Fig. 11.1
The target task is to rotate two cork balls as fast as possible in a counterclockwise direction with the left hand. The dexterity of the motor performance of the left hand was examined by counting the number of two-ball rotations during 30 s. After the experiments, one of the experimenters, who was blind to the participants’ status, reviewed the video recording and counted the number of rotations. In addition to behavioral parameters, MEP amplitudes were measured by TMS to assess corticospinal excitability before and after intervention (a). It shows that the number of ball rotations performed by the left hand and the mean MEP amplitude increased significantly after the MVF condition (b). Correlation between M1 plasticity and behavioral improvement were significantly correlated (c)
Fig. 11.2
We used cTBS to provide functional interference over the right M1 or occipital area as control to confirm the functional relevance of the M1 in the motor improvement induced by MVF. The cTBS was applied just after MVF intervention. For cTBS, TMS was delivered as 200 bursts of three pulses at 5 Hz given in a continuous train and an intensity of 80 % active motor threshold. The results showed that the number of ball rotations for the cTBS at the M1 creased significantly after the first and second MVF condition (Post1 and Post3), but not after cTBS (Post2). The mean MEP amplitude revealed a similar pattern of behavior, with significant increases at Post1 and Post3 compared with Pre
Fig. 11.3
Two patients with corpus callosum lesion participated in our study. These two patients showed impairment in test of cross-localization of finger tips (CLF), which constitute the hallmark of the interhemispheric disconnection syndrome
The potential role of somatosensory stimulation as a means to dynamically modulate the organization of the motor cortex has been postulated during the past years [16, 93–95]. It has been reported that a short period of electrical stimulation is sufficient to trigger changes in the M1 representation in neurologically intact individuals [96–98]. Further exploration has strengthened the understanding that electrical peripheral nerve stimulation is a powerful tool to induce sustained excitability increases as well as rapidly evolving neuroplastic changes of the human motor cortex [99, 100]. Passive movement is also applied as a proprioceptive stimulation in neurorehabilitation. This technique of somatosensory stimulation has been found to generate cortical activity in both sensory and motor cortical areas in humans [101, 102] and/or induce persistent neuroplastic changes of the sensorimotor representation when administered repeatedly.
In rehabilitation field, some new interventions to optimize training strategies after brain lesion have been proposed in the past few years such as constraint-induced movement therapy [103–105], bilateral arm training [106], mirror therapy [70, 71], and robotic-based approached [107–109]. Additionally, other new technical approaches have been suggested to facilitate the beneficial effects of training on motor learning in the setting of rehabilitation such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). These noninvasive brain stimulation techniques have been used to explore possible causal relations between activity in specific brain areas and particular behaviors [110, 111]. Moreover, knowledge of the relationship of a brain region in a type of behavior was executed by attempts to modulate activity in specific cortical areas with the goal to enhance motor [112, 113] and cognitive [114–116] performance.
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