Maybe there is something in here but you'll have to ask your doctor for a translation into something you can do to recover.
Motor priming in neurorehabilitation
2015, Journal of neurologic physical therapy : JNPT
Mary Ellen Stoykov, PhD, OTR/L, and Sangeetha Madhavan, PT, PhD
Priming is a type of implicit learning wherein a stimulus prompts a change in behavior. Priming has been long studied in the field of psychology. More recently, rehabilitation researchers have studied motor priming as a possible way to facilitate motor learning. For example, priming of the motor cortex is associated with changes in neuroplasticity that are associated with improvements in motor performance.Of the numerous motor priming paradigms under investigation,only a few are practical for the current clinical environment, and the optimal priming modalities for specific clinical presentations are not known.Accordingly,developing an understanding of the various types of motor priming paradigms and their underlying neural mechanisms is an important step for therapists in neurorehabilitation. Most importantly,an understanding of the methods and their underlying mechanisms is essential for optimizing rehabilitation outcomes. The future of neurorehabilitation is likely to include these priming methods, which are delivered prior to or in conjunction with primary neurorehabilitation therapies. In this Special Interest article, we discuss those priming paradigms that are supported by the greatest amount of evidence, including (i) stimulation based priming, (ii) motor imagery and action observation,(iii)sensory priming,(iv)movement based priming,and (v) pharmacological priming.
Video Abstract available.
(seeSupplementalDigitalContent1,http://links.lww.com/JNPT/A86) for more insights from the authors.
Key words:
Motor cortex, priming, brain stimulation, Bilateral movement, Sensory stimulation
( JNPT 2015;39: 33–42)
INTRODUCTION
Priming is defined as a change in behavior based on previous stimuli. Priming, which may occur after a single learning episode, is a type of implicit learning. The role of implicit learning in physical therapy (PT) has been the subject of recent investigation.1−4Priming-induced learning is different from other types of implicit learning because skill-learning requires repetition.5Studies of priming originated in psychology, but have since been investigated in neuroscience,neurorehabilitation, and cognitive neuroscience using behavioral and brain mapping techniques. These studies, both translational and clinical, have been examining motor priming asa tool for inducing neuroplasticity and enhancing the effects of rehabilitation. Priming can be categorized as a restorative intervention that reduces impairment by targeting underlying neural mechanisms in neurological disorders.6Priming stimuli can be from the same modality as the accompanying task(modal specific) or from a different modality(cross-modal). An example of modal specific priming is bilateral mirror symmetrical movement(a form of movement based priming) that is performed prior to a motor task practice and has been found to increase the rate of motor learning in neurologically healthy subjects.7Cross-modal priming can also be used to enhance motor learning. For example, semantic priming, reading relevant words describing an action, can produce more efficient movements in young, neurologically healthy adults compared with a control condition.8Although there are examples of cross-modal priming producing positive results,results from studies in the psychology literature have reported that the effects of priming are smaller with cross-modal priming as compared with priming using the same modality.9Initial interest in priming was fueled by popular psychology research completed several decades ago that included the isolation of memory subtypes and examination of individuals with amnesia.10Priming is an action that generates a type of implicit memory; therefore, researchers were surprised when individuals with amnesia had intact priming as this indicates that priming, unlike explicit memory, is not controlled by the medial temporal lobe. In contrast to explicit memory, priming is believed to arise from facilitated neural processing in a variety of cortical regions that are specific to the stimulus and the accompanying task. For example, the posterior cortex (extratriatal area) is implicated in perceptual priming, whereas the prefrontal cortex is implicated in conceptually based semantic priming.9The general theory underlying priming is that the brain,that has been primed by prior activation is generally more re-sponsive to the accompanying or subsequent training. Priming presupposes that enhanced neural activity before or duringtraining can facilitate the activation of long-term potentiation-(LTP) or long-term depression-(LTD)like mechanisms.11Two proposed neural mechanisms for priming include gating and homeostatic plasticity12Gating occurs by disinhibition of intracortical inhibitory circuits as a result of an increase in
calcium in the targeted cortical neurons. Gating occurs instantaneously and is achieved concurrently with motor training.11Homeostatic plasticity is the ability of neurons to increase excitability after a period of low synaptic activity (and conversely, to decrease excitability after a period of high synaptic activity) and is related to changes in postsynaptic glutamate receptors.11,12The time scale of homeostatic metaplasticity,in comparison to gating, is protracted, and hence the resting state of neurons is modulated prior tomotor training to induce synaptic plasticity. Neural mechanisms mediating motor priming vary according to priming method. However, they may produce similar effects that may include increased excitability or normalization of inhibition, which coincide with improvements in motor behavior.13Methods of priming the motor cortex that are most relevant to rehabilitation include (1) stimulation-based priming14−22; (2) motor imagery and action observation23−28;(3) manipulation of sensory input29−31; (4) movement-based priming7,32−36; and (5) pharmacology-based priming.37Stud-ies examining priming for the primary motor cortex (M1) areincreasing in number. Hence, it is important for neuroreha- bilitation professionals to be aware of the basic principles of priming and how they influence motor training (Table 1).A search of the literature through December 2013 was performed using the search engines: PubMed, Web of Sci-ence, and Ovid. Key words used were “priming” combined with one of the following terms: “brain plasticity,” “motor recovery,” “TMS,” “rTMS,” “tDCS,” “PAS,” “PNS,” “mo-tor imagery,” “action observation,” “movement based,” “bilat-eral movements,” unilateral movements, “aerobic exercise,”“pharmacology based,” “sensory priming,” “peripheral nervestimulation,” “temporary functional deafferentation,” and “vibration.” Peer-reviewed articles were selected if they met thefollowing criteria: (1) written in English, (2) involved more than 1 human participant, and (3) included at least 1 motor performance-based outcome measure, and (4) fit the defini-tion of “priming” as described in the “Introduction” section.Papers that were cited in the selected articles, such as mecha-nistic or studies using animal models, were also included for background information. We also included studies that cited the selected articles. The 5 priming paradigms are described later.
Mary Ellen Stoykov, PhD, OTR/L, and Sangeetha Madhavan, PT, PhD
Priming is a type of implicit learning wherein a stimulus prompts a change in behavior. Priming has been long studied in the field of psychology. More recently, rehabilitation researchers have studied motor priming as a possible way to facilitate motor learning. For example, priming of the motor cortex is associated with changes in neuroplasticity that are associated with improvements in motor performance.Of the numerous motor priming paradigms under investigation,only a few are practical for the current clinical environment, and the optimal priming modalities for specific clinical presentations are not known.Accordingly,developing an understanding of the various types of motor priming paradigms and their underlying neural mechanisms is an important step for therapists in neurorehabilitation. Most importantly,an understanding of the methods and their underlying mechanisms is essential for optimizing rehabilitation outcomes. The future of neurorehabilitation is likely to include these priming methods, which are delivered prior to or in conjunction with primary neurorehabilitation therapies. In this Special Interest article, we discuss those priming paradigms that are supported by the greatest amount of evidence, including (i) stimulation based priming, (ii) motor imagery and action observation,(iii)sensory priming,(iv)movement based priming,and (v) pharmacological priming.
Video Abstract available.
(seeSupplementalDigitalContent1,http://links.lww.com/JNPT/A86) for more insights from the authors.
Key words:
Motor cortex, priming, brain stimulation, Bilateral movement, Sensory stimulation
( JNPT 2015;39: 33–42)
INTRODUCTION
Priming is defined as a change in behavior based on previous stimuli. Priming, which may occur after a single learning episode, is a type of implicit learning. The role of implicit learning in physical therapy (PT) has been the subject of recent investigation.1−4Priming-induced learning is different from other types of implicit learning because skill-learning requires repetition.5Studies of priming originated in psychology, but have since been investigated in neuroscience,neurorehabilitation, and cognitive neuroscience using behavioral and brain mapping techniques. These studies, both translational and clinical, have been examining motor priming asa tool for inducing neuroplasticity and enhancing the effects of rehabilitation. Priming can be categorized as a restorative intervention that reduces impairment by targeting underlying neural mechanisms in neurological disorders.6Priming stimuli can be from the same modality as the accompanying task(modal specific) or from a different modality(cross-modal). An example of modal specific priming is bilateral mirror symmetrical movement(a form of movement based priming) that is performed prior to a motor task practice and has been found to increase the rate of motor learning in neurologically healthy subjects.7Cross-modal priming can also be used to enhance motor learning. For example, semantic priming, reading relevant words describing an action, can produce more efficient movements in young, neurologically healthy adults compared with a control condition.8Although there are examples of cross-modal priming producing positive results,results from studies in the psychology literature have reported that the effects of priming are smaller with cross-modal priming as compared with priming using the same modality.9Initial interest in priming was fueled by popular psychology research completed several decades ago that included the isolation of memory subtypes and examination of individuals with amnesia.10Priming is an action that generates a type of implicit memory; therefore, researchers were surprised when individuals with amnesia had intact priming as this indicates that priming, unlike explicit memory, is not controlled by the medial temporal lobe. In contrast to explicit memory, priming is believed to arise from facilitated neural processing in a variety of cortical regions that are specific to the stimulus and the accompanying task. For example, the posterior cortex (extratriatal area) is implicated in perceptual priming, whereas the prefrontal cortex is implicated in conceptually based semantic priming.9The general theory underlying priming is that the brain,that has been primed by prior activation is generally more re-sponsive to the accompanying or subsequent training. Priming presupposes that enhanced neural activity before or duringtraining can facilitate the activation of long-term potentiation-(LTP) or long-term depression-(LTD)like mechanisms.11Two proposed neural mechanisms for priming include gating and homeostatic plasticity12Gating occurs by disinhibition of intracortical inhibitory circuits as a result of an increase in
calcium in the targeted cortical neurons. Gating occurs instantaneously and is achieved concurrently with motor training.11Homeostatic plasticity is the ability of neurons to increase excitability after a period of low synaptic activity (and conversely, to decrease excitability after a period of high synaptic activity) and is related to changes in postsynaptic glutamate receptors.11,12The time scale of homeostatic metaplasticity,in comparison to gating, is protracted, and hence the resting state of neurons is modulated prior tomotor training to induce synaptic plasticity. Neural mechanisms mediating motor priming vary according to priming method. However, they may produce similar effects that may include increased excitability or normalization of inhibition, which coincide with improvements in motor behavior.13Methods of priming the motor cortex that are most relevant to rehabilitation include (1) stimulation-based priming14−22; (2) motor imagery and action observation23−28;(3) manipulation of sensory input29−31; (4) movement-based priming7,32−36; and (5) pharmacology-based priming.37Stud-ies examining priming for the primary motor cortex (M1) areincreasing in number. Hence, it is important for neuroreha- bilitation professionals to be aware of the basic principles of priming and how they influence motor training (Table 1).A search of the literature through December 2013 was performed using the search engines: PubMed, Web of Sci-ence, and Ovid. Key words used were “priming” combined with one of the following terms: “brain plasticity,” “motor recovery,” “TMS,” “rTMS,” “tDCS,” “PAS,” “PNS,” “mo-tor imagery,” “action observation,” “movement based,” “bilat-eral movements,” unilateral movements, “aerobic exercise,”“pharmacology based,” “sensory priming,” “peripheral nervestimulation,” “temporary functional deafferentation,” and “vibration.” Peer-reviewed articles were selected if they met thefollowing criteria: (1) written in English, (2) involved more than 1 human participant, and (3) included at least 1 motor performance-based outcome measure, and (4) fit the defini-tion of “priming” as described in the “Introduction” section.Papers that were cited in the selected articles, such as mecha-nistic or studies using animal models, were also included for background information. We also included studies that cited the selected articles. The 5 priming paradigms are described later.
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