Role of afferent input in motor organization in health and disease

In the healthy brain, there is a highly organized relationship between sensory input from one part of the body and the motor cortical output to muscles acting on that same part. This work investigates whether a change in purely sensory input have an impact on the organization of the motor cortex. In a previous study transcranial magnetic stimulation (TMS) techniques were used to probe the excitability of the motor cortex hand area. A measurement of the amplitude of the motor evoked potential (MEP) to standard single-pulse stimuli given through a focal coil was done. The excitability of two types of intracortical inhibition, SICI and LICI, was also measured using a paired-pulse TMS design. SICI is thought to be sensitive to activity in GABA_A-ergic systems, whereas LICI may involve activation of GABA_B-ergic systems. The work of other researchers has shown that these measures could be influenced by sensory input. Yet, all of them used electrical stimulation of peripheral nerve rather than a natural input. In order to investigate a more natural input, we delivered very low-amplitude vibration to the muscle belly of individual hand muscles through a small probe. This work explores the pattern of effects on MEPs and SICI in three different intrinsic hand muscles after vibration of each muscle in turn. In addition, the study also tested LICI with a paired-pulse TMS paradigm. In conclusion, it was seen that a period of sensory input, with or without the subject´s attention, produces a specific pattern of sensory-motor reorganization in human cortex which develops quickly (after only 15 minutes) and lasts for at least 30 min. Since this produces changes in the motor cortex without requiring any active motor output, it may be a promising tool for neurorehabilitation even in patients who are unable to perform the active movements conventionally employed in therapy.