In healthy humans and patients with lesions of the CNS, leaming to perfomn a sequence of movements with one hand results in performance improvements in the opposite hand, a process referred to as interrtianual transfer. The neural substrates underlying this transfer function are incompletely understood. In patients with CNS lesions, understanding how iearning acquired with one limb transfers to a disabled, untrained limb could lead to more effective neurorehabilitative treatments. The purposes of the ROO phase are to (a) identify using fMRI and rTMS the mechanisms of intermanual transfer of motor learning to a disabled, untrained limb in patients with incomplete SCI, and (b) modulate excitability of the cortical areas in charge of the transfer function identified with fMRI and rTMS to facilitate intermanual transfer to the paralyzed limb.
From a scientific point of view, results from these experiments will improve our understanding of the neural substrates underlying intennanual transfer of motor leaming in patients with incomplete SCI. From a clintcal view point, these experiments could lead to the development of a novel interventional approach, based on the concept of facilitating intermanual transfer, to improve function of a paralyzed hand (unable to carry out motor training) by combining brain stimulatbn and training of the less affected hand. The absence of universally accepted treatments for the motor disability resulting from SCI, and the substantial psychological, familiar, financial and sodal impact of this disease highlight the importance of these investigations.
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