Functional Magnetic Resonance Imaging Clinical Trial
Official title:
Assessment of Brain Activity During Complex Fine Hand Movements: an fMRI Study
Brain cortex controls movement but the influence of peripheral component of movement on the
cortex is not known. Functional Magnetic Resonance Imaging(fMRI) studies in stroke and fantom
limb patients investigate cortex areas activated during execution and imagination of complex
hand movements. These studies aim to understand the mechanisms of the motor component of
movement but the results are limited as there is no effector organ in fantom limb patients
and the affecting organ is damaged in stroke patients. The investigators hypothesized that
the areas of the cortex that is activated to remember, set-up and order to move can be
isolated from the areas that are activated during the motor component of movement. To prove
this hypothesis the investigators developed a model that investigate the brain activation
areas during the patient try to execute and imagine doing a complex motor task (sequential
opposition with the thumb to the other four fingers) with a peripherally blocked arm. Brain
fMRI in 15 right-handed patients scheduled to undergo right-hand surgery with peripheral
block anesthesia will be obtained before the surgery day and just before surgery after the
block. Participants will be screened when executing the task (after the block they just
attempt), during rest and during they imagine doing the task. Bilateral cortex activation
areas will be compared when the right hand was intact and was peripherally blocked.
There are many unknowns in the relationship between the brain-peripheric organ during
movement. The investigators hope that some of these mechanisms will be identified by the new
model we used in our study. The final benefit will be to develop stroke therapies and new
therapies for neuropathic pain which is closely related to motor function.
In this study, the investigators aim to separate the cortex areas that are activated during
one remember, set-up and plan and start doing a motor task from the areas that are activated
during performing the motor component. The investigators hypothesized that these areas can be
identified by screening areas with fMRI when participants are asked to perform a complex
motor task with a hand that is completely blocked. The hypothesis is based on the fact that
in a participant with a peripherally blocked arm the central component of the movement will
not be affected and the activation areas that remember and plan to do a motor task can be
separated from the areas that are activated when the effector organ is doing the motor task,
in other words, the motor component of the task.
the investigators also aim to show;
1. If there is an ipsilateral cortex activity during a participant with a peripherally
blocked arm try to execute a complex motor task. The investigators know that in
centrally paralyzed hands there is ipsilateral activity and there is no argument if this
is an adaptive response or it is present from the beginning of the motor paralysis due
to the strength of the central event of the contralateral brain area.
2. If there is a difference between activation areas of the cortex during the imaginary of
complex hand movements with the intact and peripherally blocked arms.
Adult patients (>18) that have been scheduled to have right-hand surgery with peripheral
blockage of the arm will be evaluated for the study. The patients will be informed about all
the details and the consequences of the study and patients who give written informed consent
will be included in the study. Local ethics committee approval is obtained in 05.12.2018. the
study will be continued until the planned 15 patients are recruited for the study.
Right-hand dominance of the patient will be confirmed by Edinburgh handedness inventory
(Oldfield,1971) and scores will be recorded. In the end, the mean of the score will be
obtained for the whole study population. medium-high degree right handedness will be required
for inclusion to the study. The patients who do not give written informed consents, patients
who use their left hand dominantly, patients who have a neurologic or psychiatric disease,
the patients with hearing and visual loss, who have history of substance abuse or who had
surgery in the previous 12 months, with a history of major systemic disease (ASA III and IV)
, with history of drugs that alter neurologic activity, who are unable to stay at MR machine
without sedation, who are accepted to have a surgery duration of more than 3 hours, and
patients who have a motor deficit at their right hand that makes the performance of the motor
task impossible will not be included to the study. before the MR scanning patients will have
a neurologic examination to show any neurologic insult related to the pathology they will
have the operation for.
All these examinations and evaluations will be made at most 10 days before surgery.
The participants will perform a given motor task of block sequence. Patients will touch the
other digits by the thumb in a given order and sequence. At the same session patients, will
be screened while imagining doing the same task. The orders to rest, imagine and perform the
task will be given by an MRI compatible monitor- mirror set. Patients will practice the task
of the experiment before the real screening sessions. The patients will be observed while in
the magnet to see if they perform the task appropriately.
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