a1 Department of Physical Medicine and Rehabilitation, Temple University School of Medicine, Moss Rehabilitation Hospital, Philadelphia, Pa. 19141
Though its existence has been known for well over 30 years, only recently has the supplementary motor area (SMA) and its role in the cortical organization of movement come to be examined in detail by neuroscientists. Evidence from a wide variety of investigational perspectives is reviewed in an attempt to synthesize a conceptual framework for understanding SMA function. It is suggested that the SMA has an important role to play in the intentional process whereby internal context influences the elaboration of action. It may be viewed as phylogenetically older motor cortex, derived from anterior cingulate periarchicortical limbic cortex, which, as a key part of a medial premotor system, is crucial in the “programming” and fluent execution of extended action sequences which are “projectional” in that they rely on model-based prediction. This medial system can be distinguished from a lateral premotor system postulated to have evolved over phylogeny from a different neural source. An anatomico-physiologic model of the medial premotor system is proposed which embodies the principles of cyclicity and reentrance in the process of selecting those neural components to become active in conjunction with the performance of a particular action. The postulated dynamic action of this model in the microgenesis of a discrete action is outlined. It is concluded that although there is a great deal to be learned about the SMA, a convergence of current evidence can be identified. Such evidence suggests that the SMA plays an important role in the development of the intention-to-act and the specification and elaboration of action through its mediation between medial limbic cortex and primary motor cortex.