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Brain Advance Access published online on October 24, 2005
Brain, doi:10.1093/brain/awh648
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© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received June 24, 2005
Revised August 29, 2005
Accepted September 3, 2005

Article

Brain motor system function after chronic, complete spinal cord injury

Steven C. Cramer 1*, Lindsey Lastra 2, Michael G. Lacourse 3, and Michael J. Cohen 4

1 Department of Neurology, Anatomy and Neurobiology, Reeve-Irvine Research Center, University of California, Irvine, CA, USA
2 Neuroimaging Research Laboratory, Department of Veterans Affairs Long Beach Healthcare System, California State University, Long Beach, CA, USA
3 Neuroimaging Research Laboratory, Department of Veterans Affairs Long Beach Healthcare System, California State University, Long Beach, CA, USA; Department of Kinesiology, California State University, Long Beach, CA, USA
4 Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA; Neuroimaging Research Laboratory, Department of Veterans Affairs Long Beach Healthcare System, California State University, Long Beach, CA, USA

* To whom correspondence should be addressed.
Steven C. Cramer, E-mail: scramer{at}uci.edu


  Abstract

Most therapies under development to restore motor function after spinal cord injury (SCI) assume intact brain motor functions. To examine this assumption, 12 patients with chronic, complete SCI and 12 controls underwent functional MRI during attempted, and during imagined, right foot movement, each at two force levels. In patients with SCI, many features of normal motor system function were preserved, however, several departures from normal were apparent: (i) volume of activation was generally much reduced, e.g. 4-8% of normal in primary sensorimotor cortex, in the setting of twice normal variance in signal change; (ii) abnormal activation patterns were present, e.g. increased pallido-thalamocortical loop activity during attempted movement and abnormal processing in primary sensorimotor cortex during imagined movement; and (iii) modulation of function with change in task or in force level did not conform to patterns seen in controls, e.g. in controls, attempted movement activated more than imagined movement did within left primary sensorimotor cortex and right dorsal cerebellum, while imagined movement activated more than attempted movement did in dorsolateral prefrontal cortex and right precentral gyrus. These modulations were absent in patients with SCI. Many features of brain motor system function during foot movement persist after chronic complete SCI. However, substantial derangements of brain activation, poor modulation of function with change in task demands and emergence of pathological brain events were present in patients. Because brain function is central to voluntary movement, interventions that aim to improve motor function after chronic SCI likely also need to attend to these abnormalities of brain function.

Keywords: motor system; spinal cord injury; plasticity.
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