Jared Medina

From maps to form to space: Touch and the body schema

Evidence from patients has shown that primary somatosensory representations are plastic, dynamically changing in response to central or peripheral alterations, as well as experience. Furthermore, recent research has also demonstrated that altering body posture results in changes in the perceived sensation and localization of tactile stimuli. Using evidence from behavioral studies with brain-damaged and healthy subjects, as well as functional imaging, we propose that the traditional concept of the body schema should be divided into three components. First are primary somatosensory representations, which are representations of the skin surface that are typically somatotopically organized, and have been shown to change dynamically due to peripheral (usage, amputation, deafferentation) or central (lesion) modifications. Second, we argue for a mapping from a primary somatosensory representation to a secondary representation of body size and shape (body form representation). Finally, we review evidence for a third set of representations that encodes limb position and is used to represent the location of tactile stimuli relative to the subject using external, non-somatotopic reference frames (postural representations).

Inappropriate usage of the Brunner-Munzel test in recent voxel-based lesion-symptom mapping studies

Voxel-based lesion-symptom mapping (VLSM) techniques have been important in elucidating structure-function relationships in the human brain. Rorden, Karnath, and Bonilha (2007) introduced the non-parametric Brunner-Munzel rank order test as an alternative to parametric tests often used in VLSM analyses. However, the Brunner-Munzel statistic produces inflated z scores when used at any voxel where there are less than 10 subjects in either the lesion or no lesion groups. Unfortunately, a number of recently published VLSM studies using this statistic include relatively small patient populations, such that most (if not all) examined voxels do not meet the necessary criteria. We demonstrate the effects of inappropriate usage of the Brunner-Munzel test using a dataset included with MRIcron, and find large Type I errors. To correct for this we suggest that researchers use a permutation derived correction as implemented in current versions of MRIcron when using the Brunner-Munzel test.

Mental Motor Imagery Indexes Pain: The Hand Laterality Task

Mental motor imagery is subserved by the same cognitive systems that underlie action. In turn, action is informed by the anticipated sensory consequences of movement, including pain. In light of these considerations, one would predict that motor imagery would provide a useful measure pain‐related functional interference. We report a study in which 19 patients with chronic musculoskeletal or radiculopathic arm or shoulder pain, 24 subjects with chronic pain not involving the arm/shoulder and 41 normal controls were asked to indicate if a line drawing was a right or left hand. Previous work demonstrated that this task is performed by mental rotation of the subjects hand to match the stimulus. Relative to normal and pain control subjects, arm/shoulder pain subjects were significantly slower for stimuli that required greater amplitude rotations. For the arm/shoulder pain subjects only there was a correlation between degree of slowing and the rating of severity of pain with movement but not the non‐specific pain rating. The hand laterality task may supplement the assessment of subjects with chronic arm/shoulder pain.

Mental motor imagery and chronic pain: The foot laterality task

Several lines of evidence suggest that mental motor imagery is subserved by the same cognitive operations and brain structures that underlie action. Additionally, motor imagery is informed by the anticipated sensory consequences of action, including pain. We reasoned that motor imagery could provide a useful measure of chronic leg or foot pain. Forty subjects with leg pain (19 bilateral, 11 right, and 10 left leg pain), 42 subjects with chronic pain not involving the legs, and 38 controls were shown 12 different line drawings of the right or left foot and asked to indicate which foot was depicted. Previous work suggests that subjects perform this task by mentally rotating their foot to match the visually presented stimulus. All groups of subjects were slower and less accurate with stimuli that required a greater degree of mental rotation of their foot. Subjects with leg pain were both slower and less accurate than normal and pain control subjects in responding to drawings of a painful extremity. Furthermore, subjects with leg pain exhibited a significantly greater decrement in performance for stimuli that required larger amplitude mental rotations. These data suggest that motor imagery may provide important insights into the nature of the pain experience.

Finding the Right Words: Transcranial Magnetic Stimulation Improves Discourse Productivity in Non-fluent Aphasia After Stroke

Background: Loss of fluency is a significant source of functional impairment in many individuals with aphasia. Repetitive transcranial magnetic stimulation (rTMS) administered to the right inferior frontal gyrus (IFG) has been shown to facilitate naming in persons with chronic left hemisphere stroke and non-fluent aphasia. However, changes in fluency in aphasic participants receiving rTMS have not been adequately explored. Aims: To determine whether rTMS improves fluency in individuals with chronic nonfluent aphasia, and to identify aspects of fluency that are modulated in persons who respond to rTMS. Methods & Procedures: Ten individuals with left hemisphere MCA strokes and mild to moderate non-fluent aphasia participated in the study. Before treatment participants were asked to describe the Cookie Theft picture in three separate sessions. During treatment all participants received 1200 pulses of 1 Hz rTMS daily in 10 sessions over 2 weeks at a site that had previously been shown to improve naming. Participants repeated the Cookie Theft description 2 months after treatment. Five participants initially received sham stimulation instead of real TMS; 2 months after sham treatment these individuals received real rTMS. Performance both at baseline and after stimulation was coded using Quantitative Production Analysis (Saffran, Berndt, & Schwartz, 1989) and Correct Information Unit (Nicholas & Brookshire, 1993) analysis. Outcomes & Results: Across all participants (n = 10), real rTMS treatment resulted in a significant increase in multiple measures of discourse productivity compared to baseline performance. There was no significant increase in measures of sentence productivity or grammatical accuracy. There was no significant increase from baseline in the sham condition (n = 5) on any study measures. Conclusions: Stimulation of the right IFG in patients with chronic non-fluent aphasia facilitates discourse production. We posit that this effect may be attributable to improved lexical-semantic access.

Phantom tactile sensations modulated by body position.

Bilateral activation of somatosensory areas after unilateral stimulation is assumed to be mediated by crosshemispheric connections. Despite evidence of bilateral activity in response to unilateral stimulation, neurologically intact humans do not experience bilateral percepts when stimulated on one side of the body. This may be due to active suppression of ipsilateral neural activity by inhibitory mechanisms whose functioning is poorly understood. We describe an individual with left fronto-parietal damage who experiences bilateral sensations in response to unilateral tactile stimulation-a rarely reported condition known as synchiria (previously described in visual, auditory, and somatosensory modalities). Presumably, the phantom sensations result from normal bilateral crosshemispheric activation, combined with a failure of inhibitory mechanisms to prevent bilateral perceptual experiences. Disruption of these mechanisms provides a valuable opportunity to examine their internal functioning. We find that the synchiria rate is affected by hand position relative to multiple reference frames. Specifically, synchiria decreases as the hands move from right (contralesional) to left (ipsilesional) space in trunk- and head-centered reference frames and disappears when the hands are crossed. These findings provide novel evidence that mechanisms that inhibit bilateral percepts operate in multiple reference frames.

Transcranial Direct Current Stimulation Accelerates Allocentric Target Detection

BACKGROUND Previous research on hemispatial neglect has provided evidence for dissociable mechanisms for egocentric and allocentric processing. Although a few studies have examined whether tDCS to posterior parietal cortex can be beneficial for attentional processing in neurologically intact individuals, none have examined the potential effect of tDCS on allocentric and/or egocentric processing. OBJECTIVE/HYPOTHESIS Our objective was to examine whether transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique that can increase (anodal) or decrease (cathodal) cortical activity, can affect visuospatial processing in an allocentric and/or egocentric frame of reference. METHODS We tested healthy individuals on a target detection task in which the target--a circle with a gap--was either to the right or left of the viewer (egocentric), or contained a gap on the right or left side of the circle (allocentric). Individuals performed the task before, during, and after tDCS to the posterior parietal cortex in one of three stimulation conditions--right anodal/left cathodal, right cathodal/left anodal, and sham. RESULTS We found an allocentric hemispatial effect both during and after tDCS, such that right anodal/left cathodal tDCS resulted in faster reaction times for detecting stimuli with left-sided gaps compared to right-sided gaps. CONCLUSIONS Our study suggests that right anodal/left cathodal tDCS has a facilitatory effect on allocentric visuospatial processing, and might be useful as a therapeutic technique for individuals suffering from allocentric neglect.

Contributions of efference copy to limb localization: Evidence from deafferentation

Previous research with deafferented subjects suggests that efference copy can be used to update limb position. However, the contributions of efference copy to limb localization are currently unclear. We examined the performance of JDY, a woman with severe, longstanding proprioceptive deficits from a sensory peripheral neuropathy, on a reaching task to explore the contribution of efference copy to trajectory control. JDY and eight healthy controls reached without visual feedback to a target that either remained stationary or jumped to a second location after movement initiation. JDY consistently made hypermetric movements to the final target, exhibiting significant problems with amplitude control. Despite this amplitude control deficit, JDYs performance on jump trials showed that the angle of movement correction (angle between pre- and post-correction movement segments) was significantly correlated with the distance (but not time) of movement from start to turn point. These data suggest that despite an absence of proprioceptive and visual information regarding hand location, JDY derived information about movement distance that informed her movement correction on jump trials. The same type of information that permitted her to correct movement direction on-line, however, was not available for control of final arm position. We propose that efference copy can provide a consistent estimate of limb position that becomes less informative over the course of the movement. We discuss the implications of these data for current models of motor control.

Somatotopic representation of location: Evidence from the simon effect

Representing the locations of tactile stimulation can involve somatotopic reference frames in which locations are defined relative to a position on the skin surface, and also external reference frames that take into account stimulus position in external space. Locations in somatotopic and external reference frames can conflict in terms of left/right assignment when the hands are crossed or positioned outside of their typical hemispace. To investigate the spatial codes of the representation of both tactile stimuli and responses to touch, a Simon effect task, often used in the visual modality to examine issues of spatial reference frames, was deployed in the tactile modality. Participants performed the task with stimuli delivered to the hands with arms in crossed or uncrossed postures and responses were produced with foot pedals. Across all 4 experiments, participants were faster on somatotopically congruent trials (e.g., left hand stimulus, left foot response) than on somatotopically incongruent trials (left hand stimulus, right foot response), regardless of arm or leg position. However, some evidence of an externally based Simon effect also appeared in 1 experiment in which arm (stimulus) and leg (response) position were both manipulated. Overall, the results demonstrate that tactile stimulus and response codes are primarily generated based on their somatotopic identity. However, stimulus and response coding based on an external reference frame can become more salient when both hands and feet can be crossed, creating a situation in which somatotopic and external representations can differ for both stimulus and response codes.

What can errors tell us about body representations

ABSTRACT In this review, we examine how tactile misperceptions provide evidence regarding body representations. First, we propose that tactile detection and localization are serial processes, in contrast to parallel processing hypotheses based on patients with numbsense. Second, we discuss how information in primary somatosensory maps projects to body size and shape representations to localize touch on the skin surface, and how responses after use-dependent plasticity reflect changes in this mapping. Third, we review situations in which our body representations are inconsistent with our actual body shape, specifically discussing phantom limb phenomena and anesthetization. We discuss problems with the traditional remapping hypothesis in amputees, factors that modulate perceived body size and shape, and how changes in perceived body form influence tactile localization. Finally, we review studies in which brain-damaged individuals perceive touch on the opposite side of the body, and demonstrate how interhemispheric mechanisms can give rise to these anomalous percepts.