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Wang L, Wang S, Zhang S, Dou Z, Guo T. Effectiveness and Electrophysiological Mechanisms of Focal Vibration on Upper Limb Motor Dysfunction in Patients with Subacute Stroke: A Randomized Controlled Trial. Brain Res 2023; 1809:148353. [PMID: 36990135 DOI: 10.1016/j.brainres.2023.148353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
Upper limb motor dysfunction is a common complication after stroke, which has a negative impact on the daily life of patients. Focal vibration (FV) has been used to improve upper limb motor function in acute and chronic stroke patients, but its application in subacute stroke patients has not been extensively explored. Therefore, the purpose of this study was to explore the therapeutic effect of FV on upper limb motor function in subacute stroke patients and its underlying electrophysiological mechanism. Twenty-nine patients were enrolled and randomized into two groups: control group and vibration group. The control group were treated with conventional therapy including passive and active physical activity training, standing and sitting balance exercises, muscle strength training, hand extension and grasping exercises. The vibration group were given conventional rehabilitation and vibration therapy. A deep muscle stimulator (DMS) with a frequency of 60 Hz and an amplitude of 6 mm was used to provide vibration stimulation, which was sequentially applied along the biceps muscle to the flexor radialis of the affected limb for 10 minutes, once a day, and 6 times a week. Both groups received treatments for 4 consecutive weeks. In the vibration group, the motor evoked potential (MEP) latency and the somatosensory evoked potential (SEP) latency were significantly shortened (P<0.05) immediately after vibration and 30 minutes after vibration; the SEP amplitude and MEP amplitude were significantly increased (P<0.05) immediately after vibration and 30 minutes after vibration. The MEP latency (P=0.001) and SEP N20 latency (P=0.001) were shortened, and the MEP amplitude (P=0.011) and SEP N20 amplitude (P=0.017) were significantly increased after 4 weeks in the vibration group. After 4 consecutive weeks, the vibration group showed significant improvements in Modified Ashworth Scale (MAS) (P=0.037), Brunnstrom stage for upper extremity (BS-UE) (P=0.020), Fugl-Meyer assessment for upper extremity (FMA-UE) (P=0.029), Modified Barthel Index (MBI) (P=0.024), and SEP N20 (P=0.046) compared to the control group. The Brunnstrom stage for hand (BS-H) (P=0.451) did not show significant differences between the two groups. This study showed that FV was effective in improving upper limb motor function in subacute stroke patients. The underlying mechanism of FV may be that it enhances the efficacy of sensory pathways and induces plastic changes in the sensorimotor cortex.
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Trevarrow MP, Taylor BK, Reelfs AM, Wilson TW, Kurz MJ. Aberrant movement-related somatosensory cortical activity mediates the extent of the mobility impairments in persons with cerebral palsy. J Physiol 2022; 600:3537-3548. [PMID: 35723200 PMCID: PMC9357205 DOI: 10.1113/jp282898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Persons with cerebral palsy (CP) have reduced somatosensory cortical responses at rest and during movement. The somatosensory cortical responses during movement mediate the relationship between the somatosensory cortical responses at rest and mobility. Persons with CP may have altered sensorimotor feedback that ultimately contributes to impaired mobility. ABSTRACT There are numerous clinical reports that persons with cerebral palsy (CP) have proprioceptive, stereognosis and tactile discrimination deficits. The current consensus is that these altered perceptions are attributable to aberrant somatosensory cortical activity. It has been inferred from these data that persons with CP do not adequately process ongoing sensory feedback during motor actions, which accentuates the extent of their mobility impairments. However, this hypothesis has yet to be directly tested. We used magnetoencephalographic (MEG) brain imaging to address this knowledge gap by quantifying the somatosensory dynamics evoked by applying electrical stimulation to the tibial nerve in 22 persons with CP and 25 neurotypical (NT) controls while at rest and during an ankle plantarflexion isometric force motor task. We also quantified the spatiotemporal gait biomechanics of participants outside the scanner. Consistent with the literature, our results confirmed that the strength of somatosensory cortical activity was weaker in the persons with CP compared to the NT controls. Our results also showed that the strength of the somatosensory cortical responses were significantly weaker during the isometric ankle force task than at rest. Most importantly, our results showed that the strength of somatosensory cortical activity during the ankle plantarflexion force production task mediated the relationship between somatosensory cortical activity at rest and both walking velocity and step length. These results suggest that youth with CP have aberrant somatosensory cortical activity during isometric force generation, which ultimately contributes to the extent of mobility impairments seen in this patient population. Abstract figure legend Magnetoencephalographic brain imaging was used to determine the effect of sensory feedback during movement on mobility in persons with cerebral palsy. Persons with cerebral palsy had reduced somatosensory cortical activity at rest and during movement compared with their neurotypical peers. Further, the somatosensory cortical activity during movement mediated the relationship between somatosensory cortical activity at rest and mobility. These results indicate that difficulties in sensorimotor integration may contribute to the mobility impairments seen in this patient population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Brittany K Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Anna M Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA.,Department of Pharmacology & Neuroscience, Creighton University, Omaha, Nebraska
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA.,Department of Pharmacology & Neuroscience, Creighton University, Omaha, Nebraska
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3
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Finkelstein SA, Cortel‐LeBlanc MA, Cortel‐LeBlanc A, Stone J. Functional neurological disorder in the emergency department. Acad Emerg Med 2021; 28:685-696. [PMID: 33866653 DOI: 10.1111/acem.14263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/27/2022]
Abstract
We provide a narrative review of functional neurological disorder (FND, or conversion disorder) for the emergency department (ED). Diagnosis of FND has shifted from a "rule-out" disorder to one now based on the recognition of positive clinical signs, allowing the ED physician to make a suspected or likely diagnosis of FND. PubMed, Google Scholar, academic books, and a hand search through review article references were used to conduct a literature review. We review clinical features and diagnostic pitfalls for the most common functional neurologic presentations to the ED, including functional limb weakness, functional (nonepileptic) seizures, and functional movement disorders. We provide practical advice for discussing FND as a possible diagnosis and suggestions for initial steps in workup and management plans.
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Affiliation(s)
| | - Miguel A. Cortel‐LeBlanc
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
- The Ottawa Hospital Ottawa Ontario Canada
- Queensway Carleton Hospital Ottawa Ontario Canada
| | - Achelle Cortel‐LeBlanc
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
- Queensway Carleton Hospital Ottawa Ontario Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
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4
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Tomic S, Kuric TG, Popovic Z, Zubonja TM. Fatigue is related to depression in idiopathic dystonia. Neurol Sci 2021; 43:373-378. [PMID: 34018073 DOI: 10.1007/s10072-021-05322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dystonia is a movement disorder presented with involuntary muscle contraction causing abnormal posture, movement, or both. Besides motor symptoms, patients may also report non-motor symptoms such as pain, anxiety, apathy, depression, sleep problems, fatigue, and cognitive impairment. The etiology of fatigue in patients with dystonia is not yet well understood. AIM To evaluate the presence of fatigue, depression, anxiety, sleep disorders, and daily sleepiness in patients with focal and segmental dystonia and to determine which of these non-motor symptoms influence the occurrence and severity of fatigue. PATIENTS AND METHODS Patients were surveyed for symptoms of fatigue, depression, anxiety, night-time sleep problems, and daily sleepiness using the Fatigue Assessment Scale, Beck Depression Inventory II, Beck Anxiety Inventory, Pittsburgh Sleep Questionnaire Index, and Epworth Sleepiness Scale. Demographic data (sex, age, and disease duration) were collected from patient medical records. On statistical analysis, we used SPSS for Windows 10. The level of significance was set at p<0.05. RESULTS Sixty patients (43 female and 17 male) with focal or segmental dystonia were evaluated. Fatigue was reported by 67.2% of patients. Fatigue (general, physical, and mental fatigue) was found to correlate with depression, anxiety, and sleep problems. Daily sleepiness correlated only with mental fatigue. Disease duration, age, and gender did not influence the symptoms of fatigue. Multiple regression analysis showed that depression mostly predicted symptoms of general, physical, and mental fatigue. CONCLUSION Depression mostly predicted symptoms of general, physical, and mental fatigue in patients with focal and segmental dystonia.
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Affiliation(s)
- Svetlana Tomic
- Department of Neurology, Osijek University Hospital Centre, J. Huttlera 4, Osijek, Croatia. .,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000, Osijek, Croatia.
| | - Tihana Gilman Kuric
- Department of Neurology, Osijek University Hospital Centre, J. Huttlera 4, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000, Osijek, Croatia
| | - Zvonimir Popovic
- Department of Neurology, Osijek University Hospital Centre, J. Huttlera 4, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000, Osijek, Croatia
| | - Tea Mirosevic Zubonja
- Department of Neurology, Osijek University Hospital Centre, J. Huttlera 4, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000, Osijek, Croatia
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5
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Kaňovský P, Rosales R, Otruba P, Nevrlý M, Hvizdošová L, Opavský R, Kaiserová M, Hok P, Menšíková K, Hluštík P, Bareš M. Contemporary clinical neurophysiology applications in dystonia. J Neural Transm (Vienna) 2021; 128:509-519. [PMID: 33591454 DOI: 10.1007/s00702-021-02310-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/25/2022]
Abstract
The complex phenomenological understanding of dystonia has transcended from the clinics to genetics, imaging and neurophysiology. One way in which electrophysiology will impact into the clinics are cases wherein a dystonic clinical presentation may not be typical or a "forme fruste" of the disorder. Indeed, the physiological imprints of dystonia are present regardless of its clinical manifestation. Underpinnings in the understanding of dystonia span from the peripheral, segmental and suprasegmental levels to the cortex, and various electrophysiological tests have been applied in the course of time to elucidate the origin of dystonia pathophysiology. While loss of inhibition remains to be the key finding in this regard, intricacies and variabilities exist, thus leading to a notion that perhaps dystonia should best be gleaned as network disorder. Interestingly, the complex process has now spanned towards the understanding in terms of networks related to the cerebellar circuitry and the neuroplasticity. What is evolving towards a better and cohesive view will be neurophysiology attributes combined with structural dynamic imaging. Such a sound approach will significantly lead to better therapeutic modalities in the future.
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Affiliation(s)
- Petr Kaňovský
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic.
| | - Raymond Rosales
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic.,Department of Neurology and Psychiatry, The Neuroscience Institute, University of Santo Tomás Hospital, Manila, Philippines
| | - Pavel Otruba
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Martin Nevrlý
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Lenka Hvizdošová
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Robert Opavský
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Michaela Kaiserová
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Pavel Hok
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Kateřina Menšíková
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, University Hospital, Palacky University, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Martin Bareš
- 1st Department of Neurology, Masaryk University Medical School and St. Anne University Hospital, Brno, Czech Republic
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Pyasik M, Ronga I, Burin D, Salatino A, Sarasso P, Garbarini F, Ricci R, Pia L. I'm a believer: Illusory self-generated touch elicits sensory attenuation and somatosensory evoked potentials similar to the real self-touch. Neuroimage 2021; 229:117727. [PMID: 33434613 DOI: 10.1016/j.neuroimage.2021.117727] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023] Open
Abstract
Sensory attenuation (i.e., the phenomenon whereby self-produced sensations are perceived as less intense compared to externally occurring ones) is among the neurocognitive processes that help distinguishing ourselves from others. It is thought to be rooted in the motor system (e.g., related to motor intention and prediction), while the role of body awareness, which necessarily accompanies any voluntary movement, in this phenomenon is largely unknown. To fill this gap, here we compared the perceived intensity, somatosensory evoked potentials, and alpha-band desynchronization for self-generated, other-generated, and embodied-fake-hand-generated somatosensory stimuli. We showed that sensory attenuation triggered by the own hand and by the embodied fake hand had the same behavioral and neurophysiological signatures (reduced subjective intensity, reduced of N140 and P200 SEP components and post-stimulus alpha-band desynchronization). Therefore, signals subserving body ownership influenced attenuation of somatosensory stimuli, possibly in a postdictive manner. This indicates that body ownership is crucial for distinguishing the source of the perceived sensations.
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Affiliation(s)
- Maria Pyasik
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, 10123 Turin, Italy; NPSY-Lab.VR, Department of Human Sciences, University of Verona, 37129 Verona, Italy
| | - Irene Ronga
- MANIBUS - Movement ANd body In Behavioral and physiological neUroScience research group, Department of Psychology, University of Turin, 10123 Turin, Italy
| | - Dalila Burin
- IDAC - Institute of Development, Aging and Cancer, SARC - Smart-Aging Research Center, Kawashima Laboratory, Tohoku University, Sendai, Japan
| | - Adriana Salatino
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, 10123 Turin, Italy
| | - Pietro Sarasso
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, 10123 Turin, Italy
| | - Francesca Garbarini
- MANIBUS - Movement ANd body In Behavioral and physiological neUroScience research group, Department of Psychology, University of Turin, 10123 Turin, Italy
| | - Raffaella Ricci
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, 10123 Turin, Italy; NIT (Neuroscience Institute of Turin), 10123 Turin, Italy
| | - Lorenzo Pia
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, 10123 Turin, Italy; NIT (Neuroscience Institute of Turin), 10123 Turin, Italy.
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7
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Baker S, Trevarrow M, Gehringer J, Bergwell H, Arpin D, Heinrichs-Graham E, Wilson TW, Kurz MJ. Gamma somatosensory cortical oscillations are attenuated during the stance phase of human walking. Neurosci Lett 2020; 732:135090. [PMID: 32461106 DOI: 10.1016/j.neulet.2020.135090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 01/05/2023]
Abstract
It is well appreciated that processing of peripheral feedback by the somatosensory cortices plays a prominent role in the control of human motor actions like walking. However, very few studies have actually quantified the somatosensory cortical activity during walking. In this investigation, we used electroencephalography (EEG) and beamforming source reconstruction methods to quantify the frequency specific neural oscillations that are induced by an electrical stimulation that is applied to the right tibial nerve under the following experimental conditions: 1) sitting, 2) standing in place, and 3) treadmill walking. Our experimental results revealed that the peripheral stimulation induced a transient increase in theta-alpha (4-12 Hz; 50-350 ms) and gamma (40-80 Hz; 40-100 ms) activity in the leg region of the contralateral somatosensory cortices. The strength of the gamma oscillations were similar while sitting and standing, but were markedly attenuated while walking. Conversely, the strength of the theta-alpha oscillations were not different across the respective experimental conditions. Prior research suggests the afferent feedback from the Ia sensory fibers are likely attenuated during walking, while afferent feedback from the β polysynaptic sensory fibers are not. We suggest that the attenuated gamma oscillations seen during walking reflect the gating of the Ia afferents, while the similarity of theta-alpha oscillations across the experimental conditions is associated with the afferent information from the type II (Aα and β) polysynaptic sensory fibers.
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Affiliation(s)
- Sarah Baker
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States; Center for Magnetoencephalography, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Mike Trevarrow
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States; Center for Magnetoencephalography, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - James Gehringer
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Hannah Bergwell
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States; Center for Magnetoencephalography, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - David Arpin
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Elizabeth Heinrichs-Graham
- Center for Magnetoencephalography, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States; Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tony W Wilson
- Center for Magnetoencephalography, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States; Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States; Center for Magnetoencephalography, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States.
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8
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Gehringer JE, Arpin DJ, VerMaas JR, Trevarrow MP, Wilson TW, Kurz MJ. The Strength of the Movement-related Somatosensory Cortical Oscillations Differ between Adolescents and Adults. Sci Rep 2019; 9:18520. [PMID: 31811232 PMCID: PMC6898653 DOI: 10.1038/s41598-019-55004-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022] Open
Abstract
Adolescents demonstrate increasing mastery of motor actions with age. One prevailing hypothesis is that maturation of the somatosensory system during adolescence contributes to the improved motor control. However, limited efforts have been made to determine if somatosensory cortical processing is different in adolescents during movement. In this study, we used magnetoencephalographic brain imaging to begin addressing this knowledge gap by applying an electrical stimulation to the tibial nerve as adolescents (Age = 14.8 ± 2.5 yrs.) and adults (Age = 36.8 ± 5.0 yrs.) produced an isometric ankle plantarflexion force, or sat with no motor activity. Our results showed strong somatosensory cortical oscillations for both conditions in the alpha-beta (8–30 Hz) and gamma (38–80 Hz) ranges that occurred immediately after the stimulation (0–125 ms), and a beta (18–26 Hz) oscillatory response shortly thereafter (300–400 ms). Compared with the passive condition, all of these frequency specific cortical oscillations were attenuated while producing the ankle force. The attenuation of the alpha-beta response was greater in adolescents, while the adults had a greater attenuation of the beta response. These results imply that altered attenuation of the somatosensory cortical oscillations might be central to the under-developed somatosensory processing and motor performance characteristics in adolescents.
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Affiliation(s)
- James E Gehringer
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States.,Department Physical Therapy, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - David J Arpin
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States.,Department Physical Therapy, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jacy R VerMaas
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States.,Department Physical Therapy, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Michael P Trevarrow
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States.,Department Physical Therapy, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States.,Department of Neurological Sciences, UNMC, Omaha, Nebraska, United States
| | - Max J Kurz
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States. .,Department Physical Therapy, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States.
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9
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Macerollo A, Limousin P, Korlipara P, Foltynie T, Edwards MJ, Kilner J. Dopaminergic Modulation of Sensory Attenuation in Parkinson's Disease: Is There an Underlying Modulation of Beta Power? Front Neurol 2019; 10:1001. [PMID: 31620072 PMCID: PMC6759719 DOI: 10.3389/fneur.2019.01001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Pathological high amplitude of beta oscillations is thought as the underlying mechanism of motor symptoms in Parkinson's disease (PD), in particular with regard to bradykinesia. In addition, abnormality in a neurophysiological phenomenon labeled sensory attenuation has been found in patients with PD. The current study explored the hypothesis that the abnormal sensory attenuation has a causal link with the typical abnormality in beta oscillations in PD. Methods: The study tested sixteen right-handed patients with a diagnosis of PD and 22 healthy participants, which were matched by age and gender. Somatosensory evoked potentials were elicited through electrical stimulation of the median nerve at the wrist. Electrical activity was recorded at the scalp using a 128 channels EEG. Somatosensory evoked potentials were recorded in 2 conditions: at rest and at the onset of a voluntary movement, which was a self-paced abduction movement of the right thumb. Results: Healthy participants showed a reduction of the N20-P25 amplitude at the onset of the right thumb abduction compared to the rest condition (P < 0.05). When patients were OFF medication, they showed mild reduction of the N20-P25 component at movement onset (P < 0.05). On the contrary, they did show greater attenuation of the N20-P25 component at the onset of movement compared to the rest condition when ON medication (P < 0.05). There was no significant evidence of a link between the degree of sensory attenuation and the change in beta oscillations in our cohort of patients. Conclusion: These results confirmed a significant link between dopaminergic modulation and sensory attenuation. However, the sensory attenuation and beta oscillations were found as two independent phenomena.
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Affiliation(s)
- Antonella Macerollo
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.,School of Psychology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Institute of Neurology, University College of London, London, United Kingdom
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Institute of Neurology, University College of London, London, United Kingdom
| | - Prasad Korlipara
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Tom Foltynie
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Institute of Neurology, University College of London, London, United Kingdom
| | - Mark J Edwards
- Department of Neurology, St George's University of London, London, United Kingdom
| | - James Kilner
- Institute of Neurology, University College of London, London, United Kingdom
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Mulroy E, Balint B, Latorre A, Schreglmann S, Menozzi E, Bhatia KP. Syringomyelia‐Associated Dystonia: Case Series, Literature Review, and Novel Insights. Mov Disord Clin Pract 2019; 6:387-392. [DOI: 10.1002/mdc3.12772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/28/2019] [Accepted: 03/15/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology London United Kingdom
| | - Bettina Balint
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology London United Kingdom
- Department of NeurologyUniversity Hospital Heidelberg Germany
| | - Anna Latorre
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology London United Kingdom
| | - Sebastian Schreglmann
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology London United Kingdom
| | - Elisa Menozzi
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology London United Kingdom
| | - Kailash P. Bhatia
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology London United Kingdom
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11
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Rae CL, Critchley HD, Seth AK. A Bayesian Account of the Sensory-Motor Interactions Underlying Symptoms of Tourette Syndrome. Front Psychiatry 2019; 10:29. [PMID: 30890965 PMCID: PMC6412155 DOI: 10.3389/fpsyt.2019.00029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
Tourette syndrome is a hyperkinetic movement disorder. Characteristic features include tics, recurrent movements that are experienced as compulsive and "unwilled"; uncomfortable premonitory sensations that resolve through tic release; and often, the ability to suppress tics temporarily. We demonstrate how these symptoms and features can be understood in terms of aberrant predictive (Bayesian) processing in hierarchical neural systems, explaining specifically: why tics arise, their "unvoluntary" nature, how premonitory sensations emerge, and why tic suppression works-sometimes. In our model, premonitory sensations and tics are generated through over-precise priors for sensation and action within somatomotor regions of the striatum. Abnormally high precision of priors arises through the dysfunctional synaptic integration of cortical inputs. These priors for sensation and action are projected into primary sensory and motor areas, triggering premonitory sensations and tics, which in turn elicit prediction errors for unexpected feelings and movements. We propose experimental paradigms to validate this Bayesian account of tics. Our model integrates behavioural, neuroimaging, and computational approaches to provide mechanistic insight into the pathophysiological basis of Tourette syndrome.
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Affiliation(s)
- Charlotte L. Rae
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Hugo D. Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - Anil K. Seth
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- School of Engineering and Informatics, University of Sussex, Brighton, United Kingdom
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12
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Abstract
Dystonias are characterized by involuntary muscle contractions, twisting movements, abnormal postures, and often tremor in various body regions. However, in the last decade several studies have demonstrated that dystonias are also characterized by sensory abnormalities. While botulinum toxin is the gold standard therapy for focal dystonia, exactly how it improves this disorder is not entirely understood. Neurophysiological studies in animals and humans have clearly demonstrated that botulinum toxin improves dystonic motor manifestations by inducing chemodenervation, therefore weakening the injected muscles. In addition, neurophysiological and neuroimaging evidence also suggests that botulinum toxin modulates the activity of various neural structures in the CNS distant from the injected site, particularly cortical motor and sensory areas. Concordantly, recent studies have shown that in patients with focal dystonias botulinum toxin ameliorates sensory disturbances, including reduced spatial discrimination acuity and pain. Overall, these observations suggest that in these patients botulinum toxin-induced effects encompass complex mechanisms beyond chemodenervation of the injected muscles.
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Affiliation(s)
- Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
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13
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Conte A, Belvisi D, De Bartolo MI, Manzo N, Cortese FN, Tartaglia M, Ferrazzano G, Fabbrini G, Berardelli A. Abnormal sensory gating in patients with different types of focal dystonias. Mov Disord 2018; 33:1910-1917. [DOI: 10.1002/mds.27530] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/08/2018] [Accepted: 08/23/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Antonella Conte
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
- IRCCS NEUROMED; Pozzilli IS Italy
| | | | | | - Nicoletta Manzo
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
| | | | - Matteo Tartaglia
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
| | | | - Giovanni Fabbrini
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
- IRCCS NEUROMED; Pozzilli IS Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
- IRCCS NEUROMED; Pozzilli IS Italy
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14
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Kurz MJ, Wiesman AI, Coolidge NM, Wilson TW. Haptic exploration attenuates and alters somatosensory cortical oscillations. J Physiol 2018; 596:5051-5061. [PMID: 30152170 DOI: 10.1113/jp276263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/16/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Several behavioural studies have shown the sensory perceptions are reduced during movement; yet the neurophysiological reason for this is not clear. Participants underwent stimulation of the median nerve when either sitting quietly (i.e. passive stimulation condition) or performing haptic exploration of a ball with the left hand. Magnetoencephalographic brain imaging and advanced beamforming methods were used to identify the differences in somatosensory cortical responses. We show that the neural populations active during the passive stimulation condition were strongly gated during the haptic exploration task. These results imply that the reduced haptic perceptions might be governed by gating of certain somatosensory neural populations. ABSTRACT Several behavioural studies have shown that children have reduced sensory perceptions during movement; however, the neurophysiological nexus for these altered perceptions remains unknown. We used magnetoencephalographic brain imaging and advanced beamforming methods to address this knowledge gap. In our experiment, a cohort of children (aged 10-18 years) underwent stimulation of the median nerve when either sitting quietly (i.e. passive stimulation condition) or performing haptic exploration of a ball with the left hand. Our results revealed two novel observations. First, there was a relationship between the child's age and the strength of the beta (18-26 Hz) response seen within the somatosensory cortices during the passive stimulation condition. This suggests that there may be an age-dependent change in the processing of peripheral feedback by the somatosensory cortices. Second, all of the cortical regions that were active during the passive stimulation condition were almost completely gated during the haptic task. Instead, the haptic task involved neural oscillations within Brodmann area 2, which is known to convey less spatially precise tactile information but is involved in the processing of more complex somatosensations across the respective digits. These results imply that the reduced somatosensory perceptions seen during movements in healthy children may be related to the gating of certain neural generators, as well as activation of haptic-specific neural generators within the somatosensory cortices. The utilization of such haptic-specific circuits during development may lead to the enhanced somatosensory processing during haptic exploration seen in healthy adults.
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Affiliation(s)
- Max J Kurz
- Department of Physical Therapy, Munroe Meyer Institute for Genetics and Rehabilitation.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alex I Wiesman
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nathan M Coolidge
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W Wilson
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
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15
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Abstract
Dystonia is a neurological condition characterized by abnormal involuntary movements or postures owing to sustained or intermittent muscle contractions. Dystonia can be the manifesting neurological sign of many disorders, either in isolation (isolated dystonia) or with additional signs (combined dystonia). The main focus of this Primer is forms of isolated dystonia of idiopathic or genetic aetiology. These disorders differ in manifestations and severity but can affect all age groups and lead to substantial disability and impaired quality of life. The discovery of genes underlying the mendelian forms of isolated or combined dystonia has led to a better understanding of its pathophysiology. In some of the most common genetic dystonias, such as those caused by TOR1A, THAP1, GCH1 and KMT2B mutations, and idiopathic dystonia, these mechanisms include abnormalities in transcriptional regulation, striatal dopaminergic signalling and synaptic plasticity and a loss of inhibition at neuronal circuits. The diagnosis of dystonia is largely based on clinical signs, and the diagnosis and aetiological definition of this disorder remain a challenge. Effective symptomatic treatments with pharmacological therapy (anticholinergics), intramuscular botulinum toxin injection and deep brain stimulation are available; however, future research will hopefully lead to reliable biomarkers, better treatments and cure of this disorder.
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16
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Chen JC, Macerollo A, Sadnicka A, Lu MK, Tsai CH, Korlipara P, Bhatia K, Rothwell JC, Edwards MJ. Cervical dystonia: Normal auditory mismatch negativity and abnormal somatosensory mismatch negativity. Clin Neurophysiol 2018; 129:1947-1954. [PMID: 30015084 DOI: 10.1016/j.clinph.2018.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Previous electrophysiological and psychophysical tests have suggested that somatosensory integration is abnormal in dystonia. Here, we hypothesised that this abnormality could relate to a more general deficit in pre-attentive error/deviant detection in patients with dystonia. We therefore tested patients with dystonia and healthy subjects using a mismatch negativity paradigm (MMN), where evoked potentials generated in response to a standard repeated stimulus are subtracted from the responses to a rare "odd ball" stimulus. METHODS We assessed MMN for somatosensory and auditory stimuli in patients with cervical dystonia and healthy age matched controls. RESULTS We found a significant group ∗ oddball type interaction effect (F (1, 34) = 4.5, p = 0.04, ρI = 0.63). A follow up independent t-test for sMMN data, showed a smaller sMMN amplitude in dystonic patients compared to controls (mean difference control-dystonia: -1.0 µV ± 0.3, p < 0.00, t = -3.1). However the amplitude of aMMN did not differ between groups (mean difference control-dystonia: -0.2 µV ± 0.2, p = 0.24, t = -1.2). We found a positive correlation between somatosensory MMN and somatosensory temporal discrimination threshold. CONCLUSION These results suggest that pre-attentive error/deviant detection, specifically in the somatosensory domain, is abnormal in dystonia. This could underlie some previously reported electrophysiological and psychophysical abnormalities of somatosensory integration in dystonia. SIGNIFICANCE One could hypothesize a deficit in pre-conscious orientation towards potentially salient signals might lead to a more conservative threshold for decision-making in dystonia.
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Affiliation(s)
- Jui-Cheng Chen
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| | - Antonella Macerollo
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Anna Sadnicka
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Min-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Prasad Korlipara
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Mark J Edwards
- Department of Molecular and Clinical Sciences, St George's University of London, London
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17
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Macerollo A, Brown MJ, Kilner JM, Chen R. Neurophysiological Changes Measured Using Somatosensory Evoked Potentials. Trends Neurosci 2018; 41:294-310. [DOI: 10.1016/j.tins.2018.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/05/2023]
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18
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Arpin DJ, Gehringer JE, Wilson TW, Kurz MJ. Movement-Related Somatosensory Activity Is Altered in Patients with Multiple Sclerosis. Brain Topogr 2018; 31:700-707. [PMID: 29427250 DOI: 10.1007/s10548-018-0632-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 02/06/2018] [Indexed: 01/25/2023]
Abstract
During active movement the somatosensory cortical responses are often attenuated. This attenuation is referred to as movement-related sensory gating. It is well known that patients with multiple sclerosis (MS) have sensory processing deficits, and recent work has also suggested that these patients display impaired motor control of the ankle musculature. The primary goal of the current study was to: (1) examine the movement-related somatosensory gating in patients with MS and demographically-matched controls, and (2) identify the relationship between the sensory gating and motor control of the ankle musculature. To this end, we used magnetoencephalography brain imaging to assess the neural responses to a tibial nerve electrical stimulation that was applied at rest (passive) and during an ankle plantarflexion motor task (active condition). All participants also completed an ankle isometric motor control task that was performed outside the scanner. Our results indicated that the controls, but not patients with MS, exhibited significantly reduced somatosensory responses during the active relative to passive conditions, and that patients with MS had stronger responses compared with controls during the active condition. Additionally, control of the ankle musculature was related to the extent of movement-related sensory attenuation, with poor motor control being associated with reduced gating. Overall, these results show that patients with MS do not attenuate the somatosensory cortical activity during motor actions, and that the inability to modulate somatosensory cortical activity is partially related to the poor ankle motor control seen in these patients.
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Affiliation(s)
- David J Arpin
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics, and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198-5450, USA.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - James E Gehringer
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics, and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198-5450, USA.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics, and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198-5450, USA. .,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA.
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19
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Schapira AHV. Advances and insights into neurological practice 2016−17. Eur J Neurol 2017; 24:1425-1434. [DOI: 10.1111/ene.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Facilitation of information processing in the primary somatosensory area in the ball rotation task. Sci Rep 2017; 7:15507. [PMID: 29138504 PMCID: PMC5686197 DOI: 10.1038/s41598-017-15775-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/01/2017] [Indexed: 11/08/2022] Open
Abstract
Somatosensory input to the brain is known to be modulated during voluntary movement. It has been demonstrated that the response in the primary somatosensory cortex (SI) is generally gated during simple movement of the corresponding body part. This study investigated sensorimotor integration in the SI during manual movement using a motor task combining movement complexity and object manipulation. While the amplitude of M20 and M30 generated in the SI showed a significant reduction during manual movement, the subsequent component (M38) was significantly higher in the motor task than in the stationary condition. Especially, that in the ball rotation task showed a significant enhancement compared with those in the ball grasping and stone and paper tasks. Although sensorimotor integration in the SI generally has an inhibitory effect on information processing, here we found facilitation. Since the ball rotation task seems to be increasing the demand for somatosensory information to control the complex movements and operate two balls in the palm, it may have resulted in an enhancement of M38 generated in the SI.
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