2022, Vol. 26 ›› Issue (36): 5897-5904

Mechanism and application prospects of motor imagery in spinal cord injury

Ma Jiang1, Zhang Di2, Zhao Tianyu2, Liu Xiaoxiao1, Wang Ju1, Lu Li1, Wang Ying1, Jin Song1, 2   

Abstract: BACKGROUND: Spinal cord injury is a kind of common central nervous system disease, causing dysfunction below the injury plane, which affects patient’s living quality and endangering human’s life seriously. The use of motor imagery therapy in the treatment of spinal cord injury is a new rehabilitation field in recent years, and it is a kind of rehabilitation treatment technology with a great development potential.  
OBJECTIVE: To review the basic principles of motor imagery, the possible mechanism of motor imagery applied to spinal cord injury and the research progress.
METHODS:   “Spinal cord injury, motor imagery” were used as search terms to retrieve articles on PubMed, Web of Science, CNKI, and Wanfang databases from inception to September 2021. The author excluded the articles that were not correlated with the research purpose, were repetitive, and had low credibility, and summarized the 94 articles that finally met the standard.  
RESULTS AND CONCLUSION: (1) Motor imagery first was put forward in the 1950s, and then it is identified that motor imagery is a special kind of movement function status, and is repeatedly simulation and rehearse some movement of patients with a mental state. It exists in memory, activates the motor memory center, and without any obvious motor output, and follows the principle of central motion control. (2) The theoretical model of motor imagery therapy is generally recognized as psycho-neuromuscular theory, which holds that motor imagery is similar to the neuromuscular activity induced by motor execution. (3) The mechanism of motor imagery therapy for spinal cord injury is unclear. For patients with spinal cord injury, because brain structure is not damaged, the patient’s ability of motor imagery should be properly preserved. The current studies show that the mechanism may be that spinal cord injury patients and healthy people could activate similar brain regions. In patients with spinal cord injury, similar brain regions are activated by motor imagery and motor execution. Patients can induce the development of central nerve plasticity and functional reorganization through continuous motor imagery training, which can promote the recovery of function. (4) Clinically, current studies have shown that motor imagery training can relieve neuropathic pain, improve motor and bladder function in patients with spinal cord injury. Motor imagery therapy as an adjuvant therapy should be adopted in conventional rehabilitation programs for patients with spinal cord injury. However, there is high heterogeneity in clinical efficacy, and further research is necessary. (5) Brain computer interface can convert the signals generated during the patient’s motor imagery into driving signals to control external devices to achieve the re-movement of paralyzed limbs. The development of motor imagery with brain computer interface is considered to be a revolutionary change in rehabilitation after spinal cord injury and has a very good development prospect.
Key words: spinal cord injury, motor imagery, magnetic resonance imaging, magnetoencephalography, brain-machine interface, neurological rehabilitation, rehabilitation research, review