Jennifer A. Stevens

Using Motor Imagery in the Rehabilitation of Hemiparesis

OBJECTIVE To examine the effectiveness of using motor imagery training in the rehabilitation of hemiparesis. DESIGN A before-after trial with clinical and behavioral analyses of single cases. SETTING Academic-affiliated rehabilitation hospital. PARTICIPANTS Two survivors of embolic middle cerebral artery stroke that resulted in chronic hemiparesis. INTERVENTION A motor imagery training program consisting of imagined wrist movements (extension, pronation-supination) and mental simulations of reaching and object manipulation making use of a mirror box apparatus. Twelve 1-hour experimental sessions were delivered, 3 times a week for 4 consecutive weeks. MAIN OUTCOME MEASURES Two clinical assessments, grip strength, 4 wrist functionality measurements, and 3 timed performance tests. All outcome measures were recorded before training began, at 3 times during the intervention month, with 2 additional long-term measurements. RESULTS Performance of the paretic limb improved after the imagery intervention, indicated by increases in assessment scores and functionality and decreases in movement times. The improvements over baseline performance remained stable over a 3-month period. CONCLUSIONS These results demonstrate the potential for using motor imagery as a cognitive strategy for functional recovery from hemiparesis. The intervention targets the cognitive level of action processing while its effects may be realized in overt behavioral performance.

New aspects of motion perception: selective neural encoding of apparent human movements.

Perception of apparent motion operates somewhat differently for objects and human figures. Depending on the interstimulus interval, the latter d may give rise to either perception of a direct path (i.e. biologically impossible) or indirect path (i.e. biologically possible). Here, PET was used to investigate whether a change in brain activity accompanies this perceptual shift. We found neural encoding of apparent motion to be a function of the intrinsic properties of the stimulus presented (object vs human) as well as the kind of human movement path perceived (biomechanically possible vs impossible). Motor and parietal cortex were only involved for possible motion which suggests that these regions are selectively activated to process actions which conform to the capabilities of the observer.

Motor imagery of gait: a quantitative approach.

Motor imagery (MI) is widely used to study cognitive aspects of the neural control of action. Prior studies were mostly centred on hand and arm movements. Recently a few studies have used imagery tasks to explore the neurophysiology of human gait, but it remains unclear how to ascertain whether subjects actually perform imagery of gait as requested. Here we describe a new experimental protocol to quantify imagery of gait, by behaviourally distinguishing it from visual imagery (VI) processes and by showing its temporal correspondence with actual gait. Fourteen young healthy subjects performed two imagery tasks and an actual walking (AW) task. During both imagery tasks subjects were sitting on a chair and faced a computer screen that presented photographs of walking trajectories. During one task (MI), subjects had to imagine walking along the walking trajectory. During the other task (VI), subjects had to imagine seeing a disc moving along the walking trajectory. During the AW task, subjects had to physically walk along the same walking trajectory as presented on the photographs during the imagery tasks. We manipulated movement distance by changing the length of the walking trajectory, and movement difficulty by changing the width of the walking trajectory. Subjects reported onset and offset of both actual and imagined movements with a button press. The time between the two button presses was taken as the imagined or actual movement time (MT). MT increased with increasing path length and decreasing path width in all three tasks. Crucially, the effect of path width on MT was significantly stronger during MI and AW than during VI. The results demonstrate a high temporal correspondence between imagined and AW, suggesting that MI taps into similar cerebral resources as those used during actual gait. These results open the possibility of using this protocol for exploring neurophysiological correlates of gait control in humans.

The Effect of Motor Imagery on Spinal Segmental Excitability

The purpose of this study was to investigate the effect of motor imagery on spinal segmental excitability by recording the reflex responses to externally applied stretch of the extrinsic finger flexors and extensors during the performance of an imaginary task. Nine young healthy subjects performed a series of imagined flexion-extension movements of the fingers. Muscle stretch was imposed concurrently by applying rotations of the metacarpophalangeal joints at 100, 300, or 500°/sec. Three of the nine tested subjects also generated 0.2 Newton meter voluntary flexion torque in preloading tasks before stretch. At 300°/sec stretch, electromyogram (EMG) and torque reflex responses, which were observed in the finger flexors in four of nine subjects during motor imagery, were activated at a short latency (38.6 ± 10.6 msec). This latency was similar to that recorded during a stretch of preactivated flexor muscles (34.4 ± 3.6 msec), in which motoneurons are already suprathreshold and in which monosynaptic effects of muscle afferents are likely to be discernable. In a similar manner, for stretches imposed at 500°/sec, responses to stretch of the flexors were observed in all five tested subjects in imaginary flexion tasks at very short latencies (26.4 ± 3.7 msec), again similar to those induced by tendon taps (22.8 ± 1.2 msec). No EMG response was observed at rest during stretches. These observations support the view that effects must have been mediated by imagery-related subthreshold activation of spinal motoneurons and/or interneurons, rather than by long-latency transcortical reflex responses. We conclude that motor imagery has a potent effect on the excitability of spinal reflex pathways.

Simulation of Bilateral Movement Training Through Mirror Reflection: A Case Report Demonstrating an Occupational Therapy Technique for Hemiparesis

Abstract In rehabilitation for hemiparesis, one of the goals of an occupational therapist is to practice upper extremity tasks with the recovering individual. The practice is intended to strengthen muscles and refine movements. It also provides examples for the recovering body and brain as they attempt to reestablish the now delicate cognitive and neural connections mediating voluntary behavior. However, the paresis significantly limits the movement sequence possibilities that may be physically practiced. We outline a method for using simulation of movement, which is intended to provide a means for experiencing a range of smooth and controlled movements completed by a paretic limb. The simulation provides a compelling perceptual experience of bilateral motion beyond the current capabilities of the affected limb. The benefits of this technique after a 3-week course of the simulation practice are exemplified by the presented case study that reveals improved function as demonstrated by increases in Fugl-Meyer scores and faster movement speeds as demonstrated by decreased movement times for the Jebsen test of hand function.

Planning to Reach for an Object Changes How the Reacher Perceives It

Three experiments assessed the influence of the Ebbinghaus illusion on size judgments that preceded verbal, grasp, or touch responses. Prior studies have found reduced effects of the illusion for the grip-scaling component of grasping, and these findings are commonly interpreted as evidence that different visual systems are employed for perceptual judgment and visually guided action. In the current experiments, the magnitude of the illusion was reduced by comparable amounts for grasping and for judgments that preceded grasping (Experiment 1). A similar effect was obtained prior to reaching to touch the targets (Experiment 2). The effect on verbal responses was apparent even when participants were simply instructed that a target touch task would follow the verbal task. After participants had completed a grasping task, the reduction in the magnitude of the illusion remained for a subsequent verbal-response judgment task (Experiment 3). Overall, the studies demonstrate strong connections between action planning and perception.

Interactions between imagined movement and the initiation of voluntary movement: a TMS study.

OBJECTIVE The purpose was to examine motor imagery-induced enhancement in corticospinal excitability during a reaction time (RT) task. METHODS Nine young and healthy subjects performed an isometric finger flexion tasks in response to a visual imperative cue. In the pre-cue period, they were instructed to: (1) rest; (2) imagine flexing their fingers isometrically (ImFlex); or (3) imagine extending their fingers isometrically (ImExt). Surface EMGs from the finger flexors and extensors were monitored to ensure EMG silence before movement onset. Transcranial magnetic stimulation (TMS) was used to evaluate changes in motor-evoked potentials (MEP) in the finger flexor and extensor muscles during the response phase. TMS was delivered either with the imperative cue, or 120 ms before and after the imperative cue. RESULTS RT was slower when they were imagining finger extension prior to the visual imperative cue. MEPs were significantly increased for the finger flexors during imagined finger flexion and for the finger extensors during imagined finger extension at both TMS delivery time points, reflecting movement specific enhancement in corticospinal excitability during motor imagery. When TMS was delivered 120 ms after the cue, finger flexor MEPs were further facilitated under the Rest and ImFlex conditions, but not under the ImExt condition, suggesting additive interactions between imagery-induced enhancement and early rise in corticospinal excitability during the initiation of a reaction time response. CONCLUSIONS Our results provide neurophysiological evidence mediating dynamic interactions between imagined movement and the initiation of voluntary movement. SIGNIFICANCE Motor imagery can be integrated into a rehabilitation protocol to facilitate motor recovery.

Using touch or imagined touch to compensate for loss of proprioception: A case study

Proprioception is the sense of the position of ones own body. Here, we present a case study of an individual with proprioceptive loss in one limb consequent to stroke. The patient indicated that merely touching his impaired arm with his unimpaired arm temporarily restored his proprioception. We examined this claim and the effects of imagined touch by the unimpaired arm. Assessments were made using three-dimensional tracking of reaching trajectories towards targets in conditions of light and darkness. Both actual and imagined touching significantly reduced movement error and jerk, specifically for targets located in regions that both hands would be able to reach.

Graphical passwords for older computer users

Traditional text password authentication is widely used to gain access to computing resources. Older users find the cognitive effort, and manual dexterity skills needed to use strong text passwords challenging. We designed and evaluated our Graphical Password system based on touchscreen selection of familiar facial images embedded randomly among unfamiliar, yet similar images. In our usability study, older users demonstrated a recall rate of 97%, password entropy superior to short PINs, and authentication time comparable to short text passwords.

How preparation to touch or grasp alters visual size perception.

Prior studies have suggested that visually guided actions are resistant to the effects of some pictorial size illusions, e.g., the maximum grip aperture component of a grasp for an element of the Ebbinghaus illusion display. We present evidence that when participants prepare to grasp, the reduction in illusion magnitude observed for action components is also present for conscious perceptual judgments. Our studies characterize how visual size perception changes when we choose to engage in different size-mediated behaviors. Even when the stimuli used were identical for two different tasks, we found that available information was processed differently. In the studies, participants always selected which of the two targets was larger. In some conditions, the context in which the targets were presented induced a visual illusion of size. We varied the sizes of target pairs to assess the magnitude of these visual illusions. In some tasks, participants indicated their size choice verbally. For other tasks, participants reached to grasp or touch the target that they perceived as larger. Illusion magnitudes were smaller when participants engaged in actions directed at a target or when participants imagined performing those actions. This shift in visual processing persisted for several minutes after participants switched back to a verbal, non-grasping, non-touch task. A motor interference task eliminated the reduction in illusion magnitude.