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Cerebral Cortex Advance Access published online on July 6, 2004
Cerebral Cortex, doi:10.1093/cercor/bhh116
© 2004 by Oxford University Press
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Article

What Disconnection Tells about Motor Imagery: Evidence from Paraplegic Patients

Hatem Alkadhi 1, Peter Brugger 2, Sabina Hotz Boendermaker 3, Gerard Crelier 1, Armin Curt 3, Marie-Claude Hepp-Reymond 4, Spyros S. Kollias 1*

1 Institute of Neuroradiology, University Hospital Zurich, CH-8091 Zurich, Switzerland
2 Department of Neurology, University Hospital Zurich, CH-8091 Zurich, Switzerland
3 Spinal Cord Injury Center, Balgrist University Hospital, CH-8008 Zurich, Switzerland
4 Institute of Neuroinformatics, University and ETH Zurich, CH-8057 Zurich, Switzerland

* To whom correspondence should be addressed. E-mail: kollias{at}dmr.usz.ch.


  Abstract

Brain activation during motor imagery has been the subject of a large number of studies in healthy subjects, leading to divergent interpretations with respect to the role of descending pathways and kinesthetic feedback on the mental rehearsal of movements. We investigated patients with complete spinal cord injury (SCI) to find out how the complete disruption of motor efferents and sensory afferents influences brain activation during motor imagery of the disconnected feet. Eight SCI patients underwent behavioral assessment and functional magnetic resonance imaging. When compared to a healthy population, stronger activity was detected in primary and all non-primary motor cortical areas and subcortical regions. In paraplegic patients the primary motor cortex was consistently activated, even to the same degree as during movement execution in the controls. Motor imagery in SCI patients activated in parallel both the motor execution and motor imagery networks of healthy subjects. In paraplegics the extent of activation in the primary motor cortex and in mesial non-primary motor areas was significantly correlated with the vividness of movement imagery, as assessed by an interview. The present findings provide new insights on the neuroanatomy of motor imagery and the possible role of kinesthetic feedback in the suppression of cortical motor output required during covert movements.

Keywords: functional MRI; motor imagery; spinal cord injury.
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