Ipsi- and contralateral corticospinal influences in uni- and bimanual movements in humans

Il existe des projections corticospinales (CS) vers les motoneurones (MNs) aussi bien contra- (c) qu’ipsilatérales (i). Les influences CSc sur les MNs du poignet sont connues pour être modulées entre autres par la position du poignet et les afférences cutanées. Pour cette raison, notre objectif était de vérifier si ces caractéristiques sont aussi valides pour les influences CSi. En utilisant la stimulation transcrânienne magnétique au niveau du cortex primaire droit, nous avons tout d’abord comparé les influences CSi sur les MNs des fléchisseurs du poignet à des positions maintenues de flexion et d’extension durant une tâche uni-manuelle ainsi que deux tâches bimanuelles, ceci chez des sujets droitiers (n=23). Nous avons ensuite comparé les influences CSi dans cinq tâches bi-manuelles de tenue d’objet durant lesquelles les sujets avaient à tenir entre leurs mains un bloc à la surface soit lisse, soit rugueuse, dont le poids était supporté ou non, ceci en position de flexion (n=21). Dans une tâche, un poids était ajouté au bloc lisse en condition non supportée pour amplifier les forces de préhension requises. Une modulation positiondépendante était observée au niveau des potentiels évoqués moteurs (iPEM), mais seulement lors de la tâche bi-manuelle quand les deux mains interagissaient via un bloc (p= 0.01). Une modulation basée sur la texture était également présente, quel que soit le support de poids, et le bloc lisse était associé avec des iPEMs plus importants en comparaison avec le bloc rugueux (p= 0.001). Ainsi, les influences CSi sur les MNs n’étaient modulées que lors des tâches bi-manuelles et dépendaient de la manière dont les mains interagissaient. De plus, les afférences cutanées modulaient les influences CSi facilitatrices et pourraient ainsi participer à la prise en main des objets. Il en est conclu que les hémisphères droit et gauche coopèrent durant les tâches bimanuelles impliquant la tenue d’objet entre les mains, avec la participation potentielle de projections mono-, et poly-synaptiques, transcallosales inclues. La possibilité de la contribution de reflexes cutanés et d’étirement (spinaux et transcorticaux) est discutée sur la base de la notion que tout mouvement découle du contrôle indirect, de la « référence » (referent control). Ces résultats pourraient être essentiels à la compréhension du rôle des interactions interhémisphériques chez les sujets sains et cliniques.There are both contra- (c) and ipsilateral (i) corticospinal (CS) projections to motoneurons (MNs). There is evidence that cCS influences on wrist MNs are modulated by wrist position and cutaneous afferents. Thus, we aimed to test whether these findings are valid for iCS influences as well. Using transcranial magnetic stimulation applied over the right primary motor cortex, we first compared iCS influences on wrist flexor MNs at actively maintained flexion and extension wrist positions in one uni- and two bimanual tasks in right-handed subjects (n=23). We further compared iCS influences in five bimanual holding tasks in which subjects had to hold a smooth or coarse block between their hands, with or without its weight being supported, in flexion position (n=21). In one task, a weight was added to the unsupported smooth block to increase load forces. A position-dependent modulation of the short-latency motor evoked potential (iMEP) was observed, but only in the bimanual task when the two hands interacted through a block (p=0.01). A texture-dependent modulation was present regardless of the weight supported, and the smooth block was associated with larger iMEPs in comparison to the coarse block (p=0.001). Hence, iCS influences on MNs were modulated only in bimanual tasks and depended on how the two hands interacted. Furthermore, cutaneous afferents modulated facilitatory iCS influences and thus may participate to grip forces scaling and maintaining. It is concluded that the left and right cortices cooperate in bimanual tasks involving holding an object between the hands, with possible participation of mono- and poly-synaptic, including transcallosal projections to MNs. The possible involvement of spinal and trans-cortical stretch and cutaneous reflexes in bimanual tasks when holding an object is discussed based on the notion that indirect, referent control underlies motor actions. Results might be essential for the understanding of the role of intercortical interaction in healthy and neurological subjects

Neural synchrony within the motor system: what have we learned so far?

Synchronization of neural activity is considered essential for information processing in the nervous system. Both local and inter-regional synchronization are omnipresent in different frequency regimes and relate to a variety of behavioral and cognitive functions. Over the years, many studies have sought to elucidate the question how alpha/mu, beta, and gamma synchronization contribute to motor control. Here, we review these studies with the purpose to delineate what they have added to our understanding of the neural control of movement. We highlight important findings regarding oscillations in primary motor cortex, synchronization between cortex and spinal cord, synchronization between cortical regions, as well as abnormal synchronization patterns in a selection of motor dysfunctions. The interpretation of synchronization patterns benefits from combining results of invasive and non-invasive recordings, different data analysis tools, and modeling work. Importantly, although synchronization is deemed to play a vital role, it is not the only mechanism for neural communication. Spike timing and rate coding act together during motor control and should therefore both be accounted for when interpreting movement-related activity

Brain reorganization as a function of walking experience in 12-month-old infants: implications for the development of manual laterality

Hand preference in infancy is marked by many developmental shifts in hand use and arm coupling as infants reach for and manipulate objects. Research has linked these early shifts in hand use to the emergence of fundamental postural–locomotor milestones. Specifically, it was found that bimanual reaching declines when infants learn to sit; increases if infants begin to scoot in a sitting posture; declines when infants begin to crawl on hands and knees; and increases again when infants start walking upright. Why such pattern fluctuations during periods of postural–locomotor learning? One proposed hypothesis is that arm use practiced for the specific purpose of controlling posture and achieving locomotion transfers to reaching via brain functional reorganization. There has been scientific support for functional cortical reorganization and change in neural connectivity in response to motor practice in adults and animals, and as a function of crawling experience in human infants. In this research, we examined whether changes in neural connectivity also occurred as infants coupled their arms when learning to walk and whether such coupling mapped onto reaching laterality. Electroencephalogram (EEG) coherence data were collected from 43 12-month-old infants with varied levels of walking experience. EEG was recorded during quiet, attentive baseline. Walking proficiency was laboratory assessed and reaching responses were captured using small toys presented at mid-line while infants were sitting. Results revealed greater EEG coherence at homologous prefrontal/central scalp locations for the novice walkers compared to the prewalkers or more experienced walkers. In addition, reaching laterality was low in prewalkers and early walkers but high in experienced walkers. These results are consistent with the interpretation that arm coupling practiced during early walking transferred to reaching via brain functional reorganization, leading to the observed developmental changes in manual laterality

Neurobehavioral Strategies of Skill Acquisition in Left and Right Hand Dominant Individuals

The brain consists of vast networks of connected pathways communicating through synchronized electrochemical activity propagated along fiber tracts. The current understanding is that the brain has a modular organization where regions of specialized processes are dynamically coupled through long-range projections of dense axonal networks connecting spatially distinct regions enabling signal transfer necessary for all complex thought and behavior, including regulation of movement. The central objective of the dissertation was to understand how sensorimotor information is integrated, allowing for adaptable motor behavior and skill acquisition in the left-and right-hand dominant populations. To this end participants, of both left- and right-hand dominance, repeatedly completed a visually guided, force matching task while neurobiological and neurobehavioral outcome measurements were continuously recorded via EEG and EMG. Functional connectivity and graph theoretical measurements were derived from EEG. Cortico-cortical coherence patterns were used to infer neurostrategic discrepancies employed in the execution of a motor task for each population. EEG activity was also correlated with neuromuscular activity from EMG to calculate cortico-muscular connectivity. Neurological patterns and corresponding behavioral changes were used to express how hand dominance influenced the developing motor plan, thereby increasing understanding of the sensorimotor integration process. The cumulative findings indicated fundamental differences in how left- and right-hand dominant populations interact with the world. The right-hand dominant group was found to rely on visual information to inform motor behavior where the left-hand dominant group used visual information to update motor behavior. The left-hand group was found to have a more versatile motor plan, adaptable to both dominant, nondominant, and bimanual tasks. Compared to the right-hand group it might be said that they were more successful in encoding the task, however behaviorally they performed the same. The implications of the findings are relevant to both clinical and performance applications providing insight as to potential alternative methods of information integration. The inclusion of the left-hand dominant population in the growing conceptualization of the brain will generate a more complete, stable, and accurate understanding of our complex biology

Motor learning induced neuroplasticity in minimally invasive surgery

Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.Open Acces

Sensory and cognitive factors in multi-digit touch, and its integration with vision

Every tactile sensation – an itch, a kiss, a hug, a pen gripped between fingers, a soft fabric brushing against the skin – is experienced in relation to the body. Normally, they occur somewhere on the body’s surface – they have spatiality. This sense of spatiality is what allows us to perceive a partner’s caress in terms of its changing location on the skin, its movement direction, speed, and extent. How this spatiality arises and how it is experienced is a thriving research topic, compelled by growing interest in the nature of tactile experiences from product design to brain-machine interfaces. The present thesis adds to this flourishing area of research by examining the unified spatial quality of touch. How does distinct spatial information converge from separate areas of the body surface to give rise to our normal unified experience of touch? After explaining the importance of this question in Chapter 1, a novel paradigm to tackle this problem will be presented, whereby participants are asked to estimate the average direction of two stimuli that are simultaneously moved across two different fingerpads. This paradigm is a laboratory analogue of the more ecological task of representing the overall movement of an object held between multiple fingers. An EEG study in Chapter 2 will reveal a brain mechanism that could facilitate such aggregated perception. Next, by characterising participants’ performance not just in terms of error rates, but by considering perceptual sensitivity, bias, precision, and signal weighting, a series of psychophysical experiments will show that this aggregation ability differs for within- and between-hand perception (Chapter 3), is independent from somatotopically-defined circuitry (Chapter 4) and arises after proprioceptive input about hand posture is accounted for (Chapter 5). Finally, inspired by the demand for integrated tactile and visual experience in virtual reality and the potential of tactile interface to aid navigation, Chapter 6 will examine the contribution of tactile spatiality on visual spatial experience. Ultimately, the present thesis will reveal sensory factors that limit precise representation of concurrently occurring dynamic tactile events. It will point to cognitive strategies the brain may employ to overcome those limitations to tactually perceive coherent objects. As such, this thesis advances somatosensory research beyond merely examining the selectivity to and discrimination between experienced tactile inputs, to considering the unified experience of touch despite distinct stimulus elements. The findings also have practical implications for the design of functional tactile interfaces

Motor imagery and motor illusion: from plasticity to a translational approach

Motor imagery e illusione motoria: dalla plasticit\ue0 ad un approccio traslazional

Investigating the Cortical, Metabolic and Behavioral Effects of Transcranial Direct Current Stimulation in Preparation for Combined Rehabilitation

The goal of this thesis was to determine the cortical reorganization that occurs in patients with cervical spondylotic myelopathy (CSM) after surgical decompression and to implement this knowledge into a new rehabilitation strategy. Transcranial direct current stimulation (tDCS) is a non-invasive technique to modulate human behavior. Due to the novel electrode montage used, it was first pertinent that we determine how tDCS would modulate cortical, metabolic and motor behavior in healthy individuals. We observed the longitudinal functional adaptations that occur in patients with CSM using functional MRI. Enhanced excitation of supplementary motor area (SMA) was observed following surgical decompression and associated with increased function following surgery. This novel finding of enhanced excitation of motivated us to use a bihemispheric tDCS protocol, exciting bilateral motor areas to provide optimal motor enhancement. This novel tDCS electrode montage, targeting the SMA and primary motor cortex (M1) was implemented in healthy older adults to determine its effects on enhancing manual dexterity. Furthermore, to determine the frequency with which to apply tDCS, a single and tri session protocol was used. We observed a differential pattern of action with anti-phase and in-phase motor tasks during multisession tDCS. We used ultra-high field (7T) MRI to examined the metabolic changes that occur following tDCS. After the stimulation period we observed no significant metabolite modulation. A trend towards an increase in the NAA/tCr ratio, with a concomitant decrease in the absolute concentration of tCr was observed. Finally, we examined the functional connectivity before, during and after tDCS with the use of resting-state fMRI at 7T. We observed enhanced connectivity within right sensorimotor area after stimulation compared to during stimulation. This result confirmed that cortical modulations differ during versus after tDCS, signifying that optimal modulation of behaviour may be after the stimulation period. Furthermore, we observed an enhanced correlation between motor regions and the caudate, both during and after stimulation. In conclusion, we observed novel cortical adaptations in CSM patients after surgical decompression, which led us to believe that bihemispheric tDCS of M1-SMA network would result in optimal motor enhancement and warrants further investigation in CSM and other neurological disorders