Differential effects of sustained manual pressure stimulation according to site of action

Pavel Hok, Jaroslav Opavský, René Labounek, Miroslav Kutín, Martina Šlachtová, Zbyněk Tüdös, Petr Kaňovský, Petr Hluštík

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6 Scopus citations


Sustained pressure stimulation of the body surface has been used in several physiotherapeutic techniques, such as reflex locomotion therapy. Clinical observations of global motor responses and subsequent motor behavioral changes after stimulation in certain sites suggest modulation of central sensorimotor control, however, the neuroanatomical correlates remain undescribed. We hypothesized that different body sites would specifically influence the sensorimotor system during the stimulation. We tested the hypothesis using functional magnetic resonance imaging (fMRI) in thirty healthy volunteers (mean age 24.2) scanned twice during intermittent manual pressure stimulation, once at the right lateral heel according to reflex locomotion therapy, and once at the right lateral ankle (control site). A flexible modeling approach with finite impulse response basis functions was employed since non-canonical hemodynamic response was expected. Subsequently, a clustering algorithm was used to separate areas with differential timecourses. Stimulation at both sites induced responses throughout the sensorimotor system that could be mostly separated into two anti-correlated subsystems with transient positive or negative signal change and rapid adaptation, although in heel stimulation, insulo-opercular cortices and pons showed sustained activation. In direct voxel-wise comparison, heel stimulation was associated with significantly higher activation levels in the contralateral primary motor cortex and decreased activation in the posterior parietal cortex. Thus, we demonstrate that the manual pressure stimulation affects multiple brain structures involved in motor control and the choice of stimulation site impacts the shape and amplitude of the blood oxygenation level-dependent response. We further discuss the relationship between the affected structures and behavioral changes after reflex locomotion therapy.
Original languageEnglish (US)
Article number722
JournalFrontiers in Neuroscience
Issue numberJUL
StatePublished - Jan 1 2019

Bibliographical note

Publisher Copyright:
© 2019 Hok, Opavský, Labounek, Kutín, Šlachtová, Tüdös, Kaňovský and Hluštík.


  • Brainstem
  • Magnetic resonance imaging
  • Neurological rehabilitation
  • Physical stimulation
  • Sensorimotor cortex


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