The application of neuromuscular electrical stimulation (NMES) to paretic limbs has demonstrated utility for motor rehabilitation following brain injury. When NMES is delivered to a mixed peripheral nerve, typically both efferent and afferent fibres are recruited. Muscle contractions brought about by the excitation of motor neurons are often used to compensate for disability by assisting actions such as the formation of hand aperture, or by preventing others including foot drop. In this context, exogenous stimulation provides a direct substitute for endogenous neural drive. The goal of the present narrative review is to describe the means through which NMES may also promote sustained adaptations within central motor pathways, leading ultimately to increases in (intrinsic) functional capacity. There is an obvious practical motivation, in that detailed knowledge concerning the mechanisms of adaptation has the potential to inform neurorehabilitation practice. In addition, responses to NMES provide a means of studying CNS plasticity at a systems level in humans. We summarize the fundamental aspects of NMES, focusing on the forms that are employed most commonly in clinical and experimental practice. Specific attention is devoted to adjuvant techniques that further promote adaptive responses to NMES thereby offering the prospect of increased therapeutic potential. The emergent theme is that an association with centrally initiated neural activity, whether this is generated in the context of NMES triggered by efferent drive or via indirect methods such as mental imagery, may in some circumstances promote the physiological changes that can be induced through peripheral electrical stimulation.

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Neuromuscular electrical stimulation-promoted plasticity of the human brain.

The extrastriate body area (EBA) processes visual information about body parts, and it is considered one among a series of category-specific perceptual modules distributed across the occipito-temporal cortex. However, recent evidence raises the possibility that EBA might also provide an interface between perception and action, linking the ventral and dorsal streams of visual information processing. Here, we assess anatomical evidence supporting this possibility. We localise EBA in individual subjects using a perceptual task and compare the characteristics of its functional and structural connectivity to those of two perceptual areas, the lateral occipital complex (LOC) and the fusiform body area (FBA), separately for each hemisphere. We apply complementary analyses of resting-state fMRI and diffusion-weighted MRI data in a group of healthy right-handed human subjects (N = 31). Functional and structural connectivity profiles indicate that EBA interacts more strongly with dorsal-stream regions compared to other portions of the occipito-temporal cortex involved in processing body parts (FBA) and object identification (LOC). These findings provide anatomical ground for a revision of the functional role of EBA. Building on a number of recent observations, we suggest that EBA contributes to planning goal-directed actions, possibly by specifying a desired postural configuration to parieto-frontal areas involved in computing movement parameters.

/pdf/is-the-extrastriate-body-area-part-of-the-dorsal-visuomotor-4kz0hd874b.pdf

Is the extrastriate body area part of the dorsal visuomotor stream

The present randomised placebo controlled trial explored the extent to which osteopathic manipulative treatment (OMT) affects brain activity, particularly the insula, during both an "interoceptive awareness" and "exteroceptive awareness" task in a sample of 32 right-handed adults with chronic Low Back Pain (CLBP) randomly assigned to either the OMT or sham group. Patients received 4 weekly sessions and fMRI was performed at enrolment (T0), immediately after the first session (T1) and at 1 month (T2). The results revealed that the OMT produced a distinct and specific reduction in BOLD response in specific brain areas related to interoception, i.e., bilateral insula, ACC, left striatum and rMFG. The observed trend across the three time points appears uncharacteristic. At T1, a marginal increase of the BOLD response was observed in all the above-mentioned areas except the rMFG, which showed a decrease in BOLD response. At T2, the response was the opposite: areas related to interoception (bilateral insula and ACC) as well as the rMFG and left striatum demonstrated significant decreased in BOLD response. The findings of this study provide an insight into the effects of manual therapies on brain activity and have implications for future research in the field.

/pdf/effect-of-manual-approaches-with-osteopathic-modality-on-2aa099se5m.pdf

Giorgos Kalaitzakis

Papers

Neural foundations of overt and covert actions.