Preserved cortical somatotopic and motor representations in tetraplegic humans

A rich literature has documented changes in cortical representations of the body in somatosensory and motor cortex. Recent clinical studies of brain–machine interfaces designed to assist paralyzed patients have afforded the opportunity to record from and stimulate human somatosensory, motor, and action-related areas of the posterior parietal cortex. These studies show considerable preserved structure in the cortical somato-motor system. Motor cortex can immediately control assistive devices, stimulation of somatosensory cortex produces sensations in an orderly somatotopic map, and the posterior parietal cortex shows a high-dimensional representation of cognitive action variables. These results are strikingly similar to what would be expected in a healthy subject, demonstrating considerable stability of adult cortex even after severe injury and despite potential plasticity-induced new activations within the same region of cortex. Clinically, these results emphasize the importance of targeting cortical areas for BMI control signals that are consistent with their normal functional role.