Torbay Hospital, Torbay and South Devon NHS Trust, Newton Rd, Torquay, TQ2 7AA, UK.
Koç University Hospital, Topkapı, Koç Üniversitesi Hastanesi, Davutpasa Cd. No:4, Zeytinburnu, Istanbul, 34010, Turkey.
J Physiol. 2021 Apr;599(8):2255-2272. doi: 10.1113/JP281273. Epub 2021 Mar 23.
Massive irreparable rotator cuff tear was used as a model to study the impact of chronic pain and motor impairment on the motor systems of the human brain using magnetic resonance imaging. Patients show markers of lower grey/white matter integrity and lower functional connectivity compared with control participants in regions responsible for movement and the perception of visual movement and body shape. An independent cohort of patients showed relative deficits in the perception of visual motion and hand laterality compared with an age-matched control group. These data support the hypothesis that the structure and function of the motor control system differs in patients who have experienced chronic motor impairment. This work also raises a new hypothesis, supported by neuroimaging and behaviour, that a loss of motor function could also be associated with off-target effects, namely a reduced ability to perceive motion and body form.
Changes in the way we move can induce changes in the brain, yet we know little of such plasticity in relation to musculoskeletal diseases. Here we use massive irreparable rotator cuff tear as a model to study the impact of chronic motor impairment and pain on the human brain. Cuff tear destabilises the shoulder, impairing upper-limb function in overhead and load-bearing tasks. We used neuroimaging and behavioural testing to investigate how brain structure and function differed in cuff tear patients and controls (imaging: 21 patients, age 76.3 ± 7.68; 18 controls, age 74.9 ± 6.59; behaviour: 13 patients, age 75.5 ± 10.2; 11 controls, age 73.4 ± 5.01). We observed lower grey matter density and cortical thickness in cuff tear patients in the postcentral gyrus, inferior parietal lobule, temporal-parietal junction and the pulvinar - areas implicated in somatosensation, reach/grasp and body form perception. In patients we also observed lower functional connectivity between the motor network and the middle temporal visual cortex (MT), a region involved in visual motion perception. Lower white matter integrity was observed in patients in the inferior fronto-occipital/longitudinal fasciculi. We investigated the cognitive domains associated with the brain regions identified. Patients exhibited relative impairment in visual body judgements and the perception of biological/global motion. These data support our initial hypothesis that cuff tear is associated with differences in the brain's motor control regions in comparison with unaffected individuals. Moreover, our combination of neuroimaging and behavioural data raises a new hypothesis that chronic motor impairment is associated with an altered perception of visual motion and body form.
采用巨大不可修复的肩袖撕裂模型，研究慢性疼痛和运动障碍对人类大脑运动系统的影响，使用磁共振成像。与对照组相比，患者在负责运动和视觉运动及身体形状感知的区域表现出较低的灰质/白质完整性和较低的功能连接标志物。另一组独立的患者在手眼偏侧性知觉的视觉运动方面表现出相对缺陷，与年龄匹配的对照组相比。这些数据支持这样一种假设，即经历慢性运动障碍的患者的运动控制系统的结构和功能存在差异。这项工作还提出了一个新的假设，该假设得到神经影像学和行为学的支持，即运动功能的丧失也可能与非靶向效应有关，即感知运动和身体形态的能力降低。
我们的运动方式的改变会引起大脑的变化，但我们对与肌肉骨骼疾病相关的这种可塑性知之甚少。在这里，我们采用巨大不可修复的肩袖撕裂作为模型，研究慢性运动障碍和疼痛对人类大脑的影响。肩袖撕裂使肩部不稳定，使上肢在头顶和负重任务中功能受损。我们使用神经影像学和行为测试来研究肩袖撕裂患者和对照组之间的大脑结构和功能有何不同（影像学：21 例患者，年龄 76.3±7.68；18 例对照组，年龄 74.9±6.59；行为学：13 例患者，年龄 75.5±10.2；11 例对照组，年龄 73.4±5.01）。我们观察到肩袖撕裂患者在中央后回、下顶叶、颞顶联合和丘脑枕部灰质密度和皮质厚度降低，这些区域与躯体感觉、伸手/抓握和身体形状感知有关。在患者中，我们还观察到运动网络与中颞视觉皮层（MT）之间的功能连接降低，MT 是视觉运动感知的一个区域。在额枕下/纵向束中，我们观察到患者的白质完整性降低。我们研究了与识别出的大脑区域相关的认知领域。患者在视觉身体判断和生物/整体运动知觉方面表现出相对的损伤。这些数据支持我们的初步假设，即肩袖撕裂与未受影响个体的大脑运动控制区域存在差异。此外，我们的神经影像学和行为学数据结合提出了一个新的假设，即慢性运动障碍与视觉运动和身体形态感知的改变有关。
