Motor Imagery and Action Observation as Effective Tools for Physical Therapy

Motor imagery and action observation facilitate motor recovery of patients because both the motor imagery and the action observation share the activation of cortical neural networks implicated in movement execution. Specifically, imagery, observation, and execution activate the medial parietal area of the brain located between the parieto‐occipital sulcus and the posterior end of the cingulate sulcus. This chapter reviews the neural mechanisms and clinical studies of motor imagery and action observation and discusses the applications in physical therapy

Understanding Neural Mechanisms of Action Observation for Improving Human Motor Skill Acquisition

Action observation is a useful approach for improving human motor skill acquisition. This process involves the mirror neuron system that consists of the ventral premotor area, inferior parietal lobule, and superior temporal sulcus. The interaction between these areas produces the effect of action observation. This chapter presents neurophysiological and brain imaging studies of action observation, and their application to human motor learning. For action observation, the mirror system appears to map the intention in the ventral premotor area and the goal in the inferior parietal lobule. These features of action representation may be useful for refining conditions of practice, based on the mirror system, for acquiring new motor skills

Neuroscience-Based Rehabilitation for Stroke Patients

Hitherto, physical therapy for rehabilitating patients with cerebral dysfunction has focused on acquiring and improving compensatory strategies by using the remaining functions; it has been presumed that once neural functions have been lost, they cannot be restored. However, neuroscience-based animal research and neuroimaging research since the 1980s have demonstrated that recovery arises from plastic changes in the central nervous system and reconstruction of neural networks; this research is ushering in a new age of neuroscience-based rehabilitation as a treatment for cerebral dysfunction (such as stroke). In this paper, in regard to mental practices using motor imagery and kinaesthetic illusion, we summarize basic discoveries and theories relating to motor function therapy based on neuroscientific theory; in particular, we outline a novel rehabilitation method using kinaesthetic illusion induced by vibrational stimulus, which the authors are currently attempting in stroke patients

Clinical Usefulness of Real-time Sensory Compensation Feedback Training on Sensorimotor Dysfunction After Stroke

The sensory dysfunction after the stroke also greatly affects motor function. In particular, it is known that the presence of sensory dysfunction in the fingers causes loss of somatosensory muscle reflex control and excessive muscle output when grasping objects. These are called sensorimotor dysfunction and have been shown to have a significant impact on prognosis. One element to improve this dysfunction is to reconstruct the “Sense of Agency (SOA) subject feeling” and it has become clear that SOA is enhanced by matching the collation information related to motor intention and sensory feedback in time. In order to reconstruct the SOA associated with the movement of the fingers of patients with sensorimotor dysfunction, it is important to match motor intentions while using visual information as compensation for tactile sensory information. Furthermore, considering the functional characteristics of the fingers, it is also important to adjust the fine muscle output from feedback information synchronously discriminating and recognizing somatosensory information generated by resistance, friction, etc., when an object is actively touched. This chapter outlines the importance of rehabilitation of sensory feedback for poststroke sensorimotor dysfunction and investigates the usefulness of intervention with a real-time sensory compensation feedback system that can input tactile sensory information via vibratory stimulation (deep sensation) to other body parts where sensory function is preserved

CHANGE IN MECHANICAL PROPERTIES OF TRICEPS SURAE MUSCLE-TENDON UNIT AND RACE PERFORMANCE AFTER 1 YEAR IN WELL TRAINED DISTANCE RUNNERS

The purpose of this study was to determine change in relationship between stiffness of triceps surae muscle-tendon unit and race performance after one year with continuous training in well trained long distance runners. For 9 long distance runners, official race record and stiffness indexes of both muscle and tendon were investigated in pre and post measurements (after one year). The race performance (1.9%), passive torque of ankle joint (13.2%), and muscle stiffness index (73.6%) increased significantly between pre and post. Although significant correlations were not found between increment of race performance and change in all parameters, 6 of the 9 athletes showed increments of both race performance and stiffness index of muscle tissue. These results suggest that an increment of stiffness of the ankle joint and triceps muscle could be related to improvement of race performance in distance running

Time-dependent Solutions with Null Killing Spinor in M-theory and Superstrings

Imposing the condition that there should be a null Killing spinor with all the metrics and background field strengths being functions of the light-cone coordinates, we find general 1/2 BPS solutions in D=11 supergravity, and discuss several examples. In particular we show that the linear dilaton background is the most general supersymmetric solution without background under the additional requirement of flatness in the string frame. We also give the most general solutions for flat spacetime in the string frame with RR or NS-NS backgrounds, and they are characterized by a single function.Comment: 12 pages; v2: typos corrected, refs. added; v3: typos corrected, to appear in PL

Steep posterior slope of the medial tibial plateau is associated with ramp lesions of the medial meniscus and a concomitant anterior cruciate ligament injury

Background: Medial meniscus (MM) tears are associated with both acute and chronic anterior cruciate ligament (ACL) insufficiency and can lead to degenerative changes in the knee. ACL reconstruction (ACLR) combined with the meniscal repair was reported to result in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term. However, a subtle tear of the MM posterior segment, also known as a ramp lesion, is difficult to detect on conventional magnetic resonance imaging (MRI) and is frequently missed in ACL-deficient knees. However, there are few studies about the associations between bone geometry and ramp lesion of the MM. This study aimed to compare sagittal medial tibial slope (MTS), medial tibial plateau depth (MTPD), and coronal tibial slope (CTS) between ACL-injured knees with and without ramp lesion of the MM. We hypothesised that patients with ramp lesion of the MM and a concomitant ACL injury have a steeper MTS and shallower MTPD than those without ramp lesion of the MM. Methods: Twenty-seven patients who underwent ACLR (group A), and 15 patients with combined MM repair (group AM) were included in the study. Anterior tibial translation (ATT) was measured under general anaesthesia just before surgery using a knee arthrometer. MRI was performed in the 10 degrees-knee-flexed position. The MTS and MTPD were measured on sagittal view, and the CTS was measured on coronal view. These parameters were compared between the groups. Differences in MRI measurements or patient demographics between the groups were evaluated using the Mann-Whitney U test. Results: No significant difference was observed in demographic data and post-operative side-to-side difference in ATT between both groups. Pre-operative ATT was significantly higher in group AM than in group A (P = 5.0 degrees than in those with MTS = 5.0 degrees, an occult MM ramp lesion should be strongly suspected, and surgeons should prepare for MM repair in combination with ACLR

Two simple stitches for medial meniscus posterior root repair prevents the progression of meniscal extrusion and reduces intrameniscal signal intensity better than modified Mason-Allen sutures

Purpose Medial meniscus posterior root tears (MMPRTs) can cause severe medial extrusion of the medial meniscus (MMME) and the progression of knee degenerative changes, inducing a high signal intensity of the meniscus on magnetic resonance imaging (MRI). Although MMME and intrameniscal signal intensity (IMSI) reportedly decreased within 3 months after MMPRT repair, no previous studies have reported these changes after a 1-year follow-up. This study aimed to investigate the 1-year postoperative changes in MMME and IMSI on MRI after using different suture techniques. Methods Overall, 33 patients with MMPRT were evaluated, 22 underwent FasT-Fix-dependent modified Mason–Allen suture (F-MMA) repair, and 11 underwent two simple stitches (TSS) repair. MRI examinations were performed preoperatively and 1 year postoperatively. MMME and IMSI were determined using MRI. Results A significant decrease in postoperative MMME was observed in the TSS group (4.1 ± 1.0) relative to that in the F-MMA group (5.1 ± 1.4, P = 0.03). A significant decrease in postoperative IMSI (0.75 ± 0.14) was observed relative to preoperative IMSI in the TSS group (P  Conclusions The most important finding of this study is that TSS repair yielded a greater decrease in MMME and IMSI than F-MMA repair in patients with MMPRT. These results suggest that TSS repair is more useful for restoring loading stress to the posterior horn of the medial meniscus

Medial meniscus posterior root repairs: A comparison among three surgical techniques in short-term clinical outcomes and arthroscopic meniscal healing scores

Background Medial meniscus (MM) posterior root repairs lead to favorable clinical outcomes in patients with MM posterior root tears (MMPRTs). However, there are few comparative studies in evaluating the superiority among several pullout repair techniques such as modified Mason–Allen suture, simple stitch, and concomitant posteromedial pullout repair. We hypothesized that an additional pullout suture at the MM posteromedial part would have clinical advantages in transtibial pullout repairs of the MMPRTs. The aim of this study was to compare the clinical usefulness among several types of pullout repair techniques in patients with MMPRTs. Methods Eighty-three patients who underwent arthroscopic pullout repairs of the MMPRTs were investigated. Patients were divided into three groups using different pullout repair techniques: a modified Mason–Allen suture using FasT-Fix all-inside meniscal repair device (F-MMA, n = 28), two simple stitches (TSS, n = 30), and TSS concomitant with posteromedial pullout repair using all-inside meniscal repair device (TSS-PM, n = 25). Postoperative clinical outcomes and semi-quantitative arthroscopic meniscal healing scores (0–10 points) were evaluated at second-look arthroscopies. Results No significant differences among the three groups were observed in patient demographics and preoperative clinical scores, except for preoperative Lysholm scores. At second-look arthroscopies, there were no significant differences among the three techniques in postoperative clinical outcomes and meniscal healing scores. Conclusions This study demonstrated that the TSS-PM pullout repair technique did not show better scores in postoperative clinical outcomes and meniscal healings compared with the F-MMA and TSS techniques. Our results suggest that the concomitant posteromedial pullout suture may have no clinical advantage in the conventional pullout repairs for the patients with MMPRTs