Vision without Proprioception Modulates Cortico-spinal Excitability during Hand Motor Imagery

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.

A High-Strength Neuromuscular System That Implements Reflexes as Controlled by a Multiquadrant Artificial Efferent Nerve

We demonstrate an artificial efferent nerve that distinguishes environment-responsive conditioned and unconditioned reflexes, i.e., hand-retraction reflex and muscle memory, respectively. These reflex modes are immediately switchable by altering the polarity of charge carriers in a parallel-channeled artificial synapse; this ability emulates multiplexed neurotransmission of different neurotransmitters to form glutamine-induced short-term plasticity and acetylcholine-induced long-term plasticity. This is the successful control of high-strength artificial muscle fibers by using an artificial efferent nerve to form a neuromuscular system that can realize curvature and force simultaneously and in which all these aspects far surpass currently available neuromuscular systems. Furthermore, the special four-quadrant information-processing mechanism of our artificial efferent nerve allows complex application extensions, i.e., relative-position tracking of sound sources, immediate switchable learning modes between fast information processing and long-term memory, and high-accuracy pattern cognition. This work is a step toward development of human-compatible artificial neuromuscular systems.

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.

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.

The Importance of Visual Feedback Design in BCIs; from Embodiment to Motor Imagery Learning

Brain computer interfaces (BCIs) have been developed and implemented in many areas as a new communication channel between the human brain and external devices. Despite their rapid growth and broad popularity, the inaccurate performance and cost of user-training are yet the main issues that prevent their application out of the research and clinical environment. We previously introduced a BCI system for the control of a very humanlike android that could raise a sense of embodiment and agency in the operators only by imagining a movement (motor imagery) and watching the robot perform it. Also using the same setup, we further discovered that the positive bias of subjects' performance both increased their sensation of embodiment and improved their motor imagery skills in a short period. In this work, we studied the shared mechanism between the experience of embodiment and motor imagery. We compared the trend of motor imagery learning when two groups of subjects BCI-operated different looking robots, a very humanlike android's hands and a pair of metallic gripper. Although our experiments did not show a significant change of learning between the two groups immediately during one session, the android group revealed better motor imagery skills in the follow up session when both groups repeated the task using the non-humanlike gripper. This result shows that motor imagery skills learnt during the BCI-operation of humanlike hands are more robust to time and visual feedback changes. We discuss the role of embodiment and mirror neuron system in such outcome and propose the application of androids for efficient BCI training.

Effects of brain-computer interface-based functional electrical stimulation on balance and gait function in patients with stroke: preliminary results

[Purpose] The purpose of this study was to determine the effects of brain-computer interface (BCI)-based functional electrical stimulation (FES) on balance and gait function in patients with stroke. [Subjects] Subjects were randomly allocated to a BCI-FES group (n=5) and a FES group (n=5). [Methods] The BCI-FES group received ankle dorsiflexion training with FES according to a BCI-based program for 30 minutes per day for 5 days. The FES group received ankle dorsiflexion training with FES for the same duration. [Results] Following the intervention, the BCI-FES group showed significant differences in Timed Up and Go test value, cadence, and step length on the affected side. The FES group showed no significant differences after the intervention. However, there were no significant differences between the 2 groups after the intervention. [Conclusion] The results of this study suggest that BCI-based FES training is a more effective exercise for balance and gait function than FES training alone in patients with stroke.

The embodied nature of motor imagery processes highlighted by short-term limb immobilization

We investigated the embodied nature of motor imagery processes through a recent use-dependent plasticity approach, a short-term limb immobilization paradigm. A splint placed on the participants' left-hand during a brief period of 24 h was used for immobilization. The immobilized participants performed two mental rotation tasks (a hand mental rotation task and a number mental rotation task) before (pre-test) and immediately after (post-test) the splint removal. The control group did not undergo the immobilization procedure. The main results showed an immobilization-induced effect on left-hand stimuli, resulting in a lack of task-repetition benefit. By contrast, accuracy was higher and response times were shorter for right-hand stimuli. No immobilization-induced effects appeared for number stimuli. These results revealed that the cognitive representation of hand movements can be modified by a brief period of sensorimotor deprivation, supporting the hypothesis of the embodied nature of motor simulation processes.

Effect of motor imagery in children with unilateral cerebral palsy: fMRI study

Background

Motor imagery is considered as a promising therapeutic tool for rehabilitation of motor planning problems in patients with cerebral palsy. However motor planning problems may lead to poor motor imagery ability.

Aim

The aim of this functional magnetic resonance imaging study was to examine and compare brain activation following motor imagery tasks in patients with hemiplegic cerebral palsy with left or right early brain lesions. We tested also the influence of the side of imagined hand movement.

Method

Twenty patients with clinical hemiplegic cerebral palsy (sixteen males, mean age 12 years and 10 months, aged 6 years 10 months to 20 years 10 months) participated in this study. Using block design, brain activations following motor imagery of a simple opening-closing hand movement performed by either the paretic or nonparetic hand was examined.

Results

During motor imagery tasks, patients with early right brain damages activated bilateral fronto-parietal network that comprise most of the nodes of the network well described in healthy subjects. Inversely, in patients with left early brain lesion brain activation following motor imagery tasks was reduced, compared to patients with right brain lesions. We found also a weak influence of the side of imagined hand movement.

Conclusion

Decreased activations following motor imagery in patients with right unilateral cerebral palsy highlight the dominance of the left hemisphere during motor imagery tasks. This study gives neuronal substrate to propose motor imagery tasks in unilateral cerebral palsy rehabilitation at least for patients with right brain lesions.

Augmented visual feedback counteracts the effects of surface muscular functional electrical stimulation on physiological tremor

Background

Recent studies suggest that surface muscular functional electrical stimulation (FES) might suppress neurological upper limb tremor. We assessed its effects on upper limb physiological tremor, which is mainly driven by mechanical-reflex oscillations. We investigated the interaction between FES and augmented visual feedback, since (a) most daily activities are performed using visual cues, and (b) augmented visual feedback exacerbates upper limb tremor.

Methods

10 healthy subjects (23.4 ± 7.7 years) performed 2 postural tasks with combinations of FES (4 sites; frequency of stimulation: 30 Hz; pulse width: 300 microsec; range of current delivered 10–34 mAmp) and augmented visual feedback.

Results

Spectral analysis of tremor showed a decrease of power spectral density to 62.18% (p = 0.01), of the integral in the 8-12 Hz frequency band to 57.67% (p = 0.003), and of tremor root mean square (RMS) to 57.16% (p = 0.002) during FES, without any changes in tremor frequency. Augmented visual feedback blocked the beneficial effect of FES, as confirmed by power spectral analysis (p = 0.01). We found a statistically significant interaction between augmented visual feedback and electrical stimulation (p = 0.039).

Conclusions

Augmented visual feedback antagonizes the effects of FES on physiological tremor. The absence of changes of peak frequency argues against an effect of FES on mechanical properties of the upper limb.

Afferent and efferent activity control in the design of brain computer interfaces for motor rehabilitation

Stroke is a cardiovascular accident within the brain resulting in motor and sensory impairment in most of the survivors. A stroke can produce complete paralysis of the limb although sensory abilities are normally preserved. Functional electrical stimulation (FES), robotics and brain computer interfaces (BCIs) have been used to induce motor rehabilitation. In this work we measured the brain activity of healthy volunteers using electroencephalography (EEG) during FES, passive movements, active movements, motor imagery of the hand and resting to compare afferent and efferent brain signals produced during these motor related activities and to define possible features for an online FES-BCI. In the conditions in which the hand was moved we limited the movement range in order to control the afferent flow. Although we observed that there is a subject dependent frequency and spatial distribution of efferent and afferent signals, common patterns between conditions and subjects were present mainly in the low beta frequency range. When averaging all the subjects together the most significant frequency bin comparing each condition versus rest was exactly the same for all conditions but motor imagery. These results suggest that to implement an on-line FES-BCI, afferent brain signals resulting from FES have to be filtered and time-frequency-spatial features need to be used.

The effect of chronic deafferentation on mental imagery: a case study

Visual- and motor imagery rely primarily on perceptual and motor processes, respectively. In healthy controls, the type of imagery used to solve a task depends on personal preference, task instruction, and task properties. But how does the chronic loss of proprioceptive and tactile sensory inputs from the body periphery influence mental imagery? In a unique case study, we investigated the imagery capabilities of the chronically deafferented patient IW when he was performing a mental rotation task. We found that IW's motor imagery processes were impaired and that visual imagery processes were enhanced compared to controls. These results suggest that kinaesthetic afferent signals from the body periphery play a crucial role in enabling and maintaining central sensorimotor representations and hence the ability to incorporate kinaesthetic information into the imagery processes.

Facilitation of corticospinal excitability during motor imagery of wrist movement with visual or quantitative inspection of EMG activity

The present study investigated facilitation of corticospinal excitability during motor imagery of wrist movement with visual or quantitative inspection of background electromyographic (EMG) activity. Ten healthy participants imagined wrist extension from a first-person perspective in response to a start cue. Transcranial magnetic stimulation was delivered to the motor cortex 2 sec. after the start cue. EMG signals were recorded from the extensor carpi radialis muscle. Trials with background EMG activity were discarded based on visual inspection. Both motor-evoked potential (MEP) and background EMG amplitudes increased during motor imagery. The amount of increase in MEP amplitude was positively correlated with the amount of increase in background EMG amplitude during motor imagery. The statistically significant increase in MEP amplitude during motor imagery disappeared when the effect of muscle activity was statistically eliminated or after trials with background EMG activity were discarded based on strict quantitative criteria. Facilitation of corticospinal excitability during motor imagery of wrist movement depends partially on muscle activity. Discarding background EMG activity during motor imagery based on visual inspection is not sufficient to equalize background EMG amplitude between resting and motor imagery. Discarding trials with background EMG activity through strict quantitative criteria is useful to equalize background EMG amplitude between at rest and during motor imagery.

The modulation of corticospinal excitability during motor imagery of actions with objects

We investigated whether corticospinal excitability during motor imagery of actions (the power or the pincer grip) with objects was influenced by actually touching objects (tactile input) and by the congruency of posture with the imagined action (proprioceptive input). Corticospinal excitability was assessed by monitoring motor evoked potentials (MEPs) in the first dorsal interosseous following transcranial magnetic stimulation over the motor cortex. MEPs were recorded during imagery of the power grip of a larger-sized ball (7 cm) or the pincer grip of a smaller-sized ball (3 cm)^—with or without passively holding the larger-sized ball with the holding posture or the smaller-sized ball with the pinching posture. During imagery of the power grip, MEPs amplitude was increased only while the actual posture was the same as the imagined action (the holding posture). On the other hand, during imagery of the pincer grip while touching the ball, MEPs amplitude was enhanced in both postures. To examine the pure effect of touching (tactile input), we recorded MEPs during imagery of the power and pincer grip while touching various areas of an open palm with a flat foam pad. The MEPs amplitude was not affected by the palmer touching. These findings suggest that corticospinal excitability during imagery with an object is modulated by actually touching an object through the combination of tactile and proprioceptive inputs.

Corticospinal excitability during observation and imagery of simple and complex hand tasks: implications for motor rehabilitation

Movement observation and imagery are increasingly propagandized for motor rehabilitation. Both observation and imagery are thought to improve motor function through repeated activation of mental motor representations. However, it is unknown what stimulation parameters or imagery conditions are optimal for rehabilitation purposes. A better understanding of the mechanisms underlying movement observation and imagery is essential for the optimization of functional outcome using these training conditions. This study systematically assessed the corticospinal excitability during rest, observation, imagery and execution of a simple and a complex finger-tapping sequence in healthy controls using transcranial magnetic stimulation (TMS). Observation was conducted passively (without prior instructions) as well as actively (in order to imitate). Imagery was performed visually and kinesthetically. A larger increase in corticospinal excitability was found during active observation in comparison with passive observation and visual or kinesthetic imagery. No significant difference between kinesthetic and visual imagery was found. Overall, the complex task led to a higher corticospinal excitability in comparison with the simple task. In conclusion, the corticospinal excitability was modulated during both movement observation and imagery. Specifically, active observation of a complex motor task resulted in increased corticospinal excitability. Active observation may be more effective than imagery for motor rehabilitation purposes. In addition, the activation of mental motor representations may be optimized by varying task-complexity.

Visuomotor adaptation and intermanual transfer under different viewing conditions

Does the brain use a separate internal model for cursor mechanics during visuomotor adaptation? We compared the amount of adaptation and transfer to the opposite arm when subjects reached the targets under different viewing conditions of the arm during reaching. If the brain forms separate models, we predict a difference in the amount of adaptation and transfer for each viewing condition. If the brain forms one model, we predict equivalent amounts of adaptation and transfer between the two hands for each viewing condition. Separate groups of subjects performed a reaching task with either a rotated view of cursor motion representing their unseen hand or a rotated view of their actual hand. The two groups were further divided so that the magnitude of the rotation was either 45 degrees or 75 degrees counter-clockwise. After adapting to the rotation with one hand, subjects reached the same targets under the same viewing condition but with the opposite hand. Similar amounts of adaptation and intermanual transfer were found across the different magnitudes of rotation and across patterns of hand-order. Our results suggest that the brain may not be learning a distinct model for cursor mechanics, or if it is, it must be equivalent or overlapping with the arm model.

Perceptual integration of illusory and imagined kinesthetic images

It is generally agreed that motor imagery involves kinesthetic sensations especially as far as first-person imagery is concerned. It was proposed to determine the extent to which motor imagery and vibration-induced illusory sensations of movement are integrated perceptually. Imagined and illusory hand movements were evoked both separately and in various combinations in 12 volunteers. After each trial, the participants were asked to draw the movement trajectory perceived. In all the subjects, propriomimetic vibration patterns applied to various wrist muscles induced spatially oriented or more complex illusory hand movements such as writing or drawing. Depending on the instructions, the subjects were also able to produce imagined hand movements in various directions and at two different velocities. When straight illusory and imagined movements were evoked simultaneously, all the subjects perceived a single movement trajectory, in which the direction and the velocity of the two ongoing sensations were exactly integrated. This perceptual integration also occurred in the case of more complex movements, such as writing and drawing, giving rise to the perception of original trajectories also combining the features of both motor images. Because these two kinesthetic images, the one intentionally and centrally induced and the other peripherally evoked, activate almost the same neural network including cortical sensory and motor areas, parietal regions, and the cerebellum, these results suggest that common processes may be involved in such a perceptual fusion. The nature of these common processes is discussed, and some fields of research in which these findings could potentially be applied are suggested.

Visuokinesthetic perception of hand movement is mediated by cerebro-cerebellar interaction between the left cerebellum and right parietal cortex

Combination of visual and kinesthetic information is essential to perceive bodily movements. We conducted behavioral and functional magnetic resonance imaging experiments to investigate the neuronal correlates of visuokinesthetic combination in perception of hand movement. Participants experienced illusory flexion movement of their hand elicited by tendon vibration while they viewed video-recorded flexion (congruent: CONG) or extension (incongruent: INCONG) motions of their hand. The amount of illusory experience was graded by the visual velocities only when visual information regarding hand motion was concordant with kinesthetic information (CONG). The left posterolateral cerebellum was specifically recruited under the CONG, and this left cerebellar activation was consistent for both left and right hands. The left cerebellar activity reflected the participants' intensity of illusory hand movement under the CONG, and we further showed that coupling of activity between the left cerebellum and the "right" parietal cortex emerges during this visuokinesthetic combination/perception. The "left" cerebellum, working with the anatomically connected high-order bodily region of the "right" parietal cortex, participates in online combination of exteroceptive (vision) and interoceptive (kinesthesia) information to perceive hand movement. The cerebro-cerebellar interaction may underlie updating of one's "body image," when perceiving bodily movement from visual and kinesthetic information.