Abstract
BackgroundThe aim of this study was to determine whether computer-aided training (CAT) of motor tasks would increase muscle activity and change its spatial distribution in a patient with a bilateral upper-limb congenital transverse deficiency. We believe that our study makes a significant contribution to the literature because it demonstrates the usefulness of CAT in promoting the neuromuscular adaptation in people with congenital limb deficiencies and altered body image.Case presentationThe patient with bilateral upper-limb congenital transverse deficiency and the healthy control subject performed 12 weeks of the CAT. The subject’s task was to imagine reaching and grasping a book with the hand. Subjects were provided a visual animation of that movement and sensory feedback to facilitate the mental engagement to accomplish the task. High-density electromyography (HD-EMG; 64-electrode) were collected from the trapezius muscle during a shrug isometric contraction before and after 4, 8, 12 weeks of the training. After training, we observed in our patient changes in the spatial distribution of the activation, and the increased average intensity of the EMG maps and maximal force.ConclusionsThese results, although from only one patient, suggest that mental training supported by computer-generated visual and sensory stimuli leads to beneficial changes in muscle strength and activity. The increased muscle activation and changed spatial distribution of the EMG activity after mental training may indicate the training-induced functional plasticity of the motor activation strategy within the trapezius muscle in individual with bilateral upper-limb congenital transverse deficiency. Marked changes in spatial distribution during the submaximal contraction in the patient after training could be associated with changes of the neural drive to the muscle, which corresponds with specific (unfamiliar for patient) motor task.These findings are relevant to neuromuscular functional rehabilitation in patients with a bilateral upper-limb congenital transverse deficiency especially before and after upper limb transplantation and to development of the EMG based prostheses.
Highlights
The aim of this study was to determine whether computer-aided training (CAT) of motor tasks would increase muscle activity and change its spatial distribution in a patient with a bilateral upper-limb congenital transverse deficiency
We believe that engaging this population in computer-aided training (CAT) consisting of virtual reality and sensory feedback before and after upper-extremity transplantation would facilitate functional reorganization of the skeletal muscles and promote motor function recovery
Expansion within the primary sensorimotor cortices of the cortical surface corresponding to unaffected body parts toward the adjacent de-afferented and de-efferented areas is well established (e.g. [8, 9]). It is unknown whether a person born without an upper extremity is able to develop the similar response as upper-extremity amputees [1,2,3,4], we suppose that lack of the upper limb affects trapezius muscle function as it never had to play a role in limb weightbearing action and movement initiation
Summary
The aim of this study was to determine whether computer-aided training (CAT) of motor tasks would increase muscle activity and change its spatial distribution in a patient with a bilateral upper-limb congenital transverse deficiency. Case presentation: The patient with bilateral upper-limb congenital transverse deficiency and the healthy control subject performed 12 weeks of the CAT. We believe that engaging this population in computer-aided training (CAT) consisting of virtual reality and sensory feedback before and after upper-extremity transplantation would facilitate functional reorganization of the skeletal muscles and promote motor function recovery. Cases of bilateral upper-limb congenital transverse deficiency are sparse and we failed to find information in the literature about muscle activity and the effect of the mental training on reach and grasp skills as well as motor control plasticity in affected humans. Based on the brain reorganization due to activity in primates [10, 11] and following limb loss (and a lack of sensory input), we expected to observe different effect of the CAT on the muscle activity in a congenitally amputated subject
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