Journal Club: Recent Advances

on
“Physiology of Motor learning and Recovery of
Function”

Presented by
Madan Gautam
MPT 1st year Resident
 Motor Learning
• Study of acquisition and /or modifications of movement

• Set of process associated with practice or experience leading to relatively permanent

changes in the capability for producing skilled action. (Schmidt & Lee, 2010)

• Motor learning requires practice, feedback and knowledge of results.(Sheila Lennon

& et al 2008)
 Recovery of Function

• Reacquisition of movement skills that are lost through injury

• It is the ability to achieve task goals using effective and efficient means but not
necessarily those used before the injury.

• Due to neural plasticity characteristics of CNS, recovery of functions occurs

through regeneration and reorganization.
 Physiology behind Motor learning &
Recovery of Function
• Neural plasticity: short term functional to long term structural
changes

• Learning and memory: structural changes in CNS

• Synaptic modulation and cortical reorganizations

 Localization of Learning and memory

Area of Brain Type of Learning

Cerebellum, Premotor cortex Associative learning
Striatum of Basal Ganglia, cerebellum Procedural Learning
Medial Temporal lobe, Sensory association Cortex, Declarative Learning
Hippocampus
ARTICLE -ONE
Neurophysiological correlates of visuo-motor
learning through mental and physical practice
• Motor imagery activates the Motor system (Binkofski et al, 2009)

• Physical and mental practice reported similar functional change in brain

plasticity.(Jackson et al., 2010)

• A direct neurophysiological comparison between the neuronal changes

occurring after learning through physical or mental practice was still
lacking.

Nadia Allami et al, 2014

 Neurophysiological correlates of visuo-motor
learning through mental and physical practice
Execution Group -5 RH Subjects Imagination Group-5 RH Subjects
reach to grasp task for 240 trials mental rehearsal for the initial 180 trials
plus reach to grasp task of 60 trials.

Amplitudes of N2 components of Event-related potentials (ERPs) in EEG

During Early Training Session, weak N2 components of ERPs

Increase in Amplitude of N2 Increase in Amplitude of N2
(mainly Fronto-central sites) (mainly Fronto-central sites)

Nadia Allami, et al, 2014

 Neurophysiological correlates of visuo-motor
learning through mental and physical practice
• ERP activity increases with training

• During mental rehearsal, neuronal changes occur in the motor networks.

• Physical practice after mental rehearsal is more effective in configuring

functional networks for skillful behavior

• Mental rehearsal can replace up to 75% of physical practice for learning a

visuo-motor task

Nadia Allami, et al, 2014

ARTICLE -TWO
Brain Neuroplasticity Related to Lateral Ankle
Ligamentous Injuries: A Systematic Review
• Lateral Ankle Sprain-
• most common ankle injuries, high recurrence, develop chronic ankle
instability
• Chronic ankle instability-persistent ankle dysfunctions and
detrimental long-term sequelae.
• Objective-structural and functional brain adaptations related to lateral
ankle sprains and in patients with chronic ankle instability
• Methods- Excluded Studies, Included Studies

Alexandre Maricot et al, 2023

Brain Neuroplasticity Related to Lateral Ankle
Ligamentous Injuries: A Systematic Review
• Result-25 articles
• White matter microstructure changes in the cerebellum -lateral ankle
sprains.
• Functional brain adaptations -chronic ankle instability (15 studies)
• Alterations in the sensorimotor network & dorsal anterior cingulate
cortex -chronic ankle instability (5 Studies).

Alexandre Maricot et al, 2023

ARTICLE -THREE
Brain (re)organisation following amputation:
Implications for phantom limb pain
• Following arm amputation the region that represented the missing
hand in primary somatosensory cortex (S1) becomes deprived of its
primary input, resulting in changed boundaries of the S1 body map .

• Reorganization: perceptual and behavioral factors—Cortical changes

Tamar R. Makin et al, 2020

Brain (re)organisation following amputation:
Implications for phantom limb pain
• Sensorimotor -Homonucleus
• Human neuro-imaging identify body and hand representation beyond S1/M1
– namely in the cerebellum, basal ganglia , supplementary motor cortex,
occipitotemporal cortex and parietal cortex. (Hahamy et al 2019)

Tamar R. Makin et al, 2020

Brain (re)organisation following amputation:
Implications for phantom limb pain
• Altered body representation following arm amputation
• Once neurons are deprived of their primary input, they become responsive to
stimulation that activate the cortical neighbors of the deprived area. (Merzenich
et al)

Tamar R. Makin et al, 2020

Brain (re)organisation following amputation:
Implications for phantom limb pain
• Remapping and Phantom limb pain from clinical studies
• In mirror treatment, phantom hand moves along (chan et al) or no phantom hand
movement was present (Foell at al), it was observed that
• not all amputees activated the cortical representation of the phantom
hand (foell et al)
• Those that did, experienced less Phantom limb pain (foell et al)

Tamar R. Makin et al, 2020

ARTICLE -FOUR
Temporal dynamics of cerebellar and motor cortex
physiological processes during motor skill learning

• Neurophysiological changes in Motor learning : modulation of Cerebellar

(CB)output and induction of long-term potentiation (LTP) in M1

• Cerebellum is involved in acquisition of motor task (Smith and et al)

• M1 is involved in encoding of learned movement (Galea et al)

• Temporal dynamics of these two physiological mechanism is less studied.

D. Spampinato et al 2017
Temporal dynamics of cerebellar and motor cortex
physiological processes during motor skill learning
Long (10) Short (11) Random(8)

Sequential Visual isometric pinch task

30 trials (1 block) 30 Trial (1 block) 30 trials (1 block)

30 trials (1 block) 30 trials (1 block)
30 trials (1 block) 30 trials (1 block)
30 trials (1 block) 30 trials (1 block)
30 trials (1 block) 30 trials (1 block)

32 leads EEG

Assess CB excitability and M1 occlusion

Assess after each block, end of session at day 1 and day 2

Temporal dynamics of cerebellar and motor cortex
physiological processes during motor skill learning
Long group Short group Random group
Skill learning Occurred Occurred Not occured
CB exitability Decreases after block1 Decreases after Remain unchanged
Returned to baseline at block1
end
Occlusion of Decrease MEP in M1 at Increase in MEP in Increase in MEP in
LTP in M1 the end of trg M1 M1
at the end of trg at the end of trg

D. Spampinato et al 2017
Temporal dynamics of cerebellar and motor cortex
physiological processes during motor skill learning

• Demonstrated the temporal dissociation in neurophysiological role of

CB and M1 during skill learning

• CB excitability reduction early in skill training but not late

• Occlusion of M1 LTP occurred after a significant training

• These changes doesn’t occur in random training

D. Spampinato et al 2017
 IMPLICATIONS TO CLINICAL
PRACTICE
• Mental rehearsal may lead to better results when it is used at a high
rate combined with physical practice.

• Rehabilitation programs should integrate sensorimotor and motor

control strategies to cope with neuroplasticity related to ligamentous
ankle injuries.
 IMPLICATIONS TO CLINICAL
PRACTICE
• Phantom limb pain can be alleviated by computer based virtual
reality, mirror therapy

• Sequence of learning is crucial in retention of learnt motor skill.

 IMPLICATIONS TO REASERCH

• Quantify the dynamics of changes in physical and mental practice

• Future research should aim to study phantom limb pain considering

role of multiple brain networks

• Interactions of cortical and subcortical structures in musculoskeletal

injuries
 CONCLUSION

• Motor learning and recovery of functions is the basic foundation of

movement and rehabilitation.

• Sensory input and interactions of cortical and subcortical structures

for motor learning needs further research for developing
rehabilitation strategies in physiotherapy.