Après une déprivation sensorielle ou après une réhabilitation sensorielle périphérique, les aires sensori-motrices primaires du cerveau se réorganisent anatomiquement et fonctionnellement. Dans le cas du transfert tendineux, une réhabilitation des fonctions manuelles est opérée grâce à une inversion de certaines fonctions de flexion en extension. Chez les patients opérés, la commande centrale de ces mouvements élémentaires repose sur des processus de plasticité cérébrale, processus encore mal connus, lents qui se stabilisent en une année et qui présentent une co-occurrence avec la récupération manuelle. Nous faisons l'hypothèse que l'IRM fonctionnelle de haute résolution permet de détecter la plasticité cérébrale liée à cette récupération motrice. Cette thèse a pour but de mettre en place des méthodes de suivi longitudinal individuel à partir des images fonctionnelles cérébrales des patients pour étudier la plasticité cérébrale lors de la récupération fonctionnelle. On a d’abord cherché à obtenir des cartes de référence de la motricité fine de la main sur un groupe de sujets contrôles. Ces cartes sont ensuite utilisées pour évaluer, à partir des données obtenues lors du suivi longitudinal de patients, la plasticité cérébrale liée au transfert tendineux. Pour mieux comprendre la représentation des mouvements de flexion et d'extension de la main dans le cortex moteur primaire, nous avons mis en place une étude en IRM fonctionnelle de haute résolution à 3T sur un groupe de 13 sujets sains. Pour généraliser les résultats individuels obtenus pour chaque mouvement au niveau de la population, il faut pouvoir réaligner les cerveaux individuels dans un référentiel commun afin d'effectuer une analyse statistique sur le groupe. Or, la variabilité anatomique inter-individuelle des aires motrices primaires constituait un verrou scientifique car celles-ci ne se réalignaient pas correctement par les méthodes classiques. Dans un premier temps, nous avons donc évalué différentes méthodes de recalage non-linéaires au niveau du cortex moteur pour assurer un alignement inter-individuel robuste. Nous avons comparé une méthode locale, Demons qui permet des déformations locales très importantes des images, une méthode classique non-linéaire (SPM), qui permet un alignement global des images, et une méthode de recalage global difféomorphique (DARTEL) utilisant de nombreux degrés de liberté. De plus, nous avons appliqué une méthode récente basée sur l’alignement des sillons corticaux au préalable à l’utilisation de DARTEL (DISCO+DARTEL) en partenariat avec l’équipe du LSIS, (CNRS Marseille) qui ajoute un caractère local à la technique globale de recalage. Nous montrons que cette dernière méthode produit le meilleur alignement sur des critères à la fois anatomiques (distance de Hausdorff, superposition des masques de tissus, et caractéristiques du champ de déformations) et fonctionnels (précision de la localisation et robustesse statistique des activations détectées). Nous avons alors pu établir des cartes de référence en haute résolution des mouvements élémentaires de la main, selon la dominance manuelle, selon la direction du mouvement et selon le segment de la main. Ces cartes présentent de multiples foyers d’activation et un chevauchement important dans la région dite du « hand-knob ». Dans un deuxième temps, nous avons évalué la robustesse de nos résultats, en réalisant une deuxième série d’examens sur les mêmes sujets contrôles (test-retest). Deux patients ont été suivis longitudinalement: avant la chirurgie (M0), à 1 mois (M1), à 3 (M3), 6 (M6) et 12 mois (M12) après la chirurgie. On a observé le recrutement au cours de la récupération de la SMA, de M1 et S1 ipsilatéral, de S1 contralatéral et des lobules V et VI du cervelet. Par rapport aux sujets sains, les patients mettent en place une réorganisation compensatoire au cours de la récupération fonctionnelle. / After a sensory deprivation or a peripheral sensory rehabilitation, primary sensorimotor areas undergo anatomical and functional reorganization. The hand tendon transfer is a rehabilitative surgery that restores the hand extension function by changing the insertion of chosen flexor muscles. During rehabilitation, the central control of the flexion and extension movements is based on elementary processes of brain plasticity, still poorly understood, but known to be slow, taking up to one year and occurring simultaneously with manual recovery. We hypothesize that high-resolution functional MRI (fMRI) may reveal brain plasticity linked to motor-behavior recovery.This PhD thesis aims to develop fMRI methods for individual patient follow-up after hand tendon transfer surgery. We first defined reference maps, based on a group of healthy subjects, for fine cortical representation of voluntary hand movements. These maps were then used to evaluate brain plasticity linked to the hand tendon surgery. To better understand the representation of the hand’s movements of flexion and extension in the primary motor cortex, we carried out a high-resolution, functional MRI study (using a static magnetic field of 3 Tesla), on a group of 13 healthy subjects. It was necessary to register all individual brains into a common reference system in order to perform a group statistical analysis. However, the inter-individual anatomical variability of the primary motor areas prevented us from performing the registration by conventional methods. We evaluated various methods of nonlinear registration to ensure a robust inter-individual alignment of central sulci. We compared: 1. a local method (Demon), which allows for important local deformations, 2. a standard non-linear method (SPM), which allows for a global image alignment and 3. a global diffeomorphic registration method (DARTEL) with a large number of degrees of freedom. In addition, we applied a fourth, more recent method, in partnership with LSIS, (CNRS Marseille) which iteratively reinforces the alignment of identified sulci before applying DARTEL (DISCO+DARTEL). This adds a local sulci-based constraint to the global deformation. We found that the fourth method produced the best alignment according to both anatomical criteria (Hausdorff distance, mask tissues overlaps and characteristics of the deformations field) and functional criteria (localization accuracy and statistical robustness of activations detected). We were then able to establish high spatial resolution reference maps of the elementary movements of the hand. These maps showed multiple foci of activity and significant overlaps in the region known as the "hand-knob."This first step of testing completed, we entered into a second round of testing where we evaluated the reproducibility of our initial results by performing a second series of tests on the same control group (“test-retest”).Two patients were followed up: before surgery (M0) and 1 month (M1), 3 (M3), 6 (M6) and 12 months (M12) after surgery. Functional recruitment was observed during recovery in SMA, M1, ispilateral and contralateral S1 and lobules V-VI of the cerebellum. Compared with healthy subjects, these two patients presented compensatory cortex reorganization during progressive recovery of hand function.

No description available.

Traditionally, language was proposed to be mediated by various left hemisphere perisylvian structures and the associated role of the motor cortices was limited to tasks such as articulation. Recent theoretical models have proposed that effector specific words with motor related meaning are represented somatotopically on the primary motor (Brodmann’s Area 4) and premotor (Brodmann’s Area 6) cortices. For example, it has been reported that when verbs associated with the hand (e.g., pick) are processed, the primary and premotor areas involved with moving the hand are engaged. However, fundamental methodological problems exist within the reported research. This thesis aimed to address and correct the inconsistencies and methodological limitations within the existing literature to provide more conclusive evidence regarding the involvement of the primary and premotor cortices in processing verbs with motor related meaning. This thesis also aimed to investigate whether the names of effectors (nouns) also involve processing by the motor cortices, either generally or somatotopically. Three behavioural dual task experiments and one fMRI experiment were conducted. Results indicated no evidence of somatotopically organised overlapping activation in the primary or premotor cortex between the various semantic categories of words and related effector movements. However, in the fMRI experiment, motor related verbs in general yielded significant overlapping activity between reading all effector related verbs and moving all effectors in the pre-supplementary motor area of the premotor cortex. These findings indicate that an embodied language involving somatotopic representations of effector specific verbs on the primary or premotor cortex is unlikely to be the case. Rather there appears to be a more general representation of effector related verbs in a more cognitive than motor area of the premotor cortex. The findings of this thesis are consistent a wealth of evidence supporting the motor cortices being generally associated with motor related language and with the idea that semantic representations are distributed throughout the brain according to the embodied cognitive framework, rather than being localised to amodal regions that process all words.

Traditionally, language was proposed to be mediated by various left hemisphere perisylvian structures and the associated role of the motor cortices was limited to tasks such as articulation. Recent theoretical models have proposed that effector specific words with motor related meaning are represented somatotopically on the primary motor (Brodmann’s Area 4) and premotor (Brodmann’s Area 6) cortices. For example, it has been reported that when verbs associated with the hand (e.g., pick) are processed, the primary and premotor areas involved with moving the hand are engaged. However, fundamental methodological problems exist within the reported research. This thesis aimed to address and correct the inconsistencies and methodological limitations within the existing literature to provide more conclusive evidence regarding the involvement of the primary and premotor cortices in processing verbs with motor related meaning. This thesis also aimed to investigate whether the names of effectors (nouns) also involve processing by the motor cortices, either generally or somatotopically. Three behavioural dual task experiments and one fMRI experiment were conducted. Results indicated no evidence of somatotopically organised overlapping activation in the primary or premotor cortex between the various semantic categories of words and related effector movements. However, in the fMRI experiment, motor related verbs in general yielded significant overlapping activity between reading all effector related verbs and moving all effectors in the pre-supplementary motor area of the premotor cortex. These findings indicate that an embodied language involving somatotopic representations of effector specific verbs on the primary or premotor cortex is unlikely to be the case. Rather there appears to be a more general representation of effector related verbs in a more cognitive than motor area of the premotor cortex. The findings of this thesis are consistent a wealth of evidence supporting the motor cortices being generally associated with motor related language and with the idea that semantic representations are distributed throughout the brain according to the embodied cognitive framework, rather than being localised to amodal regions that process all words.

Traditionally, language was proposed to be mediated by various left hemisphere perisylvian structures and the associated role of the motor cortices was limited to tasks such as articulation. Recent theoretical models have proposed that effector specific words with motor related meaning are represented somatotopically on the primary motor (Brodmann’s Area 4) and premotor (Brodmann’s Area 6) cortices. For example, it has been reported that when verbs associated with the hand (e.g., pick) are processed, the primary and premotor areas involved with moving the hand are engaged. However, fundamental methodological problems exist within the reported research. This thesis aimed to address and correct the inconsistencies and methodological limitations within the existing literature to provide more conclusive evidence regarding the involvement of the primary and premotor cortices in processing verbs with motor related meaning. This thesis also aimed to investigate whether the names of effectors (nouns) also involve processing by the motor cortices, either generally or somatotopically. Three behavioural dual task experiments and one fMRI experiment were conducted. Results indicated no evidence of somatotopically organised overlapping activation in the primary or premotor cortex between the various semantic categories of words and related effector movements. However, in the fMRI experiment, motor related verbs in general yielded significant overlapping activity between reading all effector related verbs and moving all effectors in the pre-supplementary motor area of the premotor cortex. These findings indicate that an embodied language involving somatotopic representations of effector specific verbs on the primary or premotor cortex is unlikely to be the case. Rather there appears to be a more general representation of effector related verbs in a more cognitive than motor area of the premotor cortex. The findings of this thesis are consistent a wealth of evidence supporting the motor cortices being generally associated with motor related language and with the idea that semantic representations are distributed throughout the brain according to the embodied cognitive framework, rather than being localised to amodal regions that process all words.

Prenatal alcohol exposure (PAE) alters limb development that may lead to structural and functional abnormalities of the limb reported in children diagnosed with Fetal Alcohol Spectrum Disorder. To determine whether PAE alters the central representation of the forelimb we used the rodent barrel cortex as our model system where it was possible to visualize and quantitatively measure the size of the forepaw representation in the forepaw barrel subfield (FBS) in first somatosensory cortex. In the present study, we examined the effects of PAE on pattern and size of the forepaw and forepaw representation in FBS in neonatal rats at gestational day 32 that corresponds to postnatal day 9. Pregnant Sprague-Dawley rats were chronically intubated with binge doses of ethanol (6 g/kg) from gestational day 1 through gestational day 20. The offspring of the ethanol treated dams comprised the ethanol (EtOH) group. The effect of PAE on the EtOH group was compared with a nutritional-controlled pairfed (PF) group and a normal chowfed (CF) group. The ventral (glabrous) surface area of the forepaw digits, length of digit 2 through digit 5, and the corresponding glabrous forepaw digit representations in the FBS were measured and compared between treatment groups. In rats exposed to in utero alcohol, the sizes of the overall glabrous forepaw and forepaw digits were significantly reduced in EtOH pups compared to CF and PF pups; overall glabrous forepaw area was 11% smaller than CF controls. Glabrous digit lengths were also smaller in EtOH rats compared to CF controls and significantly smaller in digit 2 through digit 4. The glabrous digit representation in FBS was 18% smaller in the EtOH group when compared to the CF treatment. However, PAE did not produce malformations in the forepaw or alter the pattern of the forepaw representation in FBS; instead, PAE significantly reduced both body and brain weights compared to controls. Unexpectedly, little or no correlation was observed between the size of the glabrous forepaw compared to the size of the glabrous forepaw representation in the FBS for any of the treatment groups. The present findings of PAE-related alterations in sensory periphery and the central cortical representation may underlie deficits in sensorimotor integration reported among children with Fetal Alcohol Spectrum Disorder.

Durant les dernières décennies, le système moteur a été largement étudié. Pourtant, bien des zones d'incertitudes persistent concernant d'une part la nature des circuits neuronaux de haut niveau impliqués dans l'émergence des sentiments d'intention ou de conscience motrice et d'autre part l'organisation des structures cérébrales de bas-niveau impliquées dans l'expression de ces sentiments. Il a été suggéré que le cortex pariétal et l'aire motrice supplémentaire pourraient jouer un rôle dans la génération des intentions motrices, alors que le cortex prémoteur pourrait plutôt sous-tendre la conscience du geste. Cela étant, les processus exacts implémentés dans chacune de ces régions, la façon dont elles interagissent fonctionnellement et la nature des signaux qu'elles échangent avec les structures sensorimotrices considérées de bas-niveau demeurent méconnus. Il est établi que ces structures bas-niveau, dont le cortex moteur primaire et le cervelet, contiennent des cartes sensorimotrices organisées de manière topographique. Cependant, l'organisation fine de cette topographie et la nature des interactions entre les différentes cartes restent à définir. Dans ce travail de thèse, j'ai utilisé la stimulation électrique directe chez des patients opérés de tumeurs et malformations cérébrales pour explorer la manière dont les multiples représentations motrices sont organisées et pour identifier les régions responsables de l'émergence des sentiments d'intention et de conscience motrice. J'ai alors pu montrer, en particulier, l'existence de cartes motrices multiples au sein des cortex moteur primaire et cérébelleux. Par ailleurs, j'ai pu identifier le rôle critique du cortex pariétal pour l'émergence du sentiment d'intention motrice et -sur la base de processus prédictifs- de la conscience d'agir. Par rapport à ce point, j'ai aussi pu mettre en évidence que le cortex prémoteur était impliqué, à travers un contrôle continu des prédictions pariétales, dans l'émergence d'une conscience d'agir non plus inférée mais véritable / During the last five decades, the motor system has been widely studied. Yet, little is known about the neural substrate of high-level aspects of movement such as intention and awareness and how these functions are related to low-level movement execution processes. It has been suggested that the parietal cortex and supplementary motor area are involved in generating motor intentions, while premotor cortex may play a role in the emergence of motor awareness. However, the precise mechanisms implemented within each of these areas, the way they interact functionally and the nature of the signals conveyed to primary sensory and motor regions is far from being understood. Furthermore, intention and awareness of movement are also influenced by peripheral information coming from the skin, muscles and joints, and this information must be integrated to produce smooth, accurate and coordinated motor actions. Cortical and subcortical structures such as the primary motor cortex and the cerebellum are known to contain motor maps thought to contribute to motor control, learning and plasticity, but the intrinsic organization of these maps and the nature of their reciprocal relations are still unknown. In this thesis I used Direct Electrical Stimulation in patients undergoing brain surgeries to investigate how multiple motor representations are organized and identify the regions responsible for the emergence of conscious motor intention and awareness. I showed, in particular, the existence of multiple efferent maps within the cerebellum and the precentral gyrus. Furthermore, I identified the critical role of the parietal cortex for the emergence of conscious intention and -based on predictive processes- motor awareness. I also provided evidence that the premotor cortex is involved in "checking" parietal estimations, thus leading to a sense of "veridical awareness"

Ce travail s'intéresse à l'organisation fonctionnelle du système sensorimoteur. La somatotopie est une caractéristique essentielle de M1, mais l'organisation fonctionnelle des autres aires motrices (PM, SMA, et IPL) n'est pas encore clairement établie. Premièrement, nous avons exploré par IRMf l'organisation fonctionnelle sensorimotrice chez des sujets sains exécutant des mouvements simples. Nos résultats montrent que les représentations motrices sont organisées selon des synergies musculaires et qu'une organisation somatotopique, différente de celle de M1, existe dans l'IPL. Bien qu'elle fasse régulièrement l'objet de critiques, la DES est à la base de la plupart de nos connaissances sur le cortex moteur, que confirme les études en IRMf. Ainsi, en réponse au débat en cours, nous avons passé en revue les arguments récents confortant la confiance que nous pouvons accorder à la DES. Des études récentes concluent à l'implication du PPC dans l'intention motrice, mais le débat reste ouvert sur la relation entre intention et préparation motrices. Certains prétendent que l'intention serait le sous-produit de la préparation motrice, ne laissant aucune place à la volonté dans le contrôle moteur. Pour étudier cette question, nous avons mis en place une expérience comportementale, incluant des tâches de réaction simple et de Libet pour comparer les deux processus cognitifs. Nos résultats montrent que le temps de réaction entre intention interne et réaction motrice est égal à celui séparant commande externe et réaction motrice. Cela contredit donc l'affirmation selon laquelle la préparation motrice précèderait l'intention et donc que l'intention émergerait du processus d'intention motrice / In this thesis, I am interested in the functional organization of human cortical sensorimotor system. Somatotopy is the prominent structure of the functional organization in sensory and motor cortex. However, the structure of the functional organization in higher order motor area, such as IPL is little known. Therefore, in the first part, I study the functional organization of human sensory- and motor- related brain regions using fMRI, by guiding healthy subjects to perform simple repetitive movements of different body parts. Our results demonstrate that, 1) motor synergy is the neural basis represented in the motor cortex; and 2) somatotopic organization also exists in IPL but with different structure from that of sensorimotor cortex. Despite continuous criticism on DES, most of our primitive knowledge of the sensorimotor cortex comes from DES studies, and our fMRI result supports the findings of DES. In response to the ongoing debate on DES, in the second study, we review recent evidence to re-establish the confidence on DES. Accumulating evidence indicates that PPC is related to the emergence of motor intention. However, debate on the relation between motor intention and preparation never stops, some claims that motor intention is the byproduct from motor preparation, thus denying the volition of human motor control. Besides this complexity, we design a straightforward behavior experiment, including simple reaction task and Libet task, in order to compare the cognitive process of motor preparation and motor intention. Our result shows that RT from internal motor intention to motor output is equal to the RT from external cue to motor output, thus rejecting the possibility that motor preparation starts in advance of motor intention and doesn't support that motor intention arises from the process of motor intention

Le but de cette thèse était d'étudier l'organisation anatomo-fonctionnelle du système sensorimoteur humain et la façon dont les mouvements volontaires sont produits et contrôlés. Avec le développement de l’imagerie cérébrale, des méthodes de corrélation anatomo-clinique et de stimulation électrique directe cérébrale, de nombreuses avancées scientifiques ont pu être réalisée. Ces trois approches complémentaires ont été utilisé dans cette thèse afin d’améliorer la compréhension de l’organisation sensorimotrice cérébrale. Dans la première étude (soumise à publication), nous avons montré que la chirurgie cérébrale éveillée utilisant la stimulation électrique directe est une procédure sûre et efficace chez les enfants afin de réduire le déficit neurologique postopératoire. L'approche améliore la précision de la détection des zones éloquentes, avec une bonne tolérance neuropsychologique et psychologique. Une évaluation psychologique et neuropsychologique est essentielle. Dans une deuxième série de deux études, nous avons montré que la partie dorso-postérieure dorsal du cortex pariétal (DPPr) est une structure clé dans l'organisation complexe du mouvement manuel fin chez l'homme à travers la mise en oeuvre d'une boucle sensori-parieto-motrice.La première étude (publiée, Current Biology 2018) montre que la stimulation électrique directe d’une region corticale focale dans la partie dorso-postérieure du cortex pariétal entraine l’inhibition de la production du mouvement manuel, c’est-à-dire bloque l'initiation et la réalisation de ce dernier, sans produire de contraction musculaire ni de sensation consciente de mouvement. Dans la seconde étude (en cours de soumission), nous avions pour objectif d'identifier précisément les bases anatomiques du circuit parietal inhibiteur précédemment décrit. Grâce à la tractographie de diffusion (DTI), nous avons réussi à isoler des projections ipsilatérales spécifiques reliant les sites d’inhibition du DPPr, retrouvés dans la première étude, avec la zones dévolues au contrôle distal fin dans les cortex primaires moteur (M1) et sensoriel (S1). Ces données montrent que la boucle pariétale inhibitrice est directe depuis S1 vers DPPr vers M1 (même s'il n'est pas possible d'exclure l'existence d'échanges bidirectionnels entre ces aires). Dans la dernière étude (en cours de soumission), nous nous sommes intéressé à une structure motrice fondamentale, qui supporte 50 % des invasions tumorales chez l'enfant : le cervelet. Il s'agissait de déterminer si les lésions précoces étaient oui ou non prédictives d'une récupération déficitaire à long terme après prise en compte des covariables les plus critiques. Nous avons mesuré la récupération fonctionnelle à long terme chez 3 groupes survivants de lésion de la fosse postérieure. Les 3 groupes étaient comparables en ce qui concerne leurs caractéristiques tumorales mais opérés à différents âges : jeune (≤ 7 ans), moyen (> 7 ans et ≤ 13 ans) et tardif (> 13 ans). La qualité de vie (échelles cliniques : Health-related Quality of Life -hrQol- et Performance Status -PS-), les performances motrices (ataxie -ICARS- et motricité fine -Pegboard-) et cognitif (quotient intellectuel -FSIQ-) furent mesurés. L'âge précoce lors de la chirurgie, une lésion des noyaux profonds cérébelleux et la nécessité d'une radiothérapie postopératoire révélèrent une influence significativement négative et indépendante sur la récupération à long terme des participants. Ces résultats confirment l'existence d'une période critique de développement au cours de laquelle la "machine à apprendre" cérébelleuse revêt une importance cruciale / The aim of the thesis was to investigate the mapping of the anatomofunctional organization of the human sensorimotor system and how volutional movements of human are produced and controlled. Neuroimaging and especially DTI, fine anatomo-functional observation in patient and direct electrical stimulation were considered. This multi-modal approach permitted to improve our understanding of sensorimotor organization in humans. In the first study, we showed that awake brain surgery with the use of direct electrical stimulation is a safe and efficient procedure in children in order to decrease post-operative neurological deficit. It improves the accuracy of detecting eloquent area, with a good tolerance from a neuropsychological and psychological aspect. Age-adapted neuropsychologic preparation may enable offering ABS even to younger children on an individual basis. In a second series of two studies, we showed that the dorso-posterior part of the parietal cortex is a key structure in the complex organization of movement in human with a S1-DPPr-M1 loop. In the first study, direct electrical stimulation of focal cortical site in the dorso-posterior part of the parietal cortex triggered inhibition of movement production and blocked ongoing movement without producing muscle contraction or conscious movement sensation. In the second study, we aimed to find a direct projection from the PRR, defined in the first study (Desmurget et al., 2018), to the primary motor cortex and the primary somatosensory cortex. Thanks to the DTI state-of-the-art tractography, we succeeded in finding such major ipsilateral streamlines projecting in the well-known hand knob region giving new insights of the white matter structures involved in the inhibition of volitional hand movements. These observations confirm clinical per-operative data showing that stimulating the counterpart of PRR in humans can disrupt hand movements ipsilaterally, irrespective of the hemisphere. Moreover, our results shed light on the implication of the PRR for the volitional hand sensorimotor operating behavior. In the last study, we investigate the impact of early cerebellar damage on long-term functional recovery in 3 groups of posterior fossa survivors, comparable with respect to their tumoural characteristics but operated at different ages: young (≤ 7 years), middle (> 7 years and ≤ 13 years) and old (> 13 years). Daily (Health-related Quality of Life -hrQol-, Performance Status -PS-), motor (International Cooperative Ataxia Rating Scale -ICARS-, Pegboard Purdue Test -PegBoard-) and cognitive (Full Scale Intelligence Quotient -FSIQ-) functioning were measured. Early age at surgery, lesion of deep cerebellar nuclei and post-operative radiotherapy had a significant, independent negative influence on long term recovery. These results support the existence of an early critical period of development during which the cerebellar "learning machine" is of critical importance