Abstract
Integration of sensory and motor information is one-step, among others, that underlies the successful production of goal-directed hand movements necessary for interacting with our environment. Disruption of sensorimotor integration is prevalent in many neurologic disorders, including stroke. In most stroke survivors, persistent paresis of the hand reduces function and overall quality of life. Current rehabilitative methods are based on neuroplastic principles to promote motor learning that focuses on regaining motor function lost due to paresis, but the sensory contributions to motor control and learning are often overlooked and currently understudied. There is a need to evaluate and understand the contribution of both sensory and motor function in the rehabilitation of skilled hand movements after stroke. Here, we will highlight the importance of integration of sensory and motor information to produce skilled hand movements in healthy individuals and individuals after stroke. We will then discuss how compromised sensorimotor integration influences relearning of skilled hand movements after stroke. Finally, we will propose an approach to target sensorimotor integration through manipulation of sensory input and motor output that may have therapeutic implications.
Highlights
Goal-directed movements of the hand are required to perform most tasks of daily living, such as tying a shoe, buttoning a shirt, and typing, among others
We propose an approach to target sensorimotor integration by manipulating sensory input and restricting motor output that may have therapeutic implications for stroke recovery
In the acute phase post-stroke, patients have reduced short-latency afferent inhibition (SAI) compared to healthy controls (Di Lazzaro et al, 2012), that seems to normalize in the chronic phase where there is no significant difference in SAI between patients and controls (Brown et al, 2018)
Summary
Goal-directed movements of the hand are required to perform most tasks of daily living, such as tying a shoe, buttoning a shirt, and typing, among others. It should be noted that strokes occur in other brain regions but usually have less of an impact on sensorimotor integration underlying goal-directed, skilled hand movements and are outside the primary scope of this review article. In non-human primates, it has been shown that PPC has disynaptic connections with hand motoneurons in the dorsal horn and intermediate zone of the spinal cord (Rathelot et al, 2017), further suggesting potential contributions of PPC to the control of hand movements via the motor and sensory information PPC provides. Lesions in the rostral portion of PPC result in difficulty with shaping the fingers prior to grasping an object (Binkofski et al, 1998), further demonstrating an important role for PPC during the sensorimotor integration required for successfully performing goal-directed hand movements
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