Modulation of proprioceptive feedback during functional electrical stimulation: an fMRI study
Modulation of proprioceptive feedback during functional electrical stimulation: an fMRI study
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DOI：
10.1111/ejn.12178
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发表时间：
2013-06-01
影响因子：
3.4
通讯作者：
Grey, Michael James
中科院分区：
文献类型：
--
作者：
Christensen, Mark Schram;Grey, Michael James
功能性电刺激（FES）有时被用作运动康复的一种治疗方式，以增强自主运动驱动来影响运动，否则单独通过自主激活是不可能实现的。有效的运动康复需要中枢神经系统整合传出指令和适当的传入信息来更新获得性技能的内部模型。在此，我们通过功能性磁共振成像（fMRI）研究了fes诱发（FES-ev）和fes辅助（FES-as）运动是否与一组健康参与者的运动指令和感觉反馈的正常整合有关。当参与者在fMRI期间进行自愿（VOL）、FES-ev或FES-as运动时，通过外周缺血性神经阻滞去除感觉反馈。外周神经阻滞前，FES-ev和FES-as组的第二体感觉区（S2）激活明显大于VOL组。在缺血神经阻滞期间，FES-ev条件下的S2激活减少，而FES-as和VOL条件下没有。在FES过程中，神经阻滞还减少了初级体感皮层和其他运动区域的激活，包括初级运动皮层、背侧运动前皮层和辅助运动区域。相反，在VOL条件下，顶叶上小叶（7A区）和楔前叶的激活由于缺血性神经阻滞而减少。这些数据表明fes相关的S2激活主要是一种感觉现象，并不反映感觉信号与运动命令的整合。
Functional electrical stimulation (FES) is sometimes used as a therapeutic modality in motor rehabilitation to augment voluntary motor drive to effect movement that would otherwise not be possible through voluntary activation alone. Effective motor rehabilitation should require that the central nervous system integrate efferent commands and appropriate afferent information to update the internal models of acquired skills. Here, we investigate whether FES-evoked (FES-ev) and FES-assisted (FES-as) movement are associated with the normal integration of motor commands and sensory feedback in a group of healthy participants during functional magnetic resonance imaging (fMRI). Sensory feedback was removed with a peripheral ischaemic nerve block while the participants performed voluntary (VOL), FES-ev or FES-as movement during fMRI. Before the peripheral nerve block, secondary somatosensory area (S2) activation was greater for the FES-ev and FES-as conditions than for the VOL condition. During the ischaemic nerve block, S2 activation was reduced for the FES-ev condition but not for FES-as and VOL conditions. The nerve block also reduced activation during FES in the primary somatosensory cortex and other motor areas including primary motor cortex, dorsal premotor cortex and supplementary motor area. In contrast, superior parietal lobule (area 7A) and precuneus activation was reduced as a consequence of the ischaemic nerve block in the VOL condition. These data suggest FES-related S2 activation is mainly a sensory phenomenon and does not reflect integration of sensory signals with motor commands.