Motor Imagery for Reach-to-grasp Rehabilitation After Tetraplegia

Single center, pilot study, to evaluate the influence of Motor Imagery (MI) on functional rehabilitation and cerebral plasticity through the qualitative and quantitative mental practice approach. For this, the investigators will use magnetoencephalography (MEG) but also physiological and behavioral indicators developed by the Laboratoire de la Performance Motrice, Mentale et du Matériel (P3M) of Université Claude Bernard Lyon 1 and its partners.

C5-C6 patients for whom surgery for rehabilitation of an upper limb is indicated with a upper limit of one year after trauma, and after complete clinical and functional evaluation

a control group (n=6) matched on age and sex to C6-C7 without medical history or neurological disorder

Intervention consisted of supervised MI during which the participants were trained to imagine performing a single-joint wrist extension movement and a multiple-joint reach-to-grasp movement using tenodesis. The two movements were practiced in separate blocks and each 45 minute MI session consisted of six to eight blocks. Within a given block patients; i) performed the movement once, ii) imagined it using visual imagery (between five and ten repetitions), iii) performed the movement again, and iv) imagined it using kinesthetic imagery (between five and ten repetitions). All movements (performed and imagined) were timed by the experimenter to ensure that the durations of both imagined and physically practiced movements were similar. Imagery vividness was controlled with self-rated assessments using a visual analogic scale (from 0, the image or feeling was absent, to 10 when it was as clear or intense as physical practice).

Kinematic parameters of movement: spatial parameters: Trajectory of movement measured in the XY plane

Kinematic parameters of movement: spatial parameters: height of elbow and wrist at the moment of grasping an object, measured in mm in the YZ plane

The Kinesthetic and Visual Imagery Questionnaire (KVIQ) will allow a qualitative evaluation of the mental representation capacity of patients

Inclusion Criteria: 18-55 years old, quadriplegia elicited by spinal cord injury (SCI) at the C5, C5-C6, C6, or C6-C7 level, complete infra-lesional motor deficit according to the ASIA impairment scale with finger and forearm flexor muscles paralysis, post-traumatic period >6 months (since a motor recovery plateau is usually reached at 6-month post-SCI Exclusion Criteria: non-stabilized hypertension or pathological autonomic nervous system dysfunction (e.g., orthostatic hypotension), cerebral damage and/or cognitive deficit, elbow or shoulder joint amplitude restriction, upper limb para-osteoarthropathy, participation to another study presence of metallic objects within the body incompatible with MEG or functional magnetic resonance imaging (fMRI) recordings.

Hôpital Henry Gabrielle - Médecine physique et Réadaptation, Hospices Civils de Lyon, 20 Route de Vourles,

Mateo S, Reilly KT, Collet C, Rode G. Descriptive pilot study of vividness and temporal equivalence during motor imagery training after quadriplegia. Ann Phys Rehabil Med. 2018 Sep;61(5):300-308. doi: 10.1016/j.rehab.2018.06.003. Epub 2018 Jun 23.