Action observation with kinesthetic illusion can produce human motor plasticity

Differences in the early stages of motor learning between visual-motor illusion and action observation

The visual-motor illusion (VMI) induces a kinesthetic illusion by watching one's physically-moving video while the body is at rest. It remains unclear whether the early stages (immediately to one hour later) of motor learning are promoted by VMI. This study investigated whether VMI changes the early stages of motor learning in healthy individuals. Thirty-six participants were randomly assigned to two groups: the VMI or action observation condition. Each condition was performed with the left hand for 20 min. The VMI condition induced a kinesthetic illusion by watching one's ball-rotation task video. The action observation condition involved watching the same video as the VMI condition but did not induce a kinesthetic illusion. The ball-rotation task and brain activity during the task were measured pre, post1 (immediately), and post2 (after 1 h) in both conditions, and brain activity was measured using functional near-infrared spectroscopy. The rate of the ball-rotation task improved significantly at post1 and post2 in the VMI condition than in the action observation condition. VMI condition lowers left dorsolateral prefrontal cortex and right premotor area activity from post1 to pre compared to the action observation condition. In conclusion, VMI effectively aids early stages of motor learning in healthy individuals.

Comparison of Functional Connectivity during Visual-Motor Illusion, Observation, and Motor Execution

This study investigated the functional connectivity during visual-motor illusion and compared it with observation and motor execution using functional near-infrared spectroscopy (fNIRS). Thirty subjects were randomly assigned to: illusion, observation, and motor execution group. Illusion group watched own finger joint movement video image and induced kinesthetic illusion, while the other group only performed observation or motor execution. Continuous brain activity was measured using fNIRS and functional connectivity was analyzed. The illusion group perceived (using 7-point Likert scale) a higher degree of kinesthetic illusion and sense of body ownership than the observation group. Visual-motor illusion was associated with stronger functional connectivity between the left premotor cortex and the left parietal area compared with observation and motor execution only, suggesting that these areas respond to visual-motor illusion.

Influence of virtual reality visual feedback on the illusion of movement induced by tendon vibration of wrist in healthy participants

Introduction

Illusion of movement induced by tendon vibration is an effective approach for motor and sensory rehabilitation in case of neurological impairments. The aim of our study was to investigate which modality of visual feedback in Virtual Reality (VR) associated with tendon vibration of the wrist could induce the best illusion of movement.

Methods

We included 30 healthy participants in the experiment. Tendon vibration inducing illusion of movement (wrist extension, 100Hz) was applied on their wrist during 3 VR visual conditions (10 times each): a moving virtual hand corresponding to the movement that the participants could feel during the tendon vibration (Moving condition), a static virtual hand (Static condition), or no virtual hand at all (Hidden condition). After each trial, the participants had to quantify the intensity of the illusory movement on a Likert scale, the subjective degree of extension of their wrist and afterwards they answered a questionnaire.

Results

There was a significant difference between the 3 visual feedback conditions concerning the Likert scale ranking and the degree of wrist’s extension (p<0.001). The Moving condition induced a higher intensity of illusion of movement and a higher sensation of wrist’s extension than the Hidden condition (p<0.001 and p<0.001 respectively) than that of the Static condition (p<0.001 and p<0.001 respectively). The Hidden condition also induced a higher intensity of illusion of movement and a higher sensation of wrist’s extension than the Static condition (p<0.01 and p<0.01 respectively). The preferred condition to facilitate movement’s illusion was the Moving condition (63.3%).

Conclusions

This study demonstrated the importance of carefully selecting a visual feedback to improve the illusion of movement induced by tendon vibration, and the increase of illusion by adding VR visual cues congruent to the illusion of movement. Further work will consist in testing the same hypothesis with stroke patients.

Enhanced Motor Imagery Based Brain- Computer Interface via FES and VR for Lower Limbs

Motor imagery based brain-computer interface (MI-BCI) has been studied for improvement of patients' motor function in neurorehabilitation and motor assistance. However, the difficulties in performing imagery tasks limit its application. To overcome the limitation, an enhanced MI-BCI based on functional electrical stimulation (FES) and virtual reality (VR) is proposed in this study. On one hand, the FES is used to stimulate the subjects' lower limbs before their imagination to make them experience the muscles' contraction and improve their attention on the lower limbs, by which it is supposed that the subjects' motor imagery (MI) abilities can be enhanced. On the other hand, a ball-kicking movement scenario from the first-person perspective is designed to provide visual guidance for performing MI tasks. The combination of FES and VR can be used to reduce the difficulties in performing MI tasks and improve classification accuracy. Finally, the comparison experiments were conducted on twelve healthy subjects to validate the performance of the enhanced MI-BCI. The results show that the classification performance can be improved significantly by using the proposed MI-BCI in terms of the classification accuracy (ACC), the area under the curve (AUC) and the F1 score (paired t-test, ).

Visual feedback therapy for restoration of upper limb function of stroke patients

Objective

To investigate the effects of mirror neuron theory-based visual feedback therapy (VFT) on restoration of upper limb function of stroke patients and motor-related cortical function using functional magnetic resonance imaging (fMRI).

Methods

Hemiplegic stroke patients were randomly divided into two groups: a VFT group and a control (CTL) group. Sixteen patients in the VFT group received conventional rehabilitation (CR) and VFT for 8 weeks, while 15 patients in the CTL group received only CR. The Barthel Index (BI) was used to assess the activities of daily living at baseline and the 8^th week of the recovery training period. The Fugl–Meyer assessment (FMA) scale, somatosensory evoked potential (SEP), and fMRI were used to evaluate the recovery effect of the training therapies. The latencies and amplitudes of N9 and N20 were measured. Before recovery training, fMRI was performed for all patients in the VFT and CTL groups. In addition, 17 patients (9 in the VFT group and 8 in the CTL group) underwent fMRI for follow-up 2 months after treatment. Qualitative data were analyzed using the χ² test. The independent sample t-test was used to compare normally distributed data among different groups, the paired sample t-test was used to compare data between groups, and the non-parametric test was used to comparing data without normal distribution among groups.

Results

There were no significant differences between the VFT and CTL group in all indexes. However, after 8 weeks of recovery training, these indexes were all significantly improved (P < 0.05). As compared with the CTL group, the FMA scores, BI, and N9/N20 latencies and amplitudes of SEP in the VFT group were significantly improved (P < 0.05). Two months after recovery training, fMRI showed that the degree of activation of the bilateral central anterior gyrus, parietal lobe, and auxiliary motor areas was significantly higher in the VFT group than the CTL group (P < 0.05).

Conclusions

VFT based on mirror neuron theory is an effective approach to improve upper extremity motor function and daily activity performance of stroke patients. The therapeutic mechanism promotes motor relearning by activating the mirror neuron system and motor cortex. SEP amplitudes increased only for patients who participated in visual feedback. VFT promotes sensory-motor plasticity and behavioral changes in both the motor and sensory domains.

Efficacy of Verbally Describing One's Own Body Movement in Motor Skill Acquisition

The present study examined whether (a) verbally describing one’s own body movement can be potentially effective for acquiring motor skills, and (b) if the effects are related to motor imagery. The participants in this study were 36 healthy young adults (21.2 ± 0.7 years), randomly assigned into two groups (describing and control). They performed a ball rotation activity, with the describing group being asked by the examiner to verbally describe their own ball rotation, while the control group was asked to read a magazine aloud. The participants’ ball rotation performances were measured before the intervention, then again immediately after, five minutes after, and one day after. In addition, participants’ motor imagery ability (mental chronometry) of their upper extremities was measured. The results showed that the number of successful ball rotations (motor smoothness) and the number of ball drops (motor error) significantly improved in the describing group. Moreover, improvement in motor skills had a significant correlation with motor imagery ability. This suggests that verbally describing an intervention is an effective tool for learning motor skills, and that motor imagery is a potential mechanism for such verbal descriptions.

What is the effect of bodily illusions on corticomotoneuronal excitability? A systematic review

Background

This systematic review aimed to summarise and critically appraise the evidence for the effect of bodily illusions on corticomotoneuronal excitability.

Methods

Five databases were searched, with two independent reviewers completing study inclusion, risk of bias, transcranial magnetic stimulation (TMS) reporting quality, and data extraction. Included studies evaluated the effect of an illusion that altered perception of the body (and/or its movement) on excitability of motor circuitry in healthy, adult, human participants. Studies were required to: use TMS to measure excitability and/or inhibition; report quantitative outcomes (e.g., motor evoked potentials); compare the illusion to a control or active comparison condition; evaluate that an illusion had occurred (e.g., measured illusion strength/presence).

Results

Of 2,257 studies identified, 11 studies (14 experiments) were included, evaluating kinaesthetic illusions (n = 5), a rubber hand illusion (RHI) paradigm (n = 5), and a missing limb illusion (n = 1). Kinaesthetic illusions (induced via vision/tendon vibration) increased corticomotoneuronal excitability. Conflicting effects were found for traditional, visuotactile RHIs of a static hand. However, embodying a hand and then observing it move (“self-action”) resulted in decreased corticomotoneuronal excitability and increased silent period duration (a measure of Gamma-Aminobutynic acid [GABA]_B-mediated intracortical inhibition in motor cortex), with the opposite occurring (increased excitability, decreased inhibition) when the fake hand was not embodied prior to observing movement (“other-action”). Visuomotor illusions manipulating agency had conflicting results, but in the lower risk study, illusory agency over movement resulted in a relative decrease in corticomotoneuronal excitability. Last, an illusion of a missing limb reduced corticomotoneuronal excitability.

Conclusion

While evidence for the effect of bodily illusions on corticomotoneuronal excitability was limited (only 14 experiments) and had a high risk of bias, kinaesthetic illusions and illusions of embodying a hand (and seeing it move), had consistent effects. Future investigations into the role of embodiment and the illusion strength on corticomotoneuronal excitability and inhibition are warranted.

Impaired Motor Skill Acquisition Using Mirror Visual Feedback Improved by Transcranial Direct Current Stimulation (tDCS) in Patients With Parkinson's Disease

Recent non-invasive brain stimulation techniques in combination with motor training can enhance neuroplasticity and learning. It is reasonable to assume that such neuroplasticity-based interventions constitute a useful rehabilitative tool for patients with Parkinson's Disease (PD). Regarding motor skill training, many kinds of tasks that do not involve real motor movements have been applied to PD patients. The purpose of this study is to elucidate whether motor skill training using mirror visual feedback (MVF) is useful to patients with PD in order to improve untrained hand performance dependent on the time course of training; and whether MVF combined with anodal transcranial direct current stimulation (tDCS) over primary motor cortex (M1) causes an additional effect based on increased motor cortical excitability. Eighteen right-handed patients with PD in the off-medication state and 10 age-matched healthy subjects (HS) performed four sessions of right-hand ball rotation using MVF (intervention) on two separate days, 1 week apart (day 1 and day 2). HS subjects received only sham stimulation. The intervention included four sessions of motor-skill training using MVF for 20 min comprised of four sets of training for 30 s each. PD patients were randomly divided into two intervention groups without or with anodal tDCS over the right M1 contralateral to the untrained hand. As the behavior evaluation, the number of ball rotations of the left hand was counted before (pre) and immediately after (post) intervention on both days (pre day 1, post day 1, pre day 2, and post day 2). Motor evoked potential (MEP), input-output function, and cortical silent period were recorded to evaluate the motor cortical excitatory and inhibitory system in M1 pre day 1 and post day 2. The number of ball rotations of the left hand and the facilitation of MEP by intervention were significantly impaired in patients with PD compared to HS. In contrast, if anodal tDCS was applied to right M1 of patients with PD, the number of ball rotations in accordance with I-O function at 150% intensity was significantly increased after day 1 and retained until day 2. This finding may help provide a new strategy for neurorehabilitation improving task-specific motor memory without real motor movements in PD.

Kinaesthetic illusion shapes the cortical plasticity evoked by action observation

KEY POINTS

The combination of action observation (AO) and a peripheral nerve stimulation has been shown to induce plasticity in the primary motor cortex (M1). However, using peripheral nerve stimulation little is known about the specificity of the sensory inputs. The current study, using muscle tendon vibration to stimulate muscle spindles and transcranial magnetic stimulation to assess M1 excitability, investigated whether a proprioceptive stimulation leading to a kinaesthetic illusion of movement (KI) was able to evoke M1 plasticity when combined with AO. M1 excitability increased immediately and up to 60 min after AO-KI stimulation as a function of the vividness of the perceived illusion, and only when the movement directions of AO and KI were congruent. Tactile stimulation coupled with AO and KI alone were not sufficient to induce M1 plasticity. This methodology might be proposed to subjects during a period of immobilization to promote M1 activity without requiring any voluntary movement.

ABSTRACT

Physical practice is crucial to evoke cortical plasticity, but motor cognition techniques, such as action observation (AO), have shown their potentiality in promoting it when associated with peripheral afferent inputs, without the need of performing a movement. Here we investigated whether the combination of AO and a proprioceptive stimulation, able to evoke a kinaesthetic illusion of movement (KI), induced plasticity in the primary motor cortex (M1). In the main experiment, the role of congruency between the observed action and the illusory movement was explored together with the importance of the specificity of the sensory input modality (proprioceptive vs. tactile stimulation) to induce plasticity in M1. Further, a control experiment was carried out to assess the role of the mere kinaesthetic illusion on M1 excitability. Results showed that the combination of AO and KI evoked plasticity in M1, with an increase of the excitability immediately and up to 60 min after the conditioning protocol (P always <0.05). Notably, a significant increase in M1 excitability occurred only when the directions of the observed and illusory movements were congruent. Further, a significant positive linear relationship was found between the amount of M1 excitability increase and the vividness of the perceived illusion (P = 0.03). Finally, the tactile stimulation coupled with AO was not sufficient to induce changes in M1 excitability as well as the KI alone. All these findings indicate the importance of combining different sensory input signals to induce plasticity in M1, and that proprioception is the most suitable sensory modality to allow it.

Learning from Goal and Action Based Observations Differentially Modulates Functional Motor Cortical Plasticity

Action observation can facilitate motor skill learning and lead to a memory trace in motor representations of action. However, it remains unclear whether the action itself or the goal of the action drive changes in motor representations after learning by observation. We performed two experiments. In Experiment 1, using serial reaction time task and transcranial magnetic stimulation, we showed that observation of right-hand actions during skill learning only increased left motor cortical excitability, leading to behavioral gains in the same hand as the observed hand. In contrast, observing a sequence of visual cue positions devoid of hand action increases motor cortical excitability in both hemispheres and facilitates motor skill learning in the right hand (Experiment 1) and left hand for a mirror-symmetric sequence (Experiment 2). We propose that the encoding of observed movements maps onto motor representations of the same action to form a limb-specific motor memory, whereas the learning of spatial goals forms memory traces in the motor representations in both hemispheres to prepare for potential action in either hand.

Enhancement of motor-imagery ability via combined action observation and motor-imagery training with proprioceptive neurofeedback

Varied individual ability to control the sensory-motor rhythms may limit the potential use of motor-imagery (MI) in neurorehabilitation and neuroprosthetics. We employed neurofeedback training of MI under action observation (AO: AOMI) with proprioceptive feedback and examined whether it could enhance MI-induced event-related desynchronization (ERD). Twenty-eight healthy young adults participated in the neurofeedback training. They performed MI while watching a video of hand-squeezing motion from a first-person perspective. Eleven participants received correct proprioceptive feedback of the same hand motion with the video, via an exoskeleton robot attached to their hand, upon their successful generation of ERD. Another nine participants received random feedback. The training lasted for approximately 20 min per day and continued for 6 days within an interval of 2 weeks. MI-ERD power was evaluated separately, without AO, on each experimental day. The MI-ERD power of the participants receiving correct feedback, as opposed to random feedback, was significantly increased after training. An additional experiment in which the remaining eight participants were trained with auditory instead of proprioceptive feedback failed to show statistically significant increase in MI-ERD power. The significant training effect obtained in shorter training time relative to previously proposed methods suggests the superiority of AOMI training and physiologically-congruent proprioceptive feedback to enhance the MI-ERD power. The proposed neurofeedback training could help patients with motor deficits to attain better use of brain-machine interfaces for rehabilitation and/or prosthesis.

Perception as a Route for Motor Skill Learning: Perspectives from Neuroscience

Learning a motor skill requires physical practice that engages neural networks involved in movement. These networks have also been found to be engaged during perception of sensory signals associated with actions. Nonetheless, despite extensive evidence for the existence of such sensory-evoked neural activity in motor pathways, much less is known about their contribution to learning and actual changes in behavior. Primate studies usually involve an overlearned task while studies in humans have largely focused on characterizing activity of the action observation network (AON) in the context of action understanding, theory of mind, and social interactions. Relatively few studies examined neural plasticity induced by perception and its role in transfer of motor knowledge. Here, we review this body of literature and point to future directions for the development of alternative, physiologically grounded ways in which sensory signals could be harnessed to improve motor skills.

Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another

As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by observation or passive movement of trainee's hands by a robotic device). This obviously presents a major challenge in the rehabilitation of a paretic limb since voluntary control of physical movement is limited. Here, we describe a novel training scheme we have developed that has the potential to circumvent this major challenge. We exploited the voluntary control of one hand and provided real-time movement-based manipulated sensory feedback as if the other hand is moving. Visual manipulation through virtual reality (VR) was combined with a device that yokes left-hand fingers to passively follow right-hand voluntary finger movements. In healthy subjects, we demonstrate enhanced within-session performance gains of a limb in the absence of voluntary physical training. Results in healthy subjects suggest that training with the unique VR setup might also be beneficial for patients with upper limb hemiparesis by exploiting the voluntary control of their healthy hand to improve rehabilitation of their affected hand.

Short Term Motor-Skill Acquisition Improves with Size of Self-Controlled Virtual Hands

Visual feedback in general, and from the body in particular, is known to influence the performance of motor skills in humans. However, it is unclear how the acquisition of motor skills depends on specific visual feedback parameters such as the size of performing effector. Here, 21 healthy subjects physically trained to perform sequences of finger movements with their right hand. Through the use of 3D Virtual Reality devices, visual feedback during training consisted of virtual hands presented on the screen, tracking subject’s hand movements in real time. Importantly, the setup allowed us to manipulate the size of the displayed virtual hands across experimental conditions. We found that performance gains increase with the size of virtual hands. In contrast, when subjects trained by mere observation (i.e., in the absence of physical movement), manipulating the size of the virtual hand did not significantly affect subsequent performance gains. These results demonstrate that when it comes to short-term motor skill learning, the size of visual feedback matters. Furthermore, these results suggest that highest performance gains in individual subjects are achieved when the size of the virtual hand matches their real hand size. These results may have implications for optimizing motor training schemes.

Activity in superior parietal cortex during training by observation predicts asymmetric learning levels across hands

A dominant concept in motor cognition associates action observation with motor control. Previous studies have shown that passive action observation can result in significant performance gains in humans. Nevertheless, it is unclear whether the neural mechanism subserving such learning codes abstract aspects of the action (e.g. goal) or low level aspects such as effector identity. Eighteen healthy subjects learned to perform sequences of finger movements by passively observing right or left hand performing the same sequences in egocentric view. Using functional magnetic resonance imaging we show that during passive observation, activity in the superior parietal lobule (SPL) contralateral to the identity of the observed hand (right\left), predicts subsequent performance gains in individual subjects. Behaviorally, left hand observation resulted in positively correlated performance gains of the two hands. Conversely right hand observation yielded negative correlation - individuals with high performance gains in one hand exhibited low gains in the other. Such behavioral asymmetry is reflected by activity in contralateral SPL during short-term training in the absence of overt physical practice and demonstrates the role of observed hand identity in learning. These results shed new light on the coding level in SPL and have implications for optimizing motor skill learning.

The Influence of Mirror-Visual Feedback on Training-Induced Motor Performance Gains in the Untrained Hand

The well-documented observation of bilateral performance gains following unilateral motor training, a phenomenon known as cross-limb transfer, has important implications for rehabilitation. It has recently been shown that provision of a mirror image of the active hand during unilateral motor training has the capacity to enhance the efficacy of this phenomenon when compared to training without augmented visual feedback (i.e., watching the passive hand), possibly via action observation effects [1]. The current experiment was designed to confirm whether mirror-visual feedback (MVF) during motor training can indeed elicit greater performance gains in the untrained hand compared to more standard visual feedback (i.e., watching the active hand). Furthermore, discussing the mechanisms underlying any such MVF-induced behavioural effects, we suggest that action observation and the cross-activation hypothesis may both play important roles in eliciting cross-limb transfer. Eighty participants practiced a fast-as-possible two-ball rotation task with their dominant hand. During training, three different groups were provided with concurrent visual feedback of the active hand, inactive hand or a mirror image of the active hand with a fourth control group receiving no training. Pre- and post-training performance was measured in both hands. MVF did not increase the extent of training-induced performance changes in the untrained hand following unilateral training above and beyond those observed for other types of feedback. The data are consistent with the notion that cross-limb transfer, when combined with MVF, is mediated by cross-activation with action observation playing a less unique role than previously suggested. Further research is needed to replicate the current and previous studies to determine the clinical relevance and potential benefits of MVF for cases that, due to the severity of impairment, rely on unilateral training programmes of the unaffected limb to drive changes in the contralateral affected limb.