Cognitive Training Improves Disconnected Limbs’ Mental Representation and Peripersonal Space after Spinal Cord Injury

Abstract

Paraplegia following spinal cord injury (SCI) affects the mental representation and peripersonal space of the paralysed body parts (i.e., lower limbs). Physical rehabilitation programs can improve these aspects, but the benefits are mostly partial and short-lasting. These limits could be due to the absence of trainings focused on SCI-induced cognitive deficits combined with traditional physical rehabilitation. To test this hypothesis, we assessed in 15 SCI-individuals the effects of adding cognitive recovery protocols (motor imagery–MI) to standard physical rehabilitation programs (Motor+MI training) on mental body representations and space representations, with respect to physical rehabilitation alone (control training). Each training comprised at least eight sessions administered over two weeks. The status of participants' mental body representation and peripersonal space was assessed at three time points: before the training (T0), after the training (T1), and in a follow-up assessment one month later (T2). The Motor+MI training induced short-term recovery of peripersonal space that however did not persist at T2. Body representation showed a slower neuroplastic recovery at T2, without differences between Motor and the Motor+MI. These results show that body and space representations are plastic after lesions, and open new rehabilitation perspectives.

Bodily Illusions and Motor Imagery in Fibromyalgia

“…This supports the idea that sensory information plays a crucial role in bodily self, as shown by studies on deafferented people, in particular individuals suffering from spinal cord injury (SCI; Scandola et al, 2014 , 2017a , 2019b ; Moro et al, 2021a ) or locked-in-syndrome ( Nizzi et al, 2012 ), and recently confirmed by the effects of interoceptive modulations on the sense of body ( Salvato et al, 2017 ; Jenkinson et al, 2020 ; Monti et al, 2020 ; Todd et al, 2021 ).Thus, representations underlying bodily self are the result of a continuous integration of multiple sources of information. This integration process provides immediate feedback on the current state of the body and is also integrated with higher-order cognitive functions (e.g., spatial perception and memory) in order to obtain a detailed map of the body and its relationship with the environment in terms of action planning and motor imagery.…”

“…More specifically, the subscale of External Visual Imagery (VMIQ-EVI) necessitates imaging oneself performing actions from a third person perspective (“as if you were watching yourself from an external position”). In contrast, the first person perspective imagery was assessed by means of the Kinesthetic Imagery scale (VMIQ-KIN) with the participants being asked to “imagine feeling themselves performing the movement.” Thus, the two subscales involve different cognitive processes, specifically visual imagery in the case of the former and simulation of bodily sensations for the latter ( Ionta et al, 2010 ; Scandola et al, 2017b ; Moro et al, 2021a ). The vividness of each action that they imagined (12 identical actions in the two subscales) was rated by the participant on a 5-point Likert scale (with 1 = perfectly vivid imagined action and 5 = not imagined at all).…”

Altered bodily perceptions in chronic neuropathic pain conditions and implications for treatment using immersive virtual reality

“…Current treatments for SCI-related neuropathic pain include pharmacological, surgical, electrotherapeutic, physiotherapeutic, and psychological treatments, with only marginal overall benefit. There is also some recent limited, but promising evidence for motor imagery interventions (Moro et al, 2021 ). Austin and Siddall ( 2019 ) published a recent narrative review of virtual reality treatments for SCI pain.…”

Identifying Body Awareness-Related Brain Network Changes after Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults with Spinal Cord Injury: Delayed Treatment arm Phase I Randomized Controlled Trial

“…[1][2][3] Increasing evidence shows that adults with SCI with motor and sensory impairments also experience body awareness deficits. [4][5][6][7][8][9][10][11][12][13][14][15] Body awareness refers to an attentional focus on and awareness of internal body sensations, including whole-body awareness as well as awareness of body parts in relation to each other, and how they are positioned and move in space. 16,17 These motor and sensory impairments, and particularly the loss of awareness of where the limbs are in space, 18 greatly compromise function and mobility.…”