Mu Rhythm Desynchronization while Observing Rubber Hand Movement in the Mirror: The Interaction of Body Representation with Visuo-Tactile Stimulation.

During rubber hand illusion (RHI), participants feel that a rubber (fake) hand is their own (i.e., embodiment of the rubber hand) if the unseen real hand and seen rubber hand are stroked synchronously (i.e., visuo-tactile stimuli). The RHI is also evoked if the real and rubber hands are placed in the same position (i.e., visual-proprioceptive congruency), which can be performed using a mirror setting. Using electroencephalography (EEG) and mirror settings, we compared µ rhythm (8-13 Hz) event-related desynchronization (ERD; an index of sensorimotor activation) while watching the movements of embodied or non-embodied rubber hands, which was preceded by an observation of the rubber hand with or without synchronous visuo-tactile stimuli. The illusory ownership of the fake hand was manipulated using visual continuity with (RHI) and without (non-RHI) a fake forearm. Resultantly, an ownership-dependent µ rhythm ERD was found when delivering visuo-tactile stimuli; a greater and more persistent µ rhythm ERD during the rubber hand movement was identified in the RHI in comparison to the non-RHI condition. However, no difference was observed between the two when observing the fake hand alone. These findings suggest the possibility that a self-related multisensory interaction between body representation (top-down processing) and visuo-tactile inputs (bottom-up processing) before a fake hand movement produces ownership-dependent sensorimotor activations during subsequent movement observations.

Tactile temporal order judgment during rubber hand illusion: Distinct modulation of the point of subjective simultaneity and temporal resolution.

During the rubber hand illusion (RHI), individuals feel a fake hand as their own (ownership) and a perceived position of their real hand shifts toward the fake hand (proprioceptive drift; PD), which represents updating of multisensory hand representations. Bimanual tactile temporal order judgment (TOJ) includes processes of localizing tactile stimuli in space, for which multisensory hand representations are essential. According to the common processes, we examined tactile TOJ performance during the RHI and non-RHI. Temporal resolution (TR) as TOJ accuracy worsened during the non-RHI compared to the RHI. Additionally, a significant correlation between TR and PD was observed only in the non-RHI condition. However, the point of subjective simultaneity (PSS), which offers relative weighting of tactile inputs from the right and left hands, was correlated with illusory hand ownership. These results suggest that PSS and TR from tactile TOJ during RHI relate to self-attribution and localization of the hand, respectively.

Subcortical Contribution of Corticospinal Transmission during Visually Guided Switching Movements of the Arm.

In animal experiments, the indirect corticospinal tract (CST) system via cervical interneurons has been shown to mediate motor commands for online adjustment of visuomotor behaviors, such as target-reaching. However, it is still unclear whether the similar CST system functions to perform similar motor behaviors in humans. To clarify this, we investigated changes in motor-evoked potentials (MEPs) in the elbow muscles following transcranial magnetic stimulation, transcranial electrical stimulation, or cervicomedullary stimulation while participants executed target-reaching and switching movements. We found that the MEP, whether elicited cortically or subcortically, was modulated depending on the direction of the switching movements. MEP facilitation began around the onset of the switching activities in an agonist muscle. Furthermore, ulnar nerve-induced MEP facilitation, which could be mediated by presumed cervical interneuronal systems, also increased at the onset of MEP facilitation. In a patient with cortical hemianopsia who showed switching movements in the scotoma, the MEPs were facilitated just before the switching activities. Our findings suggested that CST excitation was flexibly tuned with the switching movement initiation, which could partly take place in the subcortical networks, including the presumed cervical interneuronal systems.

Predictability of Delayed Visual Feedback Under Rubber Hand Illusion Modulates Localization but Not Ownership of the Hand.

The rubber hand illusion (RHI) is a perceptual illusion, whereby a fake hand is recognized as one's own hand when a fake hand and felt real hand are stroked synchronously. RHI strength is mainly assessed using a questionnaire rating and proprioceptive drift (PD). PD is characterized by the proprioceptively sensed location of the participant's own hand shifting toward the location of the fake hand after RHI. However, the relationship between the two measures of hand ownership and location remains controversial due to mixed findings: some studies report correlations between them, while others show that they are independent. Here, we demonstrated significant PD without RHI using delayed visual feedback. In this RHI study, video images of the fake hand were delivered to the subjects, and four delay intervals of visual feedback (80, 280, 480, and 680ms) were introduced. In four of six conditions, the delay interval was fixed throughout the condition. In the other two conditions, four delays were delivered in a predetermined order (i.e., serial condition; higher predictability) or in a pseudo-random order (i.e., random condition; low predictability). For the four conditions with a fixed delay, the questionnaire ratings and PD declined significantly when the delay interval exceeded circa 300ms. In both the serial and random conditions, no illusory ownership of the fake hand was reported in the questionnaire. In contrast, greater PD was found in the random condition but not in the serial condition. Our findings suggest that hand ownership and localization are caused by distinct multisensory integration processes.

Distinct modulation of mu and beta rhythm desynchronization during observation of embodied fake hand rotation.

The rubber hand illusion (RHI) is a phenomenon whereby participants recognize a fake hand as their own. Studies have examined the effects of observing fake hand movements after the RHI on brain sensorimotor activity, although results remain controversial. To address these discrepancies, we investigated the effects of observation of fake hand rotation after the RHI on sensorimotor mu (µ: 8-13 Hz) and beta (ß: 15-25 Hz) rhythm event-related desynchronization (ERD) using electroencephalography (EEG). Questionnaire results and proprioceptive drift revealed that the RHI occurred in participants when their invisible hand and fake visible hand were stroked synchronously but not during asynchronous stroking. Independent component (IC) clustering from EEG data during movement observation identified three IC clusters, including the right sensorimotor, left sensorimotor, and left occipital cluster. In the right sensorimotor cluster, we observed distinct modulation of µ and ß ERD during fake hand rotation. Illusory ownership over the fake hand enhanced µ ERD but inversely attenuated ß ERD. Further, the extent of µ ERD correlated with proprioceptive drift, but not with questionnaire ratings, whereas the converse results were obtained for ß ERD. No ownership-dependent ERD modulation was detected in the left sensorimotor cluster. Alpha (α: 8-13 Hz) rhythm ERD of the left occipital cluster was smaller in the synchronous condition than in the asynchronous condition, but α ERD was not correlated with questionnaire rating or drift. These findings suggest that observing embodied fake hand rotation induces distinct cortical processing in sensorimotor brain areas.

Visual information increases the indirect corticospinal excitation via cervical interneurons in humans.

Modulatory actions of inputs from the visual system to cervical interneurons (IN) for arm muscle control are poorly understood in humans. In the present study, we examined whether visual stimulation modulates the excitation of cervical IN systems mediating corticospinal tract (CST) inputs to biceps brachii (BB). Twenty-eight healthy volunteers were seated, and electromyogram recordings from the BB were performed across six experiments, each with discrete objectives. A flash stimulator for visual stimulation (50-µs duration) was placed 60 cm from the participant's eye. The CST was stimulated with transcranial magnetic/electrical stimulation (TMS/TES, respectively) contralateral to the recording site. Visual stimulation with TMS/TES was randomly delivered during weak tonic BB contractions. Single TMS/TES-induced motor-evoked potentials (MEPs) were markedly enhanced from 60-100 ms after visual stimulation compared with the control condition. The MEPs were significantly increased by combining the electrical stimulation of the ulnar nerve at the wrist [7.5-12 ms of nerve stimulation (NERVE)/TMS interval] with and without visual stimulation compared with the algebraic summation of responses obtained with either TMS or NERVE. Interestingly, the combined stimulation-induced MEP facilitation was significantly increased after visual stimulation compared with the control. Single motor unit (MU) recording also revealed the further enhancement of combined stimulation effects on the firing probabilities of MU during visual stimulation, which was observed in the peaks of the peristimulus time histogram, 1-2 ms later than the onset latency. The present findings suggest that visual stimulation facilitates the oligosynaptic CST excitation of arm motoneurons mediated by the cervical IN system.NEW & NOTEWORTHY To date, little is known about how visual information modulates the human cervical motor systems, including the presumed interneuron (IN) circuitry. This study demonstrates that photic visual stimulation influences presumed oligosynaptic corticospinal transmission to arm motoneurons, which are mediated by cervical INs. In animals, these systems are known to be crucial for visually guided switching movements, and similar visual input systems to INs may exist in humans.

Motor imagery enhances corticospinal transmission mediated by cervical premotoneurons in humans.

Motor imagery is known to affect the reacquisition of motor functioning after damage to the central nervous system. However, it remains unclear whether motor imagery influences corticospinal (CST) excitation mediated via cervical premotoneurons, which may be important for functional motor recovery in animals and humans. To investigate this, we examined the spatial facilitation of motor-evoked potentials (MEPs) induced by combined stimulation (CS) of CST and peripheral nerves. Thirty-two healthy volunteers were included and electromyograms from the biceps brachii (BB) were recorded. Transcranial magnetic stimulation (TMS) to motor cortex and electrical stimulation of ulnar nerve at wrist (NERVE) were delivered separately or in combination with 6-15 ms of interstimulus intervals (ISIs). Subjects were instructed to imagine performing an elbow flexion at rest and during tonic BB contraction. During both motor imagery and control tasks, CS (7.5-12 ms of ISIs) facilitated MEPs, compared with the mathematical summation of responses obtained with either only TMS or NERVE (P < 0.01). Interestingly, the CS-induced facilitation was significantly increased by motor imagery compared with control (P < 0.01). Single-motor unit recording also revealed increased facilitation during motor imagery, which was observed in peaks of the peristimulus time histogram 1-2 ms later than the onset latency (P < 0.01). The present findings suggest that motor imagery facilitates oligosynaptic CST excitation of arm motoneurons, mediated by cervical premotoneurons. Thus motor imagery may be a useful tool for activating the premotoneuron systems, which may contribute to motor reacquisition.NEW & NOTEWORTHY Imaging movement has positive effects on the reacquisition of motor functions after damage to the central nervous system. This study shows that motor imagery facilitates oligosynaptic corticospinal excitation that is mediated via cervical premotoneurons, which may be important for motor recovery in monkeys and humans. Current findings highlight how this imagery might be a beneficial tool for movement disorders through effects on premotoneuron circuitry.

Sensorimotor and Posterior Brain Activations During the Observation of Illusory Embodied Fake Hand Movement.

In the rubber hand illusion (RHI), the subject recognizes a fake hand as his or her own. We recently found that the observation of embodied fake hand movement elicited mu-rhythm (8-13 Hz) desynchronization on electroencephalography (EEG), suggesting brain activation in the sensorimotor regions. However, it is known that mu-rhythm desynchronization during action observation is confounded with occipital alpha-rhythm desynchronization, which is modulated by attention. This study examined the independence of brain activities in the sensorimotor and occipital regions relating to the movement observation under the RHI. The invisible participant's left and fake right hands were stroked simultaneously, which was interrupted by unexpected fake hand movements. A mirror-reversed image of the fake hand was shown on a monitor in front of the participant with a delay of 80, 280, or 480 ms. Illusion strength decreased as a function of the delay. EEG independent component analysis (ICA) and ICA clustering revealed six clusters with observation-induced desynchronization of 8-13 Hz frequency band. In the right sensorimotor cluster, mu-rhythm desynchronization was the greatest under the 80-ms delay, while alpha-rhythm desynchronization of the occipital clusters did not show delay-dependence. These results suggest that brain activation in the sensorimotor areas (i.e., mu-rhythm desynchronization) induced by embodied fake hand movement is independent of that in the occipital areas (alpha-rhythm desynchronization).

The Relationship Between the Virtual Hand Illusion and Motor Performance.

Bodily self-consciousness consists of agency (i.e., the feeling of controlling one's actions and causing external events) and body ownership (i.e., the feeling that one's body belongs to one's self). If a visual presentation of a virtual (fake) hand matches the active movement of a real hand, both the agency and body ownership of the virtual hand are induced [i.e., the active virtual hand illusion (VHI)]. However, previous active VHI studies have rarely considered the effects of goal-related movement errors (i.e., motor performance) on the senses of agency and ownership. Hence, the current study aimed to clarify the relationship between the active VHI and motor performance. To induce the VHI, 18 healthy subjects (three men and 15 women; 20.7 ± 7.3 years) were required to continuously move a virtual hand around a circle at a predetermined speed (i.e., spatial and temporal goals) using their active hand movements. While moving the virtual hand actively, five visual feedback delays were introduced: 90, 210, 330, 450, and 570 ms. It was found that the subjective ratings of both the agency and body ownership of the virtual hand decreased as a function of the delay intervals, whereas most of the spatial and temporal movement errors linearly increased. Using multiple regression analyses, we examined whether the agency and ownership ratings could be explained effectively by both the delay and movement errors. The results demonstrated that the agency was determined not only by the delay but also by the movement variability, whereas the body ownership was mostly determined by the delay. These findings suggest a possibility that the goal-related motor performance of the active VHI influences the agency judgment more strongly, while its effect on the ownership judgment is weaker.

Hand Dexterity Impairment in Patients with Cervical Myelopathy: A New Quantitative Assessment Using a Natural Prehension Movement.

Cervical myelopathy (CM) caused by spinal cord compression can lead to reduced hand dexterity. However, except for the 10 sec grip-and-release test, there is no objective assessment system for hand dexterity in patients with CM. Therefore, we evaluated the hand dexterity impairment of patients with CM objectively by asking them to perform a natural prehension movement. Twenty-three patients with CM and 30 age-matched controls were asked to reach for and grasp a small object with their right thumb and index finger and to subsequently lift and hold it. To examine the effects of tactile afferents from the fingers, objects with surface materials of differing textures (silk, suede, and sandpaper) were used. All patients also underwent the Japanese Orthopedic Association (JOA) test. Preoperative patients showed significantly greater grip aperture during reach-to-grasp movements and weaker grip force than controls only while attempting to lift the most slippery object (silk). Patients, immediately after surgery, (n = 15) tended to show improvements in the JOA score and in reaction time and movement time with respect to reaching movements. Multiple regression analysis demonstrated that some parameters of the prehension task could successfully predict subjective evaluations of dexterous hand movements based on JOA scores. These results suggest that quantitative assessments using prehension movements could be useful to objectively evaluate hand dexterity impairment in patients with CM.

Spontaneous imitative movements induced by an illusory embodied fake hand.

In the rubber hand illusion (RHI), individuals perceive a fake hand as their own when the hidden real hand and visible fake hand are synchronously stroked. Several RHI studies have reported that visual manipulation of the embodied fake hand inversely affects the perceptual processing of the observer's own hand (e.g., thermal or pain sensitivity). In this study, we examined whether motor manipulation of the fake hand similarly affects the observer's motor system. Our study employed a novel RHI paradigm wherein stroking was interrupted by unexpected movement of the fake hand (i.e., finger spreading) while measuring electroencephalography (EEG). We found that participants often spontaneously moved their hands in accordance with the movement of the fake hand only in the RHI (synchronous) sessions. EEG analyses revealed enhanced neural activation (mu-rhythm desynchronization) of the motor system during observation of the fake hand movement. Moreover, motor activation was greater in the synchronous than in the asynchronous condition and significantly correlated with the feeling of body ownership over the fake hand. These findings provide strong behavioral and neurophysiological evidence of 'motor back projection', in which the movement of an illusory embodied body part is inversely transferred to the sensorimotor system of the observer.

Vestibular stimulation-induced facilitation of cervical premotoneuronal systems in humans.

It is unclear how descending inputs from the vestibular system affect the excitability of cervical interneurons in humans. To elucidate this, we investigated the effects of galvanic vestibular stimulation (GVS) on the spatial facilitation of motor-evoked potentials (MEPs) induced by combined pyramidal tract and peripheral nerve stimulation. To assess the spatial facilitation, electromyograms were recorded from the biceps brachii muscles (BB) of healthy subjects. Transcranial magnetic stimulation (TMS) over the contralateral primary motor cortex and electrical stimulation of the ipsilateral ulnar nerve at the wrist were delivered either separately or together, with interstimulus intervals of 10 ms (TMS behind). Anodal/cathodal GVS was randomly delivered with TMS and/or ulnar nerve stimulation. The combination of TMS and ulnar nerve stimulation facilitated BB MEPs significantly more than the algebraic summation of responses induced separately by TMS and ulnar nerve stimulation (i.e., spatial facilitation). MEP facilitation significantly increased when combined stimulation was delivered with GVS (p < 0.01). No significant differences were found between anodal and cathodal GVS. Furthermore, single motor unit recordings showed that the short-latency excitatory peak in peri-stimulus time histograms during combined stimulation increased significantly with GVS. The spatial facilitatory effects of combined stimulation with short interstimulus intervals (i.e., 10 ms) indicate that facilitation occurred at the premotoneuronal level in the cervical cord. The present findings therefore suggest that GVS facilitates the cervical interneuron system that integrates inputs from the pyramidal tract and peripheral nerves and excites motoneurons innervating the arm muscles.

Reassessment of Non-Monosynaptic Excitation from the Motor Cortex to Motoneurons in Single Motor Units of the Human Biceps Brachii.

Corticospinal excitation is mediated by polysynaptic pathways in several vertebrates, including dexterous monkeys. However, indirect non-monosynaptic excitation has not been clearly observed following transcranial electrical stimulation (TES) or cervicomedullary stimulation (CMS) in humans. The present study evaluated indirect motor pathways in normal human subjects by recording the activities of single motor units (MUs) in the biceps brachii (BB) muscle. The pyramidal tract was stimulated with weak TES, CMS, and transcranial magnetic stimulation (TMS) contralateral to the recording side. During tasks involving weak co-contraction of the BB and hand muscles, all stimulation methods activated MUs with short latencies. Peristimulus time histograms (PSTHs) showed that responses with similar durations were induced by TES (1.9 ± 1.4 ms) and CMS (2.0 ± 1.4 ms), and these responses often showed multiple peaks with the PSTH peak having a long duration (65.3% and 44.9%, respectively). Such long-duration excitatory responses with multiple peaks were rarely observed in the finger muscles following TES or in the BB following stimulation of the Ia fibers. The responses obtained with TES were compared in the same 14 BB MUs during the co-contraction and isolated BB contraction tasks. Eleven and three units, respectively, exhibited activation with multiple peaks during the two tasks. In order to determine the dispersion effects on the axon conduction velocities (CVs) and synaptic noise, a simulation study that was comparable to the TES experiments was performed with a biologically plausible neuromuscular model. When the model included the monosynaptic-pyramidal tract, multiple peaks were obtained in about 34.5% of the motoneurons (MNs). The experimental and simulation results indicated the existence of task-dependent disparate inputs from the pyramidal tract to the MNs of the upper limb. These results suggested that intercalated interneurons are present in the spinal cord and that these interneurons might be equivalent to those identified in animal experiments.

Body ownership and agency: task-dependent effects of the virtual hand illusion on proprioceptive drift.

Body ownership and agency are fundamental to self-consciousness. These bodily experiences have been intensively investigated using the rubber hand illusion, wherein participants perceive a fake hand as their own. After presentation of the illusion, the position of the participant's hand then shifts toward the location of the fake hand (proprioceptive drift). However, it remains controversial whether proprioceptive drift is able to provide an objective measurement of body ownership, and whether agency also affects drift. Using the virtual hand illusion (VHI), the current study examined the effects of body ownership and agency on proprioceptive drift, with three different visuo-motor tasks. Twenty healthy adults (29.6 ± 9.2 years old) completed VH manipulations using their right hand under a 2 × 2 factorial design (active vs. passive manipulation, and congruent vs. incongruent virtual hand). Prior to and after VH manipulation, three different tasks were performed to assess proprioceptive drift, in which participants were unable to see their real hands. The effects of the VHI on proprioceptive drift were task-dependent. When participants were required to judge the position of their right hand using a ruler, or by reaching toward a visual target, both body ownership and agency modulated proprioceptive drift. Comparatively, when participants aligned both hands, drift was influenced by ownership but not agency. These results suggest that body ownership and agency might differentially modulate various body representations in the brain.

Soleus Hoffmann reflex amplitudes are specifically modulated by cutaneous inputs from the arms and opposite leg during walking but not standing.

Electrical stimulation of cutaneous nerves innervating heteronymous limbs (the arms or contralateral leg) modifies the excitability of soleus Hoffmann (H-) reflexes. The differences in the sensitivities of the H-reflex pathway to cutaneous afferents from different limbs and their modulation during the performance of motor tasks (i.e., standing and walking) are not fully understood. In the present study, we investigated changes in soleus H-reflex amplitudes induced by electrical stimulation of peripheral nerves. Selected targets for conditioning stimulation included the superficial peroneal nerve, which innervates the foot dorsum in the contralateral ankle (cSP), and the superficial radial nerve, which innervates the dorsum of the hand in the ipsilateral (iSR) or contralateral wrist (cSR). Stimulation and subsequent reflex assessment took place during the standing and early-stance phase of treadmill walking in ten healthy subjects. Cutaneous stimulation produced long-latency inhibition (conditioning-test interval of ~100 ms) of the H-reflex during the early-stance phase of walking, and the inhibition was stronger following cSP stimulation compared with iSR or cSR stimulation. In contrast, although similar conditioning stimulation significantly facilitated the H-reflex during standing, this effect remained constant irrespective of the different conditioning sites. These findings suggest that cutaneous inputs from the arms and contralateral leg had reversible effects on the H-reflex amplitudes, including inhibitions with different sensitivities during the early-stance phase of walking and facilitation during standing. Furthermore, the differential sensitivities of the H-reflex modulations were expressed only during walking when the locations of the afferent inputs were functionally relevant.

Maladaptive change of body representation in the brain after damage to central or peripheral nervous system.

Our brain has great flexibility to cope with various changes in the environment. Use-dependent plasticity, a kind of functional plasticity, plays the most important role in this ability to cope. For example, the functional recovery of paretic limb motor movement during post-stroke rehabilitation depends mainly on how much it is used. Patients with hemiparesis, however, tend to gradually disuse the paretic limb because of its motor impairment. Decreased use of the paretic hand then leads to further functional decline brought by use-dependent plasticity. To break this negative loop, body representation, which is the conscious and unconscious information regarding body state stored in the brain, is key for using the paretic limb because it plays an important role in selecting an effector while a motor program is generated. In an attempt to understand body representation in the brain, we reviewed animal and human literature mainly on the alterations of the sensory maps in the primary somatosensory cortex corresponding to the changes in limb usage caused by peripheral or central nervous system damage.

Phase-dependent reversal of the crossed conditioning effect on the soleus Hoffmann reflex from cutaneous afferents during walking in humans.

We previously demonstrated that non-noxious electrical stimulation of the cutaneous nerve innervating the contralateral foot modified the excitability of the Hoffmann (H-) reflex in the soleus muscle (SOL) in a task-dependent manner during standing and walking in humans. To date, however, it remains unclear how the crossed conditioning effect on the SOL H-reflex from the contralateral foot is modified during the various phases of walking. We sought to answer this question in the present study. The SOL H-reflex was evoked in healthy volunteers by an electrical test stimulation (TS) of the right (ipsilateral) posterior tibial nerve at five different phases during treadmill walking (4 km/h). A non-noxious electrical stimulation was delivered to the superficial peroneal nerve of the left (contralateral) ankle ~100 ms before the TS as a conditioning stimulation (CS). This CS significantly suppressed the H-reflex amplitude during the early stance phase, whereas the same CS significantly facilitated the H-reflex amplitude during the late stance phase. The CS alone did not produce detectable changes in the full-wave rectified electromyogram of the SOL. This result indicates that presynaptic mechanisms driven by the activation of low-threshold cutaneous afferents in the contralateral foot play a role in regulating the transmission between the Ia terminal and motoneurons in a phase-dependent manner. The modulation pattern of the crossed conditioning effect on the SOL H-reflex may be functionally relevant for the left-right coordination of leg movements during bipedal walking.

Effect of transient vascular occlusion of the upper arm on motor evoked potentials during force exertion.

We previously observed that transient vascular occlusion in volunteers increased the estimation of force exertion with no change in peripheral nerves or muscles. We hypothesized that the primary factor responsible for the overestimation of force exertion during occlusion was the centrally generated motor command, as hypothesized by McCloskey et al. (1974) and McCloskey (1978, 1981). In the present study, we tested the hypothesis that transient vascular occlusion increases the excitability of the primary motor cortex (M1) during force exertion. Healthy human volunteers lay on a bed and squeezed a dynamometer in their right hand. Repetitive gripping forces were exerted at 20%, 40%, or 60% of maximum force, with or without transient (20s) vascular occlusion of the proximal portion of the right upper arm. During the task, single-pulse transcranial magnetic stimulation was applied to the contralateral M1 to induce motor evoked potentials (MEPs) in the flexor carpi ulnaris (FCU) muscle. The MEP amplitudes were enhanced with occlusion under all conditions, with the exception of 60% contraction. In contrast, no significant difference was observed between the MEP amplitudes obtained from the occluded or non-occluded, relaxed FCU muscle. These results suggest that transient vascular occlusion increases the excitability of M1 only during force exertion.

Functional assessment of proximal arm muscles by target-reaching movements in patients with cervical myelopathy.

BACKGROUND CONTEXT: In animal studies, distal and proximal arm movements are differently affected by spinal pyramidotomy because of the contributions of spinal interneuronal systems. In animals, interneuronal systems are also suggested to contribute to the recovery of dexterous hand movements. However, no clinical tests to evaluate proximal arm movements and functions of interneuronal systems have been described. PURPOSE: To compare parameters from proximal arm movements between patients and controls and in patients before and after decompression surgery. STUDY DESIGN: A cross-sectional and longitudinal study performed at Kyorin University School of Medicine, Japan. PATIENT SAMPLE: Patients with clinical features of cervical spondylotic myelopathy, without coexisting neurological abnormality. METHODS: Twenty-eight patients and 15 age-matched controls performed reach-to-touch movements. Analysis of these movements identified several parameters, including time for online correction (correction time) induced by sudden target jump. Parameters were compared with scores from conventional tests, such as Japanese Orthopedic Association (JOA) score, 10-second grip-and-release test, manual muscle testing, and motor-evoked potential. RESULTS: Preoperatively, patients showed long correction time and variable touch position, neither of which correlated with any scores from conventional tests. Reaching parameters recovered markedly immediately after decompression surgery, whereas conventional scores, which mainly assess hand functions, recovered much more slowly. Correction time and JOA score showed correlations when postoperative data were included, and long-term recovery of JOA score was more predictable with the inclusion of data for correction times from before and immediately after surgery. CONCLUSION: Analysis of arm movements is useful to evaluate symptoms and predict recovery of hand functions after surgery in patients with cervical myelopathy. These results suggest the importance of interneuronal systems, in addition to the pyramidal tract, for motor control even in humans.

Direct and indirect cortico-motoneuronal pathways and control of hand/arm movements.

Recent studies from our group have demonstrated the existence of a disynaptic excitatory cortico-motoneuronal (CM) pathway in macaque monkeys via propriospinal neurons in the midcervical segments. Results from behavioral studies with lesion of the direct pathway suggest that the indirect CM pathway can mediate the command for dexterous finger movements.