Abstract
This study aimed to investigate whether the effect of mental practice (motor imagery training) can be enhanced by providing neurofeedback based on transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP). Twenty-four healthy, right-handed subjects were enrolled in this study. The subjects were randomly allocated into two groups: a group that was given correct TMS feedback (Real-FB group) and a group that was given randomized false TMS feedback (Sham-FB group). The subjects imagined pushing the switch with just timing, when the target circle overlapped a cross at the center of the computer monitor. In the Real-FB group, feedback was provided to the subjects based on the MEP amplitude measured in the trial immediately preceding motor imagery. In contrast, the subjects of the Sham-FB group were provided with a feedback value that was independent of the MEP amplitude. TMS was applied when the target, moving from right to left, overlapped the cross at the center of the screen, and the MEP amplitude was measured. The MEP was recorded in the right first dorsal interosseous muscle. We evaluated the pre-mental practice and post-mental practice motor performance in both groups. As a result, a significant difference was observed in the percentage change of error values between the Real-FB group and the Sham-FB group. Furthermore, the MEP was significantly different between the groups in the 4th and 5th sets. Therefore, it was suggested that TMS-induced MEP-based neurofeedback might enhance the effect of mental practice.
Highlights
With the progress in brain imaging technology in recent years, mechanisms in the brain that have been treated as black boxes are gradually being clarified
Mental practice is one of the means of rehabilitation acting in complement to movement therapy; mental practice is a method of repeatedly reproducing motor imagery
Studies using positron emission tomography (PET) and magnetic resonance imaging have reported that the premotor area, supplementary motor area, cingulate, and parietal cortex are activated during these mental exercises (Porro et al, 1996, 2000; Deiber et al, 1998; Lotze et al, 1999; Gerardin et al, 2000; Ehrsson et al, 2003; Hanakawa et al, 2003; Jackson et al, 2003; Kuhtz-Buschbeck et al, 2003; Dechent et al, 2004; Meister et al, 2004)
Summary
With the progress in brain imaging technology in recent years, mechanisms in the brain that have been treated as black boxes are gradually being clarified. Attention has been focused on rehabilitation based on knowledge of the mechanisms in the brain. Under such circumstances, mental practice (i.e., motor imagery training) is one of the means of rehabilitation acting in complement to movement therapy; mental practice is a method of repeatedly reproducing motor imagery. Mental practice does not require special machines or devices, and subjects can work on it without any time or space restrictions Since it can be carried out without actual movement, it can be applied to patients who do not have the capacity to perform voluntary exercise and minimize dangers such as risk of falling (Dietrich, 2008). A systemic review showed that mental practice is an effective intervention for upper limb dysfunction in stroke patients (Langhorne et al, 2009)
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