Adaptive motor cortex plasticity following grip reconstruction in individuals with tetraplegia

Restorative Neurology and Neuroscience, 2018 · DOI: 10.3233/RNN-170775 · Published: January 1, 2018

Spinal Cord Injury Surgery Neuroplasticity

Simple Explanation

Tendon transfer surgery can restore upper limb motor control in patients with cervical spinal cord injuries (SCI). This offers a valuable opportunity to study cortical neuroplasticity after regaining arm and hand function. The study used fMRI to examine if restored limb control after tendon transfer activates the primary motor cortex area associated with that limb. The results suggest that motor cortex resources previously used for elbow flexion adapt to control the thumb, rather than a topographic reorganization where the thumb region regains thumb control.

Study Duration

Not specified

Participants

6 right-handed males with tetraplegia, 6 right-handed gender- and age-matched control subjects

Evidence Level

Not specified

Key Findings

1
Cortical activations elicited by elbow flexion did not differ between patients and controls.
2
In patients, thumb flexion activations were not topographically distinct from their elbow flexion activations.
3
The study suggests that motor cortex resources previously dedicated to elbow flexion adapt to control the thumb, rather than a topographic reorganization.

Research Summary

The study investigated motor cortex plasticity following tendon transfer surgery in individuals with tetraplegia, focusing on thumb flexion restoration. fMRI results indicated that regained thumb control did not activate the thumb region of the primary motor cortex, challenging the initial hypothesis. Findings suggest a neuroplastic mechanism where cortical areas previously used for elbow flexion adapt to control thumb flexion, rather than a direct topographic reorganization.

Practical Implications

Rehabilitation Improvement

Understanding cortical adaptation mechanisms can lead to improved rehabilitation approaches for patients undergoing tendon transfer surgery.

Neuroprosthetics Advancement

The finding that the motor cortex can adapt suggests that cortical implants in one region may effectively control multiple robotic movements.

Surgical Considerations

Surgical reconstruction of grip functions remains possible even decades after cervical spinal cord paralysis.

Study Limitations

1
Small sample size due to the rarity of tetraplegia and strict inclusion criteria.
2
The study design did not allow exploration of brain regions or circuits outside the motor cortex.
3
Patients exhibited more movement than the control group.

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