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Current models of motor control emphasize the critical role of sensory feedback, as demonstrated by movement coordination deficits following sensory impairment. When both vision and touch are available for object-oriented manual behaviors, they serve distinct roles; vision guides the execution of planned movements, while touch provides more direct feedback on hand–object interactions. The impact of losing somatosensory feedback on eye–hand coordination during dexterous object manipulation tasks has not been thoroughly studied. Conceivably, vision is recruited to compensate for the feedback lost when touch is abolished based on the dexterity demands of the behavior. To investigate this, we tested healthy participants of either sex on a manual dexterity task requiring the movement of small metal pegs, both before and after the administration of digital anesthesia, which selectively abolished cutaneous sensations in the fingertips while preserving motor function. We recorded participants’ gaze and hand positions. Despite loss of cutaneous feedback, participants successfully completed the pegboard task. However, they exhibited significantly longer trial times and altered force profiles. Notably, acute somatosensory loss triggered a rapid shift in visual behavior, characterized by a tighter coupling between gaze and hand positions across all task actions, even those not directly involving object manipulation. These changes, which occurred with anesthesia of the dominant and nondominant hands, were not evident with sham (saline) injections. Our findings underscore the contributions of sensory feedback to force control in service of dexterous object manipulation and reveal the nonselective nature of compensatory gaze–hand coordination processes.

Despite state-of-the-art surgical and postoperative treatment, median nerve transection causes lasting impaired hand function due to limitations in the nerve’s reinnervation ability. The defective innervation and thus controllability of the affected hand can shape the brain’s control of manual behaviors. Earlier studies of changes in the processing of tactile stimuli have focused mainly on stimulation of the reinnervated hand and lack sufficient control over the brain’s use of the tactile input in perceptual terms. Here we used fMRI to measure brain activity (BOLD-signal) in 11 people with median nerve injury and healthy controls (N = 11) when performing demanding tactile tasks using the tip of either the index or little finger of either hand. For the nerve-injured group, the left median nerve had been traumatically transected in the distal forearm and surgically repaired on average 8 years before the study. The hand representation of their contralesional (right) primary somatosensory cortex (S1) showed greater activity compared to controls when the left reinnervated index finger was used, but also when the left-hand little finger and the fingers of the right hand innervated by uninjured nerves were used. We argue that the overall increase in activity reflects a general disinhibition of contralesional S1 consistent with an augmented functional reorganizational plasticity being an ongoing feature of chronic recovery from nerve injury. Also, the nerve-injured showed increased activity within three prefrontal cortical areas implicated in higher-level behavioral processing (dorsal anterior cingulate cortex, left ventrolateral prefrontal and right dorsolateral prefrontal cortex), suggesting that processes supporting decision-making and response-selection were computationally more demanding due to the compromised tactile sensibility.

Despite the best available surgical repair, traumatic median nerve injury within the forearm typically causes lifelong impairment in hand function. This stems from an inadequate reinnervation of the nerves supporting sensory functions of the thumb, index and long finger, and of nerves supplying intrinsic hand muscles. This thesis examines whether median nerve injuries can cause structural and functional changes in the brain. Understanding such changes can help the development of new treatments for improved recovery of hand function.

The first study introduces a novel apparatus and paradigm for examining tactile neural processing with fMRI under well-controlled behavioral conditions. The scientific issue challenged was whether, in healthy adults, different cortical areas could be involved in processing tactile stimuli depending on their temporal frequency content. In a threshold-tracking paradigm, the participants’ task was to detect oscillatory mechanical stimulations of various frequencies delivered to the tip of either left or right middle finger. Regardless of stimulated hand, tactile detection of audible frequencies (20 and 100 Hz) engaged the left auditory cortex while detection of slow object displacements (3 Hz) engaged visual cortex. These results corroborate and advance the metamodal theory of brain function, which posits that brain areas can contribute to sensory processing by performing specific computations – those for which they are specialized – regardless of input modality.

The second and third studies concern structural and functional changes in the brain of adults with one reinnervated hand after an injury transecting the median nerve in the forearm. Healthy individuals matched for sex, handedness and age served as controls. Irrespective of side of injury (left or right), voxel-based morphometry applied on T1 MR-images revealed reductions of gray matter in the left ventral and right dorsal premotor cortex, and reductions of white matter in related commissural pathways. We interpreted these as activity-dependent structural adaptations to reduced neural processing linked to restrictions in the diversity of the natural manual dexterity repertoire caused by a disturbed innervation of the hand. Conversely, increases in gray matter were observed bilaterally in a motion-processing visual cortical area. We interpreted this as a structural manifestation of increased neural processing linked to greater dependence on vision for controlling manual dexterity due to impaired tactile innervation of the affected hand.

To reveal functional changes in tactile cortical processing after median nerve reinnervation, we recorded brain activity using fMRI when study participants performed perceptually demanding tactile threshold-tracking and oddball detection tasks with our novel apparatus. The hand representation of the contralesional primary somatosensory cortex (S1) showed greater activity compared to the controls when the reinnervated index finger was engaged in the tasks, but strikingly also when fingers of both hands innervated by uninjured nerves were engaged, i.e., little finger of the reinnervated hand and index and little finger of the other hand. The generally increased activity indicates a general disinhibition of contralateral S1, suggesting that increased functional reorganization is an ongoing process of chronic nerve injury. In addition, prefrontal areas implicated in processes that support decision-making and response selection showed increased activity, suggesting that such processes were more computationally demanding after nerve injury.

Together, these results indicate that brain areas can undergo significant changes after peripheral nerve injury, even when followed by best available surgical repair and reinnervation conditions. These changes can include activity-dependent structural adaptations consisting of either regional decreases or increases in gray matter concentration, which likely depend on an area's functional specialization and on changes in its processing load due to behavioral constraints imposed by the injury. Moreover, the results also suggest that the affected hand's primary cortical projection area is still in a state of ongoing functional reorganization despite the fact that peripheral reinnervation of the hand should have been completed long ago, which should inspire the development of new therapeutic regimens for what today is considered a chronic impairment.

Transection of the median nerve typically causes lifelong restriction of fine sensory and motor skills of the affected hand despite the best available surgical treatment. Inspired by recent findings on activity-dependent structural plasticity of the adult brain, we used voxel-based morphometry to analyze the brains of 16 right-handed adults who more than two years earlier had suffered injury to the left or right median nerve followed by microsurgical repair. Healthy individuals served as matched controls. Irrespective of side of injury, we observed gray matter reductions in left ventral and right dorsal premotor cortex, and white matter reductions in commissural pathways interconnecting those motor areas. Only left-side injured participants showed gray matter reduction in the hand area of the contralesional primary motor cortex. We interpret these effects as structural manifestations of reduced neural processing linked to restrictions in the diversity of the natural manual dexterity repertoire. Furthermore, irrespective of side of injury, we observed gray matter increases bilaterally in a motion-processing visual area. We interpret this finding as a consequence of increased neural processing linked to greater dependence on vision for control of manual dexterity after median nerve injury because of a compromised somatosensory innervation of the affected hand.

Although some brain areas preferentially process information from a particular sensory modality, these areas can also respond to other modalities. Here we used fMRI to show that such responsiveness to tactile stimuli depends on the temporal frequency of stimulation. Participants performed a tactile threshold-tracking task where the tip of either their left or right middle finger was stimulated at 3, 20, or 100 Hz. Whole-brain analysis revealed an effect of stimulus frequency in two regions: the auditory cortex and the visual cortex. The BOLD response in the auditory cortex was stronger during stimulation at hearable frequencies (20 and 100 Hz) whereas the response in the visual cortex was suppressed at infrasonic frequencies (3 Hz). Regardless of which hand was stimulated, the frequency-dependent effects were lateralized to the left auditory cortex and the right visual cortex. Furthermore, the frequency-dependent effects in both areas were abolished when the participants performed a visual task while receiving identical tactile stimulation as in the tactile threshold-tracking task. We interpret these findings in the context of the metamodal theory of brain function, which posits that brain areas contribute to sensory processing by performing specific computations regardless of input modality.