Brain Activation Evoked by Motor Imagery in Pediatric Patients with Complete Spinal Cord Injury

Abstract

BACKGROUND AND PURPOSE: Currently, there is no effective treatment for pediatric patients with complete spinal cord injury. Motor imagery has been proposed as an alternative to physical training for patients who are unable to move voluntarily. Our aim was to reveal the potential mechanism of motor imagery in the rehabilitation of pediatric complete spinal cord injury.MATERIALS AND METHODS: Twenty-six pediatric patients with complete spinal cord injury and 26 age-and sex-matched healthy children as healthy controls were recruited. All participants underwent the motor imagery task-related fMRI scans, and additional motor execution scans were performed only on healthy controls. First, we compared the brain-activation patterns between motor imagery and motor execution in healthy controls. Then, we compared the brain activation of motor imagery between the 2 groups and compared the brain activation of motor imagery in pediatric patients with complete spinal cord injury and that of motor execution in healthy controls. RESULTS:In healthy controls, compared with motor execution, motor imagery showed increased activation in the left inferior parietal lobule and decreased activation in the left supplementary motor area, paracentral lobule, middle cingulate cortex, and right insula. In addition, our results revealed that the 2 groups both activated the bilateral supplementary motor area, middle cingulate cortex and left inferior parietal lobule, and supramarginal gyrus during motor imagery. Compared with healthy controls, higher activation in the bilateral paracentral lobule, supplementary motor area, putamen, and cerebellar lobules III-V was detected in pediatric complete spinal cord injury during motor imagery, and the activation of these regions was even higher than that of healthy controls during motor execution. CONCLUSIONS:Our study demonstrated that part of the motor imagery network was functionally preserved in pediatric complete spinal cord injury and could be activated through motor imagery. In addition, higher-level activation in sensorimotor-related regions was also found in pediatric complete spinal cord injury during motor imagery. Our findings may provide a theoretic basis for the application of motor imagery training in pediatric complete spinal cord injury.

Leveraging Motor Imagery Rehabilitation for Individuals with Disabilities: A Review

“…This activation may lead to enhancements in motor function, muscle strength, and spasticity, as demonstrated by studies conducted by Opsommer et al [25]. Furthermore, motor imagery interventions can augment body awareness, stimulate neuroplasticity, and expedite the integration of prosthetic devices or assistive technologies [26,27].…”

Rehabilitation Training after Spinal Cord Injury Affects Brain Structure and Function: From Mechanisms to Methods

“…Rienzo et al [186] found that after adding MI training to the rehabilitation program of patients with SCI, the activation of compensatory brain areas decreased, and the cortical activity was closer to the normal state, suggesting that MI training partially reversed the compensatory neural activation in patients with SCI, which was beneficial to the integration of normal neural networks. The latest study by Wang et al [187] compared the effect of MI in children with SCI with that in healthy subjects by fMRI. The results showed that the activation degrees of bilateral paracentral lobules, auxiliary motor area, putamen, and cerebellar lobules in patients with SCI were higher than those in healthy ones.…”

Alterations in cortical thickness and volumes of subcortical structures in pediatric patients with complete spinal cord injury

“… 11 , 12 Similar to adult CSCI patients, the brain reorganization caused by the interruption of ascending and descending conduction pathways has been demonstrated to be a critical factor affecting the sensory motor rehabilitation of pediatric CSCI patients. 13 , 14 Nevertheless, it remains currently unclear whether there have been changes in the brain regions related to cognitive, emotional, or other functions after CSCI. Clarifying the changes in cerebral cortex and deep GM nuclei of children after CSCI may provide a possible neural basis for the cognitive‐emotional or other disorders beyond the sensory motor disabilities, and guide relevant early intervention treatment.…”

“…Previous studies have shown that pediatric CSCI always presents many other physiological and psychological abnormalities, such as cognitive, emotional, behavioral, or other disorders, in addition to sensory motor dysfunction 11,12 . Similar to adult CSCI patients, the brain reorganization caused by the interruption of ascending and descending conduction pathways has been demonstrated to be a critical factor affecting the sensory motor rehabilitation of pediatric CSCI patients 13,14 . Nevertheless, it remains currently unclear whether there have been changes in the brain regions related to cognitive, emotional, or other functions after CSCI.…”