions. Go potentials, Nogo potentials, and Go/Nogo reaction time (Go/Nogo RT) were measured during equiprobable somatosensory and auditory Go/Nogo paradigms. Nogo potentials were obtained by subtracting Go trial from Nogo trial responses. Somatosensory Go P100 latency and Go/Nogo RT were significantly shorter in the baseball group than the T&F group, while auditory Go N100 latency and Go/Nogo RT did not differ between groups. Additionally, somatosensory subtracted Nogo N2 latency was significantly shorter in the baseball group than the T&F group. Furthermore, there were significant positive correlations between somatosensory Go/Nogo RT and both Go P100 latency and subtracted Nogo N2 latency, but no significant correlations among auditory responses. We speculate that long-term skills training induce predominantly modality-specific neuroplastic changes that can improve both execution and response inhibition.

Face-like configurations modulate electrophysiological mismatch responses

The human face is one of the most salient stimuli in the environment. It has been suggested that even basic face-like configurations (three dots composing a downward pointing triangle) may convey salience. Interestingly, stimulus salience can be signaled by mismatch detection phenomena, characterized by greater amplitudes of event-related potentials (ERPs) in response to relevant novel stimulation as compared to non-relevant repeated events. Here, we investigate whether basic face-like stimuli are salient enough to modulate mismatch detection phenomena. ERPs are elicited by a pair of sequentially presented visual stimuli (S1-S2), delivered at a constant 1-s interval, representing either a face-like stimulus (Upright configuration) or three neutral configurations (Inverted, Leftwards, and Rightwards configurations), that are obtained by rotating the Upright configuration along the three different axes. In pairs including a canonical face-like stimulus, we observe a more effective mismatch detection mechanism, with significantly larger N270 and P300 components when S2 is different from S1 as compared to when S2 is identical to S1. This ERP modulation, not significant in pairs excluding face-like stimuli, reveals that mismatch detection phenomena are significantly affected by basic face-like configurations. Even though further experiments are needed to ascertain whether this effect is specifically elicited by face-like configuration rather than by particular orientation changes, our findings suggest that face essential, structural attributes are salient enough to affect change detection processes.

Like the back of my hand: Visual ERPs reveal a specific change detection mechanism for the bodily self

The ability to identify our own body is considered a pivotal marker of self-awareness. Previous research demonstrated that subjects are more efficient in the recognition of images representing self rather than others' body effectors (self-advantage). Here, we verified whether, at an electrophysiological level, bodily-self recognition modulates change detection responses. In a first EEG experiment (discovery sample), event-related potentials (ERPs) were elicited by a pair of sequentially presented visual stimuli (vS1; vS2), representing either the self-hand or other people's hands. In a second EEG experiment (replicating sample), together with the previously described visual stimuli, also a familiar hand was presented. Participants were asked to decide whether vS2 was identical or different from vS1. Accuracy and response times were collected. In both experiments, results confirmed the presence of the self-advantage: participants responded faster and more accurately when the self-hand was presented. ERP results paralleled behavioral findings. Anytime the self-hand was presented, we observed significant change detection responses, with a larger N270 component for vS2 different rather than identical to vS1. Conversely, when the self-hand was not included, and even in response to the familiar hand in Experiment 2, we did not find any significant modulation of the change detection responses. Overall our findings, showing behavioral self-advantage and the selective modulation of N270 for the self-hand, support the existence of a specific mechanism devoted to bodily-self recognition, likely relying on the multimodal (visual and sensorimotor) dimension of the bodily-self representation. We propose that such a multimodal self-representation may activate the salience network, boosting change detection effects specifically for the self-hand.

Effect of tool-use observation on metric body representation and peripersonal space

In everyday life, we constantly act and interact with objects and with others' people through our body. To properly perform actions, the representations of the dimension of body-parts (metric body representation, BR) and of the space surrounding the body (peripersonal space, PPS) need to be constantly updated. Previous evidence has shown that BR and PPS representation are highly flexible, being modulated by sensorimotor experiences, such as the active use of tools to reach objects in the far space. In this study, we investigate whether the observation of another person using a tool to interact with objects located in the far space is sufficient to influence the plasticity of BR and PPS representation in a similar way to active tool-use. With this aim, two groups of young healthy participants were asked to perform 20 min trainings based on the active use of a tool to retrieve far cubes (active tool-use) and on the first-person observation of an experimenter doing the same tool-use training (observational tool-use). Behavioural tasks adapted from literature were used to evaluate the effects of the active and observational tool-use on BR (body-landmarks localization task-group 1), and PPS (audio-tactile interaction task - group 2). Results show that after active tool-use, participants perceived the length of their arm as longer than at baseline, while no significant differences appear after observation. Similarly, significant modifications in PPS representation, with comparable multisensory facilitation on tactile responses due to near and far sounds, were seen only after active tool-use, while this did not occur after observation. Together these results suggest that a mere observational training could not be sufficient to significantly modulate BR or PPS. The dissociation found in the active and observational tool-use points out differences between action execution and action observation, by suggesting a fundamental role of the motor planning, the motor intention, and the related sensorimotor feedback in driving BR and PPS plasticity.