Translating novel findings of perceptual-motor codes into the neuro-rehabilitation of movement disorders

The bidirectional flow of perceptual and motor information has recently proven useful as rehabilitative tool for re-building motor memories. We analyzed how the visual-motor approach has been successfully applied in neurorehabilitation, leading to surprisingly rapid and effective improvements in action execution. We proposed that the contribution of multiple sensory channels during treatment enables individuals to predict and optimize motor behavior, having a greater effect than visual input alone. We explored how the state-of-the-art neuroscience techniques show direct evidence that employment of visual-motor approach leads to increased motor cortex excitability and synaptic and cortical map plasticity. This super-additive response to multimodal stimulation may maximize neural plasticity, potentiating the effect of conventional treatment, and will be a valuable approach when it comes to advances in innovative methodologies

Action Observation for Neurorehabilitation in Apraxia

Neurorehabilitation and brain stimulation studies of post-stroke patients suggest that action-observation effects can lead to rapid improvements in the recovery of motor functions and long-term motor cortical reorganization. Apraxia is a clinically important disorder characterized by marked impairment in representing and performing skillful movements [gestures], which limits many daily activities and impedes independent functioning. Recent clinical research has revealed errors of visuo-motor integration in patients with apraxia. This paper presents a rehabilitative perspective focusing on the possibility of action observation as a therapeutic treatment for patients with apraxia. This perspective also outlines impacts on neurorehabilitation and brain repair following the reinforcement of the perceptual-motor coupling. To date, interventions based primarily on action observation in apraxia have not been undertaken

Avaliação dos efeitos de um protocolo com a plataforma NINTENDO WII® nas dimensões cognitivas e físicas /equilíbrio e coordenação) em idosos

Objetivos: Avaliar e quantificar o impacto do tratamento de fisioterapia, utilizando exclusivamente a Nintendo Wii®, na Qualidade de Vida relacionada com a saúde dos sujeitos com 65 anos ou mais e as mudanças na cognição, equilíbrio, coordenação e desempenho das Atividades da Vida Diária após o protocolo; Inquirir o grau de adesão ao treino. Material e Métodos: 30 sujeitos em dois momentos de avaliação. Medidas aplicadas: SF-12, MSE, TUG e com tarefa cognitiva, Escala de Equilíbrio de Berg, avaliação da coordenação e Escala de Barthel. Intervenção durante 4 semanas, 2 por semana, 60 minutos, em 8 sessões. Resultados: Ganhos em todas as escalas, com significado estatístico na Escala de Saúde Mental Geral, componente do SF-12 (p=0,008), MMSE (p=0,007), TUG normal (p=0,003), TUG com tarefa cognitiva (p=0,028) e Protocolo de Avaliação da Coordenação proposto por O’Neil et al. (p=0,008). Da amostra 46,67% teve um Baixo Grau de Adesão, 30% Médio Grau de Adesão, e 23,33% Alto Grau de Adesão. Conclusões: Um protocolo de intervenção de 4 semanas com a Nintendo Wii Sports® (bowling) em sujeitos institucionalizados, apresenta benefícios na QV relacionada com a Saúde Metal e de cognição, e dimensão física da coordenação e capacidade para a dupla-tarefa

Occlusion of LTP-Like Plasticity in Human Primary Motor Cortex by Action Observation

Passive observation of motor actions induces cortical activity in the primary motor cortex (M1) of the onlooker, which could potentially contribute to motor learning. While recent studies report modulation of motor performance following action observation, the neurophysiological mechanism supporting these behavioral changes remains to be specifically defined. Here, we assessed whether the observation of a repetitive thumb movement – similarly to active motor practice – would inhibit subsequent long-term potentiation-like (LTP) plasticity induced by paired-associative stimulation (PAS). Before undergoing PAS, participants were asked to either 1) perform abductions of the right thumb as fast as possible; 2) passively observe someone else perform thumb abductions; or 3) passively observe a moving dot mimicking thumb movements. Motor evoked potentials (MEP) were used to assess cortical excitability before and after motor practice (or observation) and at two time points following PAS. Results show that, similarly to participants in the motor practice group, individuals observing repeated motor actions showed marked inhibition of PAS-induced LTP, while the “moving dot” group displayed the expected increase in MEP amplitude, despite differences in baseline excitability. Interestingly, LTP occlusion in the action-observation group was present even if no increase in cortical excitability or movement speed was observed following observation. These results suggest that mere observation of repeated hand actions is sufficient to induce LTP, despite the absence of motor learning

亜急性期脳卒中患者および健常者における歩行観察時のミラーニューロンシステムの活性化

The observation of walking improves gait ability in chronic stroke survivors. It has also been suggested that activation of the mirror neuron system contributes to this effect. However, activation of the mirror neuron system during gait observation has not yet been assessed in sub-acute stroke patients. The objective of this study was to clarify the activation of mirror neuron system during gait observation in sub-acute stroke patients and healthy persons. In this study, we sequentially enrolled five sub-acute stroke patients who had undergone gait training and nine healthy persons. We used fMRI to detect neuronal activation during gait observation. During the observation period in the stroke group, neural activity in the left inferior parietal lobule, right and left inferior frontal gyrus was significantly higher than during the rest period. In the healthy group, neural activity in the left inferior parietal lobule, left inferior frontal gyrus, left middle frontal gyrus, left superior temporal lobule and right and left middle temporal gyrus was significantly higher than during the rest period. The results indicate that the mirror neuron system was activated during gait observation in sub-acute stroke patients who had undergone gait training and also in healthy persons. Our findings suggest that gait observation treatment may provide a promising therapeutic strategy in sub-acute stroke patients who have experienced gait training

Representing tools as hand movements: Early and somatotopic visuomotor transformations

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Protocolos de prática mental utilizados na reabilitação motora de sujeitos com doença de Parkinson: revisão sistemática da literatura

The Mental Practice (MP) consists of a training method by which a given specific motor act is cognitively reproduced internally and repeated with the intention of promoting learning or improvement of motor skills, without inducing any real movement. The results of MP to research in Parkinson’s disease are still ambiguous due to various reasons such as the diversity of the intervention protocols. The MP with intervention protocols are cognitively complex and challenging presenting variations in its application concerning the type of PM, task/movement to be imagined and type of instruction. Objective: The study aimed to investigate the literature MPs protocols used for motor rehabilitation of individuals with Parkinson’s disease. Methods: The searches of this systematic review was performed on the portals databases: PubMed, Scopus, Web of Science and Medicine. The descriptors were: (“mental practice” or “engine imagery” or “imagery training” and “Parkinson”). Results: 128 articles were found, of which only 4 were included according to the eligibility criteria. Conclusion: The protocols that have proven to be effective for reducing bradykinesia, improving mobility and gait speed used the MP combined with physical practice in 12 sessions, of 5 to 30 minutes, visual or visual and kinesthetic imagery of specific activities and used gait videos of patients or healthy subjects promote familiarization and identification of kinematic components of the movementA Prática Mental (PM) consiste em um método de treinamento pelo qual um dado ato motor específico é cognitivamente reproduzido internamente e repetido com a intenção de promover aprendizagem ou aperfeiçoamento de uma habilidade motora, sem induzir qualquer movimento real. Os resultados das pesquisas com PM na doença de Parkinson (DP) ainda são ambíguos devido a várias razões como à diversidade de protocolos de intervenção. Os protocolos de intervenção com PM são cognitivamente complexos e desafiadores apresentando variações em sua aplicação relativas ao tipo de PM, tarefa/movimento a ser imaginada e tipo de instrução. Objetivo: Investigar na literatura os protocolos de PM utilizados para reabilitação motora de sujeitos com DP. Métodos: A busca desta revisão sistemática foi realizada nas bases de dados dos portais: PubMed, Scopus, Web of Science e Bireme. Os descritores foram: (“mental practice” or “motor imagery” or “imagery training” and “Parkinson”). Resultados: Foram encontrados 128 artigos, dos quais apenas 4 foram incluídos segundo os critérios de elegibilidade. Conclusão: Os protocolos que se mostraram eficazes para redução da bradicinesia, melhora da mobilidade e da velocidade da marcha utilizaram a associação da PM em 12 sessões, com duração de 5 à 30 minutos, imagética visual ou visual e cinestésica de atividades especificas e usaram vídeos da marcha dos pacientes ou da marcha normal para ajudar na familiarização e identificação dos componentes cinemáticos do moviment

Effectiveness of Virtual Reality and Virtual Reality with Home Based Self Induced Movement Therapy in Improving the Upper Extremities Motor Recovery after Stroke

INTRODUCTION: Stroke is one of the commonest neurological emergencies. Stroke is the third most common cause of death in the developed world after cancer and ischemic heart disease and is responsible for a large proportion of physical disability becoming more frequent with increasing age. Stroke affects approximately 5, 00,000 new victims each year with the estimated number of stroke survivors close to 3 million. In India, there is some evidence that stroke is particularly common in young people. Every year more than 15 million world wide have a stroke. 5 million Die, 5 million recover and 5 million are disable. Mostly stroke occurs at the age of 35- 65years they can also occur in much younger people too. OBJECTIVE: The aim of study was To find out the effectiveness of visual reality and visual reality with home based self induced movement therapy in improving on upper extremities motor recovery after stroke. DESIGN: Tstudy was apre test and post test control group study. PARTICIPANTS: 20 subjects, age 35 to 65 years each subject recived visual reality and visual reality with home based self induced movement therapy for 2 months of period each subjects. OUTCOME MEASURE: The Upper Extremity Function Test (UEFT). Fugal-Meyer Assessment Scale before and after treatment. RESULT: Statistical analysis done by using Mann-Whitney U test and Wilcox on-signed ranks test showed that there was significant improvements of upper extremities. CONCLUSION: There significant rise in stoke subjects recived visual reality and visual reality with home based self induced movement therapy

Disrupting the ventral premotor cortex interferes with the contribution of action observation to use-dependent plasticity

Action observation (AO), observing another individual perform an action, has been implicated in several higher cognitive processes including forming basic motor memories. Previous work has shown that physical practice (PP) results in cortical motor representational changes, referred to as use-dependent plasticity (UDP), and that AO combined with PP potentiates UDP in both healthy adults and stroke patients. In humans, AO results in activation of the ventral premotor cortex (PMv), however, whether PMv activation has a functional contribution to UDP is not known. Here, we studied the effects disruption of PMv has on UDP when subjects performed PP combined with AO (PP+AO). Subjects participated in 2 randomized-crossover sessions measuring the amount of UDP resulting from PP+AO while receiving disruptive (1Hz) transcranial magnetic stimulation (TMS) over the fMRI activated PMv or over orbito-frontal cortex (FC, Sham). We found that unlike the sham session, disruptive TMS over PMv reduced the beneficial contribution of AO to UDP. To ensure that disruption of PMv was specifically interfering with the contribution of AO and not PP, subjects completed two more control sessions where they performed only PP while receiving disruptive TMS over PMv or FC. We found that the magnitude of UDP for both control sessions was similar to PP+AO with TMS over PMv. These findings suggest that the fMRI activation found in PMv during action observation studies is functionally relevant to task performance, at least for the beneficial effects that AO exerts over motor training

Multiple Motor Learning Processes in Humans: Defining Their Neurophysiological Bases

Learning new motor behaviors or adjusting previously learned actions to account for dynamic changes in our environment requires the operation of multiple distinct motor learning processes, which rely on different neuronal substrates. For instance, humans are capable of acquiring new motor patterns via the formation of internal model representations of the movement dynamics and through positive reinforcement. In this review, we will discuss how changes in human physiological markers, assessed with noninvasive brain stimulation techniques from distinct brain regions, can be utilized to provide insights toward the distinct learning processes underlying motor learning. We will summarize the findings from several behavioral and neurophysiological studies that have made efforts to understand how distinct processes contribute to and interact when learning new motor behaviors. In particular, we will extensively review two types of behavioral processes described in human sensorimotor learning: (1) a recalibration process of a previously learned movement and (2) acquiring an entirely new motor control policy, such as learning to play an instrument. The selected studies will demonstrate in-detail how distinct physiological mechanisms contributions change depending on the time course of learning and the type of behaviors being learned