Altered sensorimotor representations after recovery from peripheral nerve damage in neuralgic amyotrophy

Lustenhouwer, Renee; Cameron, Ian; Alfen, Nens van; Oorsprong, Talitha D.; Toni, Ivan; Engelen, B.G.M. van; Groothuis, Jan T.; Helmich, Rick C.

doi:10.1016/j.cortex.2020.02.011

Cited by 10 publications

(13 citation statements)

References 78 publications

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“…The RCT was powered to demonstrate clinical effects of a specialized rehabilitation programme on functional capability of the upper limb in NA patients. 35 The current sample (39 NA patients, 23 healthy participants) suffices to replicate our previous behavioural finding of a significant interaction effect of GROUP × LATERALITY on ER on the same task in an independent sample of NA patients 18 (with power at 0.90 and α at 0.05, the required sample size is 14). 37 Previous fMRI studies using the same task have found differences in brain activity between patient populations and healthy participants with sample sizes similar to the current sample.…”

Section: Methodsmentioning

confidence: 56%

“…NA patients in the current study were tested at an earlier disease stage (median/mean of 8/17 months after onset) than our previous sample (16/61 months). 18 Furthermore, here patients performed the task in a supine position while lying in the MRI-scanner, whereas the patients in our previous behavioural study were sitting upright in a more natural environment. 18 The effect of the MRI-scanner environment on performance may have differed between patients and healthy participants, which could explain why patients were slower, but did not show decreased accuracy compared with the healthy participants.…”

Section: Discussionmentioning

confidence: 96%

“… 18 Furthermore, here patients performed the task in a supine position while lying in the MRI-scanner, whereas the patients in our previous behavioural study were sitting upright in a more natural environment. 18 The effect of the MRI-scanner environment on performance may have differed between patients and healthy participants, which could explain why patients were slower, but did not show decreased accuracy compared with the healthy participants. Likewise, the overall slowing of responses could be a generic consequence of residual NA symptoms like fatigue, 12 , 13 , 15 which may have been exacerbated by the demanding MRI-scanner environment.…”

Section: Discussionmentioning

confidence: 96%

“…This deviates from our previous behavioural study, where we found decreased accuracy specific to the affected limb in an independent sample of NA patients. 18 Interestingly, both unilateral and bilateral deficits in both RT and accuracy have been reported in other asymmetric upper extremity disorders. 28 , 33 , 80 , 82 , 92–94 These differing results may stem from differences in patient populations and experimental settings.…”

Section: Discussionmentioning

confidence: 99%

“… 17 Finally, we have recently shown in a separate behavioural study that NA patients have behavioural deficits during motor imagery of the affected limb, as evoked by a hand laterality judgement task, suggesting that NA patients have altered sensorimotor representations related to their affected limb. 18 However, it remains unclear whether these alterations arise from changes in somatomotor processes, visuomotor processes or both.…”

Section: Introductionmentioning

confidence: 99%

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Visuomotor processing is altered after peripheral nerve damage in neuralgic amyotrophy

Lustenhouwer

Cameron

Wolfs

et al. 2022

Brain Communications

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Neuralgic amyotrophy is a common peripheral nerve disorder caused by auto-immune inflammation of the brachial plexus, clinically characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Despite recovery of the peripheral nerves, patients often have residual motor dysfunction of the upper extremity, leading to persistent pain related to altered biomechanics of the shoulder region. Building on clinical signs that suggest a role for cerebral mechanisms in these residual complaints, here we show and characterize cerebral alterations following neuralgic amyotrophy. Neuralgic amyotrophy patients often develop alternative motor strategies, which suggests that (mal)adaptations may occur in somatomotor and/or visuomotor brain areas. Here we tested where changes in cerebral sensorimotor representations occur in neuralgic amyotrophy, while controlling for altered motor execution due to peripheral neuropathy. We additionally explore the relation between potential cerebral alterations in neuralgic amyotrophy and clinical symptoms. During functional MRI scanning, 39 neuralgic amyotrophy patients with persistent, lateralized symptoms in the right upper extremity and 23 matched healthy participants solved a hand laterality judgment task that can activate sensorimotor representations of the upper extremity, across somatomotor and visuomotor brain areas. Behavioural and cerebral responses confirmed the involvement of embodied, sensorimotor processes across groups. Compared to healthy participants, neuralgic amyotrophy patients were slower in hand laterality judgment, and had decreased cerebral activity specific to their affected limb in two higher-order visual brain regions: the right extrastriate cortex and the parieto-occipital sulcus. Exploratory analyses revealed that across patients, extrastriate activity specific to the affected limb decreased as persistent pain increased, and affected limb-related parieto-occipital activity decreased as imagery performance of the affected limb became slower. These findings suggest that maladaptive cerebral plasticity in visuomotor areas involved in sensorimotor integration plays a role in residual motor dysfunction and subsequent persistent pain in neuralgic amyotrophy. Rehabilitation interventions that apply visuomotor strategies to improve sensorimotor integration may help to treat neuralgic amyotrophy patients.

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Section: Methodsmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Visuomotor processing is altered after peripheral nerve damage in neuralgic amyotrophy

Lustenhouwer

Cameron

Wolfs

et al. 2022

Brain Communications

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Body representation among adults with phantom limb pain: Results from a foot identification task

Beisheim

Pohlig

Medina

et al. 2021

European Journal of Pain

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Background: Impaired body representation (i.e. disrupted body awareness or perception) may be a critical, but understudied, factor underlying phantom limb pain (PLP). This cross-sectional study investigated whether adults with lowerlimb loss (LLL) and PLP demonstrate impaired body representation as compared to Pain-Free peers with and without LLL. Methods: Participants (n = 41 adults with PLP, n = 27 Pain-Free peers with LLL, n = 39 Controls with intact limbs) completed an online foot identification task. Participants judged whether randomized images depicted left or right feet (i.e. left-right discrimination) as quickly as possible without limb movement.Using two Generalized Estimating Equations, effects of group, image characteristics (i.e. side, foot type, view, angle) and trial block (i.e. 1-4) were evaluated, with task response time and accuracy as dependent variables (a ≤ 0.050).Results: Adults with PLP demonstrated slower and less accurate performance as compared to Controls with intact limbs (p = 0.018) but performed similarly to Pain-Free peers with LLL (p = 0.394). Significant three-way interactions of group, view and angle indicated between-group differences were greatest for dorsal-view images, but smaller and angle-dependent for plantar-view images. While all groups demonstrated significant response time improvements across blocks, improvements were greatest among adults with PLP, who also reported significant reductions in pain intensity. Conclusions: Adults with PLP demonstrate body representation impairmentsas compared to Controls with intact limbs. Body representation impairments, however, may not be unique to PLP, given similar performance between adults with and without PLP following LLL. SignificanceFollowing lower-limb loss, adults with phantom limb pain (PLP) demonstrate impaired body representation as compared to Controls with intact limbs, evidenced by slower response times and reduced accuracy when completing a task requiring mental rotation. Importantly, 80% of participants with pre-task PLP reported reduced pain intensity during the task, providing compelling evidence for future investigations into whether imagery-based, mind-body interventions have positive effects on PLP.

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Reachable workspace analysis is a potential measurement for impairment of the upper extremity in neuralgic amyotrophy

IJspeert

Lustenhouwer

Janssen³

et al. 2022

Muscle and Nerve

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Introduction/Aims: Neuralgic amyotrophy (NA) is a multifocal neuropathy involving the nerves of the upper extremity, limiting functional capability and reducing range of motion. The reachable workspace (RWS) is a computerized three-dimensinal analysis system that evaluates the relative surface area (RSA) of an individual's arm reachability and has shown utility in several neuromuscular disorders. The aims of this study were to examine the ability of the RWS to quantitatively detect limitations in upper extremity active range of motion in patients with NA, and correlate these with other upper extremity functional outcome measures. Methods: Forty-seven patients with NA and 25 healthy age-and sex-matched controls were measured with the RWS. Study participants' RSAs were correlated with scores on the Shoulder Rating Questionnaire (SRQ), the Disabilities of Arm Shoulder and Hand (DASH) questionnaire, and upper extremity strength measurements using hand-held dynamometry.Results: Patients with NA showed significantly lower values in the affected arm for all quadrants (except for the ipsilateral lower quadrant) and total RSA compared with controls (P < 0.001). We found moderate correlations between the reachable workspace, the DASH questionnaire result (r = À0.415), and serratus anterior muscle strength (r = 0.414).Discussion: RWS is able to detect limitations in active range of motion of the affected arm in patients with NA, and is moderately correlated with upper extremity functional measures. RWS can demonstrate impairment of the affected upper extremity in NA and it has potential as a clinical outcome measure.

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Altered sensorimotor representations after recovery from peripheral nerve damage in neuralgic amyotrophy

Cited by 10 publications

References 78 publications

Visuomotor processing is altered after peripheral nerve damage in neuralgic amyotrophy

Visuomotor processing is altered after peripheral nerve damage in neuralgic amyotrophy

Body representation among adults with phantom limb pain: Results from a foot identification task

Reachable workspace analysis is a potential measurement for impairment of the upper extremity in neuralgic amyotrophy

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