I think that motor recovery with all motor performance always uses neural network. For example neural networks to flow pulses from receptors from healthy parts of the body. Multisensory perception and neural network is based of neuroplasticity, does it ,

I think that it is not neural network alone responsible for performance. In addition also characteristics of muscle fibers (type 1 or 2, presence of atrophy)would determine extent and ability of performance

Yes. I agree on recovery of motor performance mainly depend on recovery of neuronal activation such as neuroplasticity or neuromodulation., but biomechanical factors including muscle atrophy, joint contractuer, spasticity also partially affect on recovery of motor performance.

yes, i agree these factors influence the motor performance of an individual. But what about his psychological state? for example if he / she is low in cognitive level how does it affect the neuronal networks? would there be a different pattern for them or what would be the difference observed in the higher centres?

I think if is preserved higher level cognitive functions in patients will be more likely to recover function if the lesions in the higher parts of the brain (eg cerebral hemispheres) because the patient can better cooperate with the therapist and the techniques can be applied as proprioceptive facilitation - PNF. The lower level of cognitive function in patients complicates cooperation with the therapist and smaller likely to recover brain function .

So is it like the motor activity depends on the cognition? or its the other way around like, motor perfomance can improve one's cognitive level?

Emotions and motivation/drive also play an important part in recovery of motor performance.

Motor performance implies a coordinated activity of several neuronal systems and networks. The word "performance" in this sense reflects a meaningful and clinical relevant activity. A simple muscle twitch or simple focal seizures usually are not regarded as "motor performance". Thus, performance even at a basic level, includes (1) voluntary activation and (2) realization of movements. While the first part is definitely dependent on the cognitive and motivational networks, the second part depends on the integrity of motors systems/networks. In the most extreme form a disturbance of the cognitive motivational part, such as akinetic mutism, can cause absolute cessation of any movements while the motor system is fully intact.

I believe recovery is networ dependent, at supraspinal or spinal levels. Inherent is the need to activate sensory neurons and interneurons in addition to motor neuron activity; the neuronal network. Without sensory activation and modulation of the motor response impairments cannot be managed (consider impairments listed by others such as fiber typing , spasticitiy, atrophy), initiation and coordination of movement requires a regulation and modulation that is sensory dependent first on somatic and schematic awareness, then on both qualitative and quantitative feedback of the motor response. I like using electrical stimulation a both a direct and indirect method of neuronal activity but feel responses and recovery or rehabilitation of motor performance is best achieved with functional, activity directed association.

Hi Lisa,

I agree with your point on the functional rehabilitation of the individual can definitely improve their performance, but can you throw some light on the point your making about ES and how could it activate the neuronal activity at higher levels?? according to me ES creates a local response only..

Dear Joshua, dear Lisa, dear all

YES, but there you are: to create a local response localy alters the network function. Striking to me is, that we do not know, what we do, when we stimulate. we do not even know exactly WHAT we stimulate with all the current flow and electrical fields generated by the local stimulation. So, thank you for your provoking thoughts. Indeed, this is a crucial issue and brings us back to the starting point: there in no PERFORMANCE, whithout network activity.

best regards

Eugen

There actually are some interesting studies, some utilizing SSEPs and others using fMRI that do give some insight as to what is being stimulated. That said we are looking through rather coarse resolution and specificity of tracts and neurons in humans remains theoretical. A series of studies by Svetlana Khaslavskaia demonstrated differing latencies, amplitudes and potentiation when comparing (in normals) active repetitive dorsiflexion, stimulated repetitive dorsiflexion and stimulated coupled with voluntary activation. Motor cortex excitability following repetitive electrical stimulation of the common peroneal nerve depends on the voluntary drive. / Khaslavskaia, Svetlana O.; Sinkjær, Thomas.

In: Experimental Brain Research, Vol. 162, No. 4, 2005, p. 497-502. A subsequent study in 2006 demonstrated significant increases in the BOLD signal that supported the earlier findings of motor cortex potentials.

Similarly Gad Alon evaluated fMRI responses to stimulation in 5 AOI (primary sensory, primary motor, cyngulate gyrus, thalamus and cerebellum) and stimulation intensity in normal individuals receiving NMES of increasing intensity to their femoral nerve. He demonstrated a statistical correlation that also assoicated greater activation of all AOI with higher intensities of stimulation. In Experimental Brain Research

May 2003, Volume 150, Issue 1, pp 33-39, Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects., Gerald V. Smith, Gad Alon, Steven R. Roys, Rao P. Gullapalli

There are other examples and a variety of stimulators on the market. I am biases, have worked intimately with distal functional stimulators manufactured by Bioness with some goood success in less impaired patients but like the 12 channel stimulators with or without associated FES ergometry that REstorative Therapies makes. In limited situations I devices my own applications using hand held stimulators and switches to effect the evoked response that best supports the activities and outcomes targeted.

I hope this porvides some insight for RECOUP Rehabilitation. I would be happy to discuss clinical applications and methods further if you are interested.

Since we are speaking of recovery of motor performance, and performance per se has to be somewhat functional, then neuronal integrity is a must. as others have said, the recovery of neuronal networks, since it may take time, it might be affected by other musculoskeletal changes taking place, that might not allow functional movement and motor performance to improve albeit having optimal neuronal activation

Adding to what Lisa is saying, to which I tend to agree, I'd like to mention also mirror therapy, neural biofeedback and premotor movement planning as modalities that tend to have quite good results with improving performance.

Darren, I agree wholeheartedly. Using multi-modal input to achieve motor performance is very important. Visual input is often very effective due to the tremendous associative areas to the visual pathways and the impact on not only sensory areas but pre-motor and motor pathways in anticipating, executive function, and feedback. I often employ visuo-reactive training training; everything from simple paper targets placed environmentally to utilizing devices such as the Dynavision D2 to facilitate movement, reaction, decision making, etc. Mirror therapy can be associated with sensory or sensory motor stimulation of the affected extremity positioned within the mirror box to add additional tactile or proprioceptive cueing to reinforce the mirror therapy. The toolbox is extensive and decision making about which approaches are most effective may mean employing a variety of approaches at different times along the recovery continuum.