Promoting enhanced motor planning in prosthesis users via matched limb imitation

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Cusack, William Fitzpatrick
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As of 2005, there were over 1.5 million amputees living in the United States, more than 548,000 of them with upper extremity involvement. The total number of amputees is projected to rise to at least 2.2 million by 2020. Unfortunately, full functional use of upper extremity prosthetic devices is low. Knowledge gained regarding the cortical systems active in amputees performing motor tasks may reveal atypical motor control strategies that contribute to these issues. Substantial evidence demonstrates a strong dependence on left parietofrontal cortical areas to successfully plan and execute tool-use movements and pantomimes. It was previously unclear how this network functioned in users of prostheses. The hypothesis of this dissertation is that in order to optimally engage the typical parietofrontal network during action imitation with a prosthetic device, the action being imitated should be performed by a matching prosthesis. Also, that greater engagement of the parietofrontal network will result in increased ability to perform tool-use movements. First, this dissertation showed that when imitating motor tasks performed by intact actors, prosthesis users exhibit lower engagement of the parietofrontal action encoding system. This network is crucial for motor adaptation. Left parietofrontal engagement was only observed when prosthesis users imitated matched limb prosthesis demonstrations, which suggests that matched limb imitation may be optimal to establish motor representations. Next, intact subjects donned a fictive amputee model system (FAMS) to simulate the limb movement that transradial amputees experience. Matched limb imitation in FAMS users yielded better movement technique compared to mismatched imitation. Finally, the longitudinal effects of a matched limb training paradigm on the cortical action encoding activity and motor behavior in FAMS users were investigated. Matched limb imitation subjects showed greater engagement of the parietofrontal network and better movement technique compared to those trained with mismatched limb. This dissertation has clinical relevance as it supports the notion that matched limb imitation could play an important role in the performance of motor tasks using a prosthetic device. These findings could be used to inform the development of improved rehabilitation protocols that may lead to greater functional adaptation of prosthetic devices into the lives of amputees.
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