Introduction: Motor imagery (MI) is widely used in the training of elite athletes and during neurorehabilitation. Studies have demonstrated the potential of MI for surgical training but heterogenous results and inconsistent methodologies have limited its uptake. Resting state functional connectivity (rsFC) using fMRI offers a unique opportunity for evaluating motor training effects on neural motor networks. This study aims to evaluate the direct effects of MI of a surgical task on neural functional connectivity.
Methods: 4 intermediate level surgical trainees were recruited and underwent an initial brain fMRI. Functional images of the participants performing MI or motor execution of a simple hand task were acquired to identify key regions of interest. Resting-state fMRI acquisition was then performed. Baseline surgical skills were evaluated using a dry lab laparoscopic suturing test. Performances were videoed for post-hoc assessment. Participants were then taught MI for the laparoscopic suturing task using MI script developed by a cognitive psychologist. After 14 days of independent MI training, resting state fMRI and laparoscopic skills assessments were repeated. Blinded technical skills assessment was performed by an experienced laparoscopic surgeon using GOALS and a validated suturing checklist.
Results: 6 regions of interest were identified. Resting state functional connectivity was analysed between all possible pairs of the 6 regions. A significant increase in the connectivity between the prefrontal and frontal regions containing the premotor and motor cortices was seen. Activity between all other clusters remained constant. There were non-significant increases in both medial GOALS and the suturing check list scores following training.
Conclusions: Short-term focussed MI training of laparoscopic suturing resulted in significantly increased connectivity between the prefrontal and frontal cortex alongside improvements in technical performance. These results highlight the potential role of MI for surgical training and support further comparative trials. Source of