Gaze direction modulates finger movement activation patterns in human cerebral cortex

Frontal eye fields in macaque monkeys: prefrontal and premotor contributions to visually guided saccades

Neuronal spiking was sampled from the frontal eye field (FEF) and from the rostral part of area 6 that reaches to the superior limb of the arcuate sulcus, dorsal to the arcuate spur when present (F2vr) in macaque monkeys performing memory-guided saccades and visually guided saccades for visual search. Neuronal spiking modulation in F2vr resembled that in FEF in many but not all respects. A new consensus clustering algorithm of neuronal modulation patterns revealed that F2vr and FEF contain a greater variety of modulation patterns than previously reported. The areas differ in the proportions of visuomotor neuron types, the proportions of neurons discriminating a target from distractors during visual search, and the consistency of modulation patterns across tasks. However, between F2vr and FEF we found no difference in the magnitude of delay period activity, the timing of the peak discharge rate relative to saccades, or the time of search target selection. The observed similarities and differences between the 2 cortical regions contribute to other work establishing the organization of eye fields in the frontal lobe and may help explain why FEF in monkeys is identified within granular prefrontal area 8 but in humans is identified within agranular premotor area 6.

Effects of an external compared to an internal focus of attention on the excitability of fast and slow(er) motor pathways

The neurophysiological mechanisms underlying the behavioural improvements usually associated with an external (EF) compared with an internal focus of attention (IF) remain poorly investigated. Surround inhibition in the primary cortex has been shown to be more pronounced with an EF, indicating a more spatial restriction of the motor command. However, the influence of different foci on the temporal aspect of the motor command, such as the modulation of fast versus slow(er) motor pathways, remains unknown and was therefore investigated in this study. Fourteen participants were asked to press on a pedal with the right foot to match its position with a target line displayed on a screen. The deviation of the pedal from the target line was used as a behavioural parameter and compared between both foci (EF vs IF). Additionally, conditioned H-reflexes were evoked during the motor task to assess the excitability of fast (direct) and slower (more indirect) motor pathways when adopting an EF or IF. With an EF compared to an IF, the motor performance was enhanced (P = .001; + 24%) and the activation of slow(er) motor pathways was reduced (P < 0.001, − 11.73%). These findings demonstrate for the first time that using different attentional strategies (EF and IF) has an influence on the excitability of slow(er) motor pathways. Together with the increased intracortical inhibition and surround inhibition known from previous studies, the diminished activation in the slow(er) motor pathways further explains why using an EF is a more economic strategy.

Comparative anatomy of the macaque and the human frontal oculomotor domain

In non-human primates, at the junction of the prefrontal with the premotor cortex, there is a sector designated as frontal eye field (FEF), involved in controlling oculomotor behavior and spatial attention. Evidence for at least two FEFs in humans is at the basis of the still open issue of the possible homologies between the macaque and the human frontal oculomotor system. In this review article we address this issue suggesting a new view solidly grounded on evidence from the last decade showing that, in macaques, the FEF is at the core of an oculomotor domain in which several distinct areas, including areas 45A and 45B, provide the substrate for parallel processing of different aspects of oculomotor behavior. Based on comparative considerations, we will propose a correspondence between some of the macaque and the human oculomotor fields, thus suggesting sharing of neural substrate for oculomotor control, gaze processing, and orienting attention in space. Accordingly, this article could contribute to settle some aspects of the so-called "enigma" of the human FEF anatomy.

Cortical Alterations by the Abnormal Visual Experience beyond the Critical Period: A Resting-state fMRI Study on Constant Exotropia

Purpose: The pathological mechanisms of constant exotropia (XT) are still not understood. This study aimed to critically investigate whether patients with XT express neuronal activity changes after the critical period of visual development and further explore how these alterations are associated with behavioral performance.Materials and methods: Fourteen patients with XT and 16 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (fMRI). The regional homogeneity (ReHo) method was used to evaluate spontaneous brain activities. The association between significantly altered mean ReHo values and behavioral performance was assessed using Pearson's correlation analysis.Results: Compared with HCs, the right secondary visual cortex (V2) in patients with XT exhibited increased ReHo values, whereas the left Brodmann area 47 (BA47) demonstrated decreased spontaneous ReHo values. In patients with XT, the correlation between the left BA47's mean ReHo value and duration of strabismus was positively significant.Conclusions: These findings indicate that patients with XT have severe neural dysfunction in the right V2 and left BA47, and pathological severity in the left BA47 is likely influenced by duration of ongoing strabismus. Therefore, these results may provide clinically important information toward understanding the underlying pathological mechanisms of XT and thus can be fundamental in future XT research.

Repetitive Passive Movement Modulates Corticospinal Excitability: Effect of Movement and Rest Cycles and Subject Attention

Repetitive passive movement (PM) affects corticospinal excitability; however, it is unknown whether a duty cycle which repeats movement and rest, or subjects’ conscious attention to movements, affects corticospinal excitability. We aimed to clarify the effect of the presence or absence of a duty cycle and subjects’ attention on corticospinal excitability. Three experiments were conducted. In Experiment 1, PM of the right index finger was performed for 10 min. Three conditions were used: (1) continuous PM (cPM) at a rate of 40°/s; (2) intermittent PM (iPM) with a duty cycle at 40°/s; and (3) iPM at 100°/s. In conditions 1 and 3, motor evoked potential (MEP) amplitude was significantly reduced. In Experiment 2, PM was performed for 30 min: condition 1 comprised cPM at a rate of 40°/s and Condition 2 comprised iPM at 40°/s. MEP amplitude significantly decreased in both conditions. In Experiment 3, PM was performed for 10 min: condition 1 comprised paying attention to the moving finger during iPM and Condition 2 was similar to Condition 1 but while counting images on a monitor without looking at the movement finger, and Condition 3 comprised counting images on a monitor without performing PM. MEP amplitude significantly increased only under Condition 1. Thus, afferent input from movements above a certain threshold may affect corticospinal excitability reduction. Furthermore, corticospinal excitability increases when paying attention to passive finger movement.

Learned control of inter-hemispheric connectivity: Effects on bimanual motor performance

Bimanual movements involve the interactions between both primary motor cortices. These interactions are assumed to involve phase-locked oscillatory brain activity referred to as inter-hemispheric functional coupling. So far, inter-hemispheric functional coupling has been investigated as a function of motor performance. These studies report mostly a negative correlation between the performance in motor tasks and the strength of functional coupling. However, correlation might not reflect a causal relationship. To overcome this limitation, we opted for an alternative approach by manipulating the strength of inter-hemispheric functional coupling and assessing bimanual motor performance as a dependent variable. We hypothesize that an increase/decrease of functional coupling deteriorates/facilitates motor performance in an out-of-phase bimanual finger-tapping task. Healthy individuals were trained to volitionally regulate functional coupling in an operant conditioning paradigm using real-time magnetoencephalography neurofeedback. During operant conditioning, two discriminative stimuli were associated with upregulation and downregulation of functional coupling. Effects of training were assessed by comparing motor performance prior to (pre-test) and after the training (post-test). Participants receiving contingent feedback learned to upregulate and downregulate functional coupling. Comparing motor performance, as indexed by the ratio of tapping speed for upregulation versus downregulation trials, no change was found in the control group between pre- and post-test. In contrast, the group receiving contingent feedback evidenced a significant decrease of the ratio implicating lower tapping speed with stronger functional coupling. Results point toward a causal role of inter-hemispheric functional coupling for the performance in bimanual tasks. Hum Brain Mapp 38:4353-4369, 2017. © 2017 Wiley Periodicals, Inc.

Reachability judgement in optic ataxia: Effect of peripheral vision on hand and target perception in depth

The concept of peripersonal space was first proposed by Rizzolatti, Scandolara, Matelli, and Gentilucci (1981), who introduced the term to highlight the close links between somatosensory and visual processing for stimuli close to the body and suggested that this near-body space could in fact be characterized as an action space (Rizzolatti, Fadiga, Fogassi, & Gallese, 1997). Supporting this idea, patients with right hemisphere lesions have been described as impaired in performing actions towards objects and in perceiving their location - but only when the objects were presented within arm's reach (Bartolo, Carlier, Hassaini, Martin, & Coello, 2014; Brain, 1941). Whether the deficit of optic ataxia patients in processing target locations for action has an effect on the representation of peripersonal space has never been explored. The present study highlights optic ataxia patients' specific difficulties in processing hand-to-target distances in a motor task and in a perceptual task requiring identification of what is reachable in the visual environment. The difficulties are especially evident when both the target and the hand are perceived in the visual periphery. Indeed, when patient I.G. was able to fixate the target, her reaching accuracy and her perception of reachable space both largely improved. Furthermore, the difficulties were enhanced when the hand and the target were both in the lower visual field (in a fixed-far condition vs a fixed-near condition). This novel up-down dimension of optic ataxia fits with the larger representation of the lower visual field in the posterior parietal cortex (Pitzalis et al., 2013; Previc, 1990).

Feed-Forward Propagation of Temporal and Rate Information between Cortical Populations during Coherent Activation in Engineered In Vitro Networks

Transient propagation of information across neuronal assembles is thought to underlie many cognitive processes. However, the nature of the neural code that is embedded within these transmissions remains uncertain. Much of our understanding of how information is transmitted among these assemblies has been derived from computational models. While these models have been instrumental in understanding these processes they often make simplifying assumptions about the biophysical properties of neurons that may influence the nature and properties expressed. To address this issue we created an in vitro analog of a feed-forward network composed of two small populations (also referred to as assemblies or layers) of living dissociated rat cortical neurons. The populations were separated by, and communicated through, a microelectromechanical systems (MEMS) device containing a strip of microscale tunnels. Delayed culturing of one population in the first layer followed by the second a few days later induced the unidirectional growth of axons through the microtunnels resulting in a primarily feed-forward communication between these two small neural populations. In this study we systematically manipulated the number of tunnels that connected each layer and hence, the number of axons providing communication between those populations. We then assess the effect of reducing the number of tunnels has upon the properties of between-layer communication capacity and fidelity of neural transmission among spike trains transmitted across and within layers. We show evidence based on Victor-Purpura's and van Rossum's spike train similarity metrics supporting the presence of both rate and temporal information embedded within these transmissions whose fidelity increased during communication both between and within layers when the number of tunnels are increased. We also provide evidence reinforcing the role of synchronized activity upon transmission fidelity during the spontaneous synchronized network burst events that propagated between layers and highlight the potential applications of these MEMs devices as a tool for further investigation of structure and functional dynamics among neural populations.

Mirrored feedback in chronic stroke: recruitment and effective connectivity of ipsilesional sensorimotor networks

BACKGROUND

Mirrored feedback has potential as a therapeutic intervention to restore hand function after stroke. However, the functional (effective) connectivity of neural networks involved in processing mirrored feedback after stroke is not known.

OBJECTIVE

To determine if regions recruited by mirrored feedback topographically overlap with those involved in control of the paretic hand and to identify the effective connectivity of activated nodes within the mirrored feedback network.

METHODS

Fifteen patients with chronic stroke performed a finger flexion task with their unaffected hand during event-related functional magnetic resonance imaging (fMRI). Real-time hand kinematics was recorded during fMRI and used to actuate hand models presented in virtual reality (VR). Visual feedback of the unaffected hand motion was manipulated pseudorandomly by either actuating the VR hand corresponding to the moving unaffected side (veridical feedback) or the affected side (mirrored feedback). In 2 control conditions, the VR hands were replaced with moving nonanthropomorphic shapes.

RESULTS

Mirrored feedback was associated with significant activation of regions within and outside the ipsilesional sensorimotor cortex, overlapping with areas engaged when patients performed the task with their affected hand. Effective connectivity analysis showed a significantly interconnected ipsilesional somatosensory and motor cortex in the mirrored feedback condition.

CONCLUSIONS

Mirrored feedback recruits ipsilesional brain areas relevant for control of the affected hand. These data provide a neurophysiological basis by which mirrored feedback may be beneficial as a therapy for restoring function after stroke.

Transfer of information by BMI

Brain machine interfaces (BMI) have become important in systems neuroscience with the goal to restore motor function in paralyzed patients. We assess the current ability of BMI devices to move objects. The topics discussed include: (1) the bits of information generated by a BMI signal, (2) the limitations of including more neurons for generating a BMI signal, (3) the superiority of a BMI signal using single cells versus electroencephalography, (4) plasticity and BMI, (5) the selection of a neural code for generating BMI, (6) the suppression of body movements during BMI, and (7) the role of vision in BMI. We conclude that further research on understanding how the brain generates movement is necessary before BMI can become a reasonable option for paralyzed patients.

Gravity affects the vertical curvature in human grasping movements

When humans make grasping movements their digits' paths are curved vertically. In a previous study the authors found that this curvature is largely caused by the local constraints at the start and end of the movement. Here the authors examined the contribution of gravity to the part of the curvature that was not explained by the local constraints. Subjects had to grasp a tealight (small cylinder) while sitting on a chair. The authors could rotate the whole setup, including the subject, relative to gravity, whereby the positions of the starting point and of the tealight relative to the subject did not change. They found differences between the paths that are consistent with a direct effect of gravity pulling the arm downward.

The function of efference copy signals: implications for symptoms of schizophrenia

Efference copy signals are used to reduce cognitive load by decreasing sensory processing of reafferent information (those incoming sensory signals that are produced by an organism's own motor output). Attenuated sensory processing of self-generated afferents is seen across species and in multiple sensory systems involving many different neural structures and circuits including both cortical and subcortical structures with thalamic nuclei playing a particularly important role. It has been proposed that the failure to disambiguate self-induced from externally generated sensory input may cause some of the positive symptoms in schizophrenia such as auditory hallucinations and delusions of passivity. Here, we review the current data on the role of efference copy signals within different sensory modalities as well as the behavioral, structural and functional abnormalities in clinical groups that support this hypothesis.

The role of non-synaptic extracellular glutamate

Although there are some mechanisms which allow the direct crossing of substances between the cytoplasm of adjacent cells (gap junctions), most substances use the extracellular space to diffuse between brain cells. The present work reviews the behavior and functions of extracellular glutamate (GLU). There are two extracellular pools of glutamate (GLU) in the brain, a synaptic pool whose functions in the excitatory neurotransmission has been widely studied and an extrasynaptic GLU pool although less known nonetheless is gaining attention among a growing number of researchers. Evidence accumulated over the last years shows a number of mechanisms capable of releasing glial GLU to the extracellular medium, thus modulating neurons, microglia and oligodendrocytes, and regulating the immune response, cerebral blood flow, neuronal synchronization and other brain functions. This new scenario is expanding present knowledge regarding the role of GLU in the brain under different physiological and pathological conditions. This article is part of a Special Issue entitled 'Extrasynaptic ionotropic receptors'.

Eye muscle proprioception is represented bilaterally in the sensorimotor cortex

The cortical representation of eye position is still uncertain. In the monkey a proprioceptive representation of the extraocular muscles (EOM) of an eye were recently found within the contralateral central sulcus. In humans, we have previously shown a change in the perceived position of the right eye after a virtual lesion with rTMS over the left somatosensory area. However, it is possible that the proprioceptive representation of the EOM extends to other brain sites, which were not examined in these previous studies. The aim of this fMRI study was to sample the whole brain to identify the proprioceptive representation for the left and the right eye separately. Data were acquired while passive eye movement was used to stimulate EOM proprioceptors in the absence of a motor command. We also controlled for the tactile stimulation of the eyelid by removing from the analysis voxels activated by eyelid touch alone. For either eye, the brain area commonly activated by passive and active eye movement was located bilaterally in the somatosensory area extending into the motor and premotor cytoarchitectonic areas. We suggest this is where EOM proprioception is processed. The bilateral representation for either eye contrasts with the contralateral representation of hand proprioception. We suggest that the proprioceptive representation of the two eyes next to each other in either somatosensory cortex and extending into the premotor cortex reflects the integrative nature of the eye position sense, which combines proprioceptive information across the two eyes with the efference copy of the oculomotor command.

Gaze and viewing angle influence visual stabilization of upright posture

Focusing gaze on a target helps stabilize upright posture. We investigated how this visual stabilization can be affected by observing a target presented under different gaze and viewing angles. In a series of 10-second trials, participants (N = 20, 29.3 ± 9 years of age) stood on a force plate and fixed their gaze on a figure presented on a screen at a distance of 1 m. The figure changed position (gaze angle: eye level (0°), 25° up or down), vertical body orientation (viewing angle: at eye level but rotated 25° as if leaning toward or away from the participant), or both (gaze and viewing angle: 25° up or down with the rotation equivalent of a natural visual perspective). Amplitude of participants' sagittal displacement, surface area, and angular position of the center of gravity (COG) were compared. Results showed decreased COG velocity and amplitude for up and down gaze angles. Changes in viewing angles resulted in altered body alignment and increased amplitude of COG displacement. No significant changes in postural stability were observed when both gaze and viewing angles were altered. Results suggest that both the gaze angle and viewing perspective may be essential variables of the visuomotor system modulating postural responses.

Misconceptions about mirror-induced motor cortex activation

Observation of self-produced hand movements through a mirror, creating an illusion of the opposite hand moving, was recently reported to induce ipsilateral motor cortex activation, that is, motor cortex activation for the hand in rest. The reported work goes far beyond earlier work on motor cortex activation induced by action observation, by implying a complete reversal of contralateral and ipsilateral motor cortex activation under mirror view conditions. Such a reversal would represent an unprecedented degree of neural plasticity. We considered such a reversal physiologically implausible and conducted a study with an improved design. The results refute the reversal of contralateral and ipsilateral motor cortex activation under mirrored viewing conditions as methodologically unsound. The investigation confirmed, however, more subtle expressions of motor cortical activity induced by self-produced movements observed through a mirror.

Representation of Eye Position in the Human Parietal Cortex

Neurons that signal eye position are thought to make a vital contribution to distinguishing real world motion from retinal motion caused by eye movements, but relatively little is known about such neurons in the human brain. Here we present data from functional MRI experiments that are consistent with the existence of neurons sensitive to eye position in darkness in the human posterior parietal cortex. We used the enhanced sensitivity of multivoxel pattern analysis (MVPA) techniques, combined with a searchlight paradigm, to isolate brain regions sensitive to direction of gaze. During data acquisition, participants were cued to direct their gaze to the left or right for sustained periods as part of a block-design paradigm. Following the exclusion of saccade-related activity from the data, the multivariate analysis showed sensitivity to tonic eye position in two localized posterior parietal regions, namely the dorsal precuneus and, more weakly, the posterior aspect of the intraparietal sulcus. Sensitivity to eye position was also seen in anterior portions of the occipital cortex. The observed sensitivity of visual cortical neurons to eye position, even in the total absence of visual stimulation, is possibly a result of feedback from posterior parietal regions that receive eye position signals and explicitly encode direction of gaze.

Role of the Rostral Superior Colliculus in Gaze Anchoring During Reach Movements

When reaching for an object, primates usually look at their target before touching it with the hand. This gaze movement prior to the arm movement allows target fixation, which is usually prolonged until the target is reached. In this manner, a stable image of the object is provided on the fovea during the reach, which is crucial for guiding the final part of the hand trajectory by visual feedback. Here we investigated a neural substrate possibly responsible for this behavior. In particular we tested the influence of reaching movements on neurons recorded at the rostral pole of the superior colliculus (rSC), an area classically related to fixation. Most rSC neurons showed a significant increase in their activity during reaching. Moreover, this increase was particularly high when the reaching movements were preceded by corresponding saccades to the targets to be reached, probably revealing a stronger coupling of the oculo-manual neural system during such a natural task. However, none of the parameters tested—including movement kinematics and target location—was found to be closely related to the observed increase in neural activity. Thus the increase in activity during reaching was found to be rather nonspecific except for its dependence on whether the reach was produced in isolation or in combination with a gaze movement. These results identify the rSC as a neural substrate sufficient for gaze anchoring during natural reaching movements, placing its activity at the core of the neural system dedicated to eye-hand coordination.

Effect of viewing angle on arm reaching while standing in a virtual environment: potential for virtual rehabilitation

Functional arm movements, such as reaching while standing, are planned and executed according to our perception of body position in space and are relative to environmental objects. The angle under which the environment is observed is one component used in creating this perception. This suggests that manipulation of viewing angle may modulate whole body movement to affect performance. We tested this by comparing its effect on reaching in a virtually generated environment. Eleven young healthy individuals performed forward and lateral reaches in the virtual environment, presented on a flat screen in third-person perspective. Participants saw a computer-generated model (avatar) of themselves standing in a courtyard facing a semi-circular hedge with flowers. The image was presented in five different viewing angles ranging from seeing the avatar from behind (0 degrees), to viewing from overhead (90 degrees). Participants attempted to touch the furthest flower possible without losing balance or stepping. Kinematic data were collected to analyze endpoint displacement, arm-postural coordination and center of mass (COM) displacement. Results showed that reach distance was greatest with angular perspectives of approximately 45-77.5 degrees , which are larger than those used in analogous real world situations. Larger reaches were characterized by increased involvement of leg and trunk body segments, altered inter-segmental coordination, and decreased inter-segmental movement time lag. Thus a viewing angle can be a critical visuomotor variable modulating motor coordination of the whole body and related functional performance. These results can be used in designing virtual reality games, in ergonomic design, teleoperation training, and in designing virtual rehabilitation programs that re-train functional movement in vulnerable individuals.

Gaze and hand position effects on finger-movement-related human brain activation

Humans commonly use their hands to move and to interact with their environment by processing visual and proprioceptive information to determine the location of a goal-object and the initial hand position. It remains elusive, however, how the human brain fully uses this sensory information to generate accurate movements. In monkeys, it appears that frontal and parietal areas use and combine gaze and hand signals to generate movements, whereas in humans, prior work has separately assessed how the brain uses these two signals. Here we investigated whether and how the human brain integrates gaze orientation and hand position during simple visually triggered finger tapping. We hypothesized that parietal, frontal, and subcortical regions involved in movement production would also exhibit modulation of movement-related activation as a function of gaze and hand positions. We used functional MRI to measure brain activation while healthy young adults performed a visually cued finger movement and fixed gaze at each of three locations and held the arm in two different configurations. We found several areas that exhibited activation related to a mixture of these hand and gaze positions; these included the sensory-motor cortex, supramarginal gyrus, superior parietal lobule, superior frontal gyrus, anterior cingulate, and left cerebellum. We also found regions within the left insula, left cuneus, left midcingulate gyrus, left putamen, and right tempo-occipital junction with activation driven only by gaze orientation. Finally, clusters with hand position effects were found in the cerebellum bilaterally. Our results indicate that these areas integrate at least two signals to perform visual-motor actions and that these could be used to subserve sensory-motor transformations.

Gaze influences finger movement-related and visual-related activation across the human brain

The brain uses gaze orientation to organize myriad spatial tasks including hand movements. However, the neural correlates of gaze signals and their interaction with brain systems for arm movement control remain unresolved. Many studies have shown that gaze orientation modifies neuronal spike discharge in monkeys and activation in humans related to reaching and finger movements in parietal and frontal areas. To continue earlier studies that addressed interaction of horizontal gaze and hand movements in humans (Baker et al. 1999), we assessed how horizontal and vertical gaze deviations modified finger-related activation, hypothesizing that areas throughout the brain would exhibit movement-related activation that depended on gaze angle. The results indicated finger movement-related activation related to combinations of horizontal, vertical, and diagonal gaze deviations. We extended our prior findings to observation of these gaze-dependent effects in visual cortex, parietal cortex, motor, supplementary motor area, putamen, and cerebellum. Most significantly, we found a modulation bias for increased activation toward rightward, upper-right and vertically upward gaze deviations. Our results indicate that gaze modulation of finger movement-related regions in the human brain is spatially organized and could subserve sensorimotor transformations.

Eye position-dependent activity in the primary visual area as revealed by fMRI

Internal senses of the position of the eye in the orbit may influence the cognitive processes that take into account gaze and limb positioning for movement or guiding actions. Neuroimaging studies have revealed eye position-dependent activity in the extrastriate visual, parietal, and frontal areas, but, at the earliest vision stage, the role of the primary visual area (V1) in these processes remains unclear. Functional MRI (fMRI) was used to investigate the effect of eye position on V1 activity evoked by a quarter-field stimulation using a visual checkerboard. We showed that the amplitude of V1 activity was modulated by the position of the eye, the activity being maximal when both the eye and head positions were aligned. Previous studies gave impetus to the emerging view that V1 activity is a cortical area in which contextual influences take place. The present study suggests that eye position may affect an early stage of visual processing.

A musculoskeletal model of low grade connective tissue inflammation in patients with thyroid associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease

Background

Low level connective tissue inflammation has been proposed to play a role in thyroid associated ophthalmopathy (TAO). The aim of this study was to investigate this postulate by a musculoskeletal approach together with biochemical parameters.

Methods

13 patients with TAO and 16 controls were examined. Erythrocyte levels of Zn, Cu, Ca²⁺, Mg, and Fe were determined. The musculoskeletal evaluation included observational data on body posture with emphasis on the orbit-head region. The angular foot position in the frontal plane was quantified following gait observation. The axial orientation of the legs and feet was evaluated in an unloaded supine position. Functional propioceptive tests based on stretch stimuli were done by using foot inversion and foot rotation.

Results

Alterations in the control group included neck tilt in 3 cases, asymmetrical foot angle during gait in 2, and a reaction to foot inversion in 5 cases. TAO patients presented facial asymmetry with displaced eye fissure inclination (mean 9.1°) as well as tilted head-on-neck position (mean 5.7°). A further asymmetry feature was external rotation of the legs and feet (mean 27°). Both foot inversion as well as foot rotation induced a condition of neuromuscular deficit. This condition could be regulated by gentle acupressure either on the lateral abdomen or the lateral ankle at the acupuncture points gall bladder 26 or bladder 62, respectively. In 5 patients, foot rotation produced a phenomenon of moving toes in the contra lateral foot. In addition foot rotation was accompanied by an audible tendon snapping. Lower erythrocyte Zn levels and altered correlations between Ca²⁺, Mg, and Fe were found in TAO.

Conclusion

This whole body observational study has revealed axial deviations and body asymmetry as well as the phenomenon of moving toes in TAO. The most common finding was an arch-like displacement of the body, i.e. eccentric position, with foot inversion and head tilt to the contra lateral side and tendon snapping. We propose that eccentric muscle action over time can be the basis for a low grade inflammatory condition. The general implications of this model and its relations to Zn and Se will be discussed.

Neuronal ensemble control of prosthetic devices by a human with tetraplegia

Neuromotor prostheses (NMPs) aim to replace or restore lost motor functions in paralysed humans by routeing movement-related signals from the brain, around damaged parts of the nervous system, to external effectors. To translate preclinical results from intact animals to a clinically useful NMP, movement signals must persist in cortex after spinal cord injury and be engaged by movement intent when sensory inputs and limb movement are long absent. Furthermore, NMPs would require that intention-driven neuronal activity be converted into a control signal that enables useful tasks. Here we show initial results for a tetraplegic human (MN) using a pilot NMP. Neuronal ensemble activity recorded through a 96-microelectrode array implanted in primary motor cortex demonstrated that intended hand motion modulates cortical spiking patterns three years after spinal cord injury. Decoders were created, providing a 'neural cursor' with which MN opened simulated e-mail and operated devices such as a television, even while conversing. Furthermore, MN used neural control to open and close a prosthetic hand, and perform rudimentary actions with a multi-jointed robotic arm. These early results suggest that NMPs based upon intracortical neuronal ensemble spiking activity could provide a valuable new neurotechnology to restore independence for humans with paralysis.

Proprioceptive guidance of saccades in eye-hand coordination

The saccade generator updates memorized target representations for saccades during eye and head movements. Here, we tested if proprioceptive feedback from the arm can also update handheld object locations for saccades, and what intrinsic coordinate system(s) is used in this transformation. We measured radial saccades beginning from a central light-emitting diode to 16 target locations arranged peripherally in eight directions and two eccentricities on a horizontal plane in front of subjects. Target locations were either indicated 1) by a visual flash, 2) by the subject actively moving the handheld central target to a peripheral location, 3) by the experimenter passively moving the subject's hand, or 4) through a combination of the above proprioceptive and visual stimuli. Saccade direction was relatively accurate, but subjects showed task-dependent systematic overshoots and variable errors in radial amplitude. Visually guided saccades showed the smallest overshoot, followed by saccades guided by both vision and proprioception, whereas proprioceptively guided saccades showed the largest overshoot. In most tasks, the overall distribution of saccade endpoints was shifted and expanded in a gaze- or head-centered cardinal coordinate system. However, the active proprioception task produced a tilted pattern of errors, apparently weighted toward a limb-centered coordinate system. This suggests the saccade generator receives an efference copy of the arm movement command but fails to compensate for the arm's inertia-related directional anisotropy. Thus the saccade system is able to transform hand-centered somatosensory signals into oculomotor coordinates and combine somatosensory signals with visual inputs, but it seems to have a poorly calibrated internal model of limb properties.

Mechanisms of recovery in stroke patients with hemiparesis or aphasia: new insights, old questions and the meaning of therapies

PURPOSE OF REVIEW

The mechanisms responsible for recovery after stroke in patients with hemiparesis or aphasia are under intense study, since knowledge of these mechanisms is a prerequisite for choosing which therapy a patient receives and when to apply it.

RECENT FINDINGS

Most of the recent insights are obtained with longitudinal studies using functional imaging and direct cortical stimulation during the process of recovery. They reveal that reorganization is a highly dynamic process, involving the establishment of new communications in the remaining system and showing similarities to learning processes in healthy individuals. Lesion localization is a major determinant for recovery and the pattern of reorganization. Neurobiological hypotheses lead to clinical studies, which in turn are now used to confirm or reject these hypotheses.

SUMMARY

Although our understanding of the mechanisms responsible for recovery is increasing, the application of this knowledge in daily praxis is still limited. A better understanding of the underlying mechanisms, however, can lead to appropriate therapies for individual patients.

Stroke recovery and its imaging

Functional imaging of stroke recovery is a unique source of information that might be useful in the development of restorative treatments. Several features of brain function change spontaneously after stroke. Current studies define many of the most common events. Key challenges for the future are to develop standardized approaches to help address certain questions, determine the psychometric qualities of these measures, and define the clinical usefulness of these methods.

Role of functional imaging in neurological disorders

Neuroimaging in recent years has greatly contributed to our understanding of a wide range of aspects related to central neurological diseases. These include the classification and localization of disease, such as in headache; the understanding of pathology, such as in Parkinson's disease (PD); the mechanisms of reorganization, such as in stroke and multiple sclerosis (MS); and the subclinical progress of disease, such as in amyotrophic lateral sclerosis (ALS). Apart from presurgical mapping, however, the clinical applications so far are limited. Nevertheless, functional imaging does enable the formulation of neurobiological hypotheses that can be tested clinically, and thus is well suited for testing classic clinical hypotheses about how the brain works. Understanding the mechanisms and sites of pathology, such as has been achieved in cluster headaches, facilitates the development of new therapeutic strategies.

Clinical applicability of functional MRI

Functional MRI (fMRI) has become the most widely used modality for examining human brain function in basic and clinical neuroscience. As compared to the application of fMRI in basic neuroscience research, clinical fMRI presents unique challenges. A growing body of literature supports the feasibility of clinical fMRI, with the best-studied applications being localization of motor cortex and lateralization of language. While it may be tempting to assume that fMRI will supercede prior approaches, it may turn out that fMRI will be used to complement more difficult or invasive methods rather than replace them entirely. This article focuses on fMRI studies in patients and patient populations. Specific considerations for such applications include pathophysiological effects on functional physiology, brain-behavior correlations in the presence of cognitive or sensorimotor deficits, and test-retest reliability for longitudinal studies.

Individual factors in constraint-induced movement therapy after stroke

OBJECTIVES

Constraint-induced movement therapy (CIMT) has been shown to be effective in chronic stroke patients. It is worthwhile to investigate the influence of individual factors for two reasons: to find out whether they influence outcome and to see whether they support the theory underlying CIMT.

METHODS

A group of 26 patients were treated with CIMT and followed over 6 months. In total, 14 individual factors were identified. Patients were assessed with 6 tests, including 2 commonly used after stroke (Frenchay Arm Test, 9 Hole Peg Test).

RESULTS

There were individual differences, but as a group, patients improved after therapy. There were no individual factors that influenced improvement in more than one test.

CONCLUSIONS

CIMT is an effective therapy in patients with moderate impairment after stroke, also in tests commonly used in stroke rehabilitation. Factors that could have expected to make a difference on the basis of the theory behind CIMT (e.g., time since stroke, previous therapy, sensory deficit) did not influence results. Patients with hemorrhagic lesions and those with a high level of performance (Motor Activity Log > 2.5) profit as well. Pairwise therapy is as effective as individual therapy.

Where does your own action influence your perception of another person's action in the brain?

Activation of premotor cortex during the observation and imitation of human actions is now increasingly accepted, but it remains unclear how the CNS is able to resolve potential conflicts between the observation of another person's action and the ongoing control of one's own action. Recent data suggest that this overlap leads to a systematic bias, where lifting a box influences participant's perceptual judgments of the weight of a box lifted by another person. We now investigate the neural basis of this bias effect using fMRI. Seventeen participants performed a perceptual weight judgment task or two control conditions while lifting a light box, a heavy box or no box during scanning. Brain regions related to perceptual bias were localized by correlating individual differences in bias with BOLD signal. Five regions were found to show correlations with psychophysical bias: left inferior frontal gyrus, left central sulcus, left extrastriate body area, left lingual gyrus and right intraparietal sulcus. The cluster in primary motor cortex was also activated by box lifting, and the cluster in extrastriate body area by the observation of hand actions and the weight judgment task. We suggest that these brain areas are part of a network where motor processing modulates perceptual judgment of observed human actions, and thus visual and motor processes cannot be thought of as two distinct systems, but instead interact at many levels.

Connectivity exploration with structural equation modeling: an fMRI study of bimanual motor coordination

The present fMRI study explores the connectivity among motor areas in a bimanual coordination task using the analysis framework of structural equation modeling (SEM). During bimanual finger tapping at different frequency ratios, temporal correlations of activations between left/right primary motor cortices (MI), left/right PMdc (caudal dorsal premotor area) and supplementary motor cortex (SMA) were detected and used as inputs to the SEM analysis. SEM was extended from its traditional role as a confirmatory analysis to be used as an exploratory technique to determine the most statistically significant connectivity model given a set of cortical areas based on anatomic constraints. The resultant network exhibits coupling from left MI to right MI, links from both PMs to the two MIs, a negative interaction from left PM to right PM, and functional influence from SMA to right MI and right PM, revealing contributions of these areas to bimanual coordination.

Hand movement distribution in the motor cortex: the influence of a concurrent task and motor imagery

The aim of this work was to study the relevance of the primary motor cortex (M1) for motor functions different to the simple execution of motor orders. The M1 activity during the performance with individual fingers of a simple motor task (tonic flexion), a motor task that includes a complex motor computation but not motor execution (motor imagery), and a motor task that involves both the computation and execution of movements (phasic movement) was evaluated by functional magnetic resonance imaging (fMRI). The possible influence of other cortical tasks on the M1 activation induced by finger movements was assessed by evaluating the effect of a distracting concurrent task (numeric calculation). Data show that both the dimension of the area activated and the intensity of response were higher during motor planning than during motor execution. There is a mosaic-like distribution for motor-planning M1 functions, with the movement of individual fingers being controlled from several M1 loci. The concurrent mental-task induces a rapid functional reconfiguration of M1, adding M1 subsets to motor programming but excluding others. Present data support the involvement of the M1 in more than just simple motor execution, showing broader and more intense modifications during motor tasks not accompanied by movements (motor imagery) than during the execution of simple motor acts (tonic flexion).

Modulation of Associative Human Motor Cortical Plasticity by Attention

The role of attention in generating motor memories remains controversial principally because it is difficult to separate the effects of attention from changes in kinematics of motor performance. We attempted to disentangle attention from performance effects by varying attention while plasticity was induced in human primary motor cortex by external stimulation in the absence of voluntary movement. A paired associative stimulation (PAS) protocol was employed consisting of repetitive application of single afferent electric stimuli, delivered to the right median nerve, paired with single-pulse transcranial magnetic stimulation (TMS) over the optimal site for activation of the right abductor pollicis brevis muscle (APB) to generate near-synchronous events in the left primary motor cortex. In experiment 1, the spatial location of attention was varied. PAS failed to induce plasticity when the subject's attention was directed to their left hand, away from the right target hand the cortical representation of which was being stimulated by PAS. In experiment 2, the grade of attention to the target hand was manipulated. PAS-induced plasticity was maximal when the subject viewed their target hand, and its magnitude was slightly reduced when the subject could only feel their hand. Conversely, plasticity was completely blocked when the subject's attention was diverted from the target hand by a competing cognitive task. A similar modulation by attention was observed for PAS-induced changes in the duration of the silent period evoked by TMS in voluntarily contracted muscle. Associative plasticity in the human motor cortex depends decisively on attention.

Absence of gaze direction effects on EEG measures of sensorimotor function

OBJECTIVE

Gaze direction is known to modulate the activation patterns of sensorimotor areas as seen at the single cell level and in functional magnetic resonance imaging (fMRI). To determine whether such gaze direction effects can be observed in scalp-recorded electroencephalogram (EEG) measures of sensorimotor function we investigated somatosensory evoked potentials (SEPs) and steady state movement related cortical potentials (MRPs).

METHODS

In two separate experiments, SEPs were elicited by electrical stimulation of the median nerve (experiment 1) and steady state MRPs were induced by 2 Hz tapping paced by an auditory cue (experiment 2), while subjects directed their gaze 15 degrees to the left or to the right.

RESULTS

Gaze direction failed to produce any appreciable differences in the waveforms of the SEPs or MRPs. In particular, there was no effect on peak amplitude, peak latency and peak scalp topography measures of SEP and MRP components, or on spatial or temporal parameters of dipole models of the underlying cortical generators. Additional frequency domain analyses did not reveal reliable gaze-related changes in induced power at electrode sites overlying somatosensory and motor areas, or in coherence between pairs of parietal, central and frontal electrodes, across a broad range of frequencies.

CONCLUSIONS

EEG measures of sensorimotor function, obtained in a non-visual motor task, are insensitive to modulatory effects of gaze direction in sensorimotor areas that are observable with fMRI.