Corticomotor plasticity and learning of a ballistic thumb training task are diminished in older adults

Integrative neuromuscular training and sex-specific fitness performance in 7-year-old children: an exploratory investigation

CONTEXT

Integrative neuromuscular training (INT) has successfully enhanced physical fitness and reduced abnormal biomechanics, which appear to decrease injury rates in adolescent female athletes. If not addressed at the proper time, low levels of physical fitness and abnormal mechanics may predispose female athletes to an increased risk of musculoskeletal injuries.

OBJECTIVES

To evaluate sex-specific effects of INT on selected measures of health- and skill-related fitness in children during physical education (PE).

DESIGN

Cohort study.

SETTING

Public primary school.

PATIENTS OR OTHER PARTICIPANTS

Forty children (16 boys, 24 girls; age = 7.6 ± 0.3 years, height = 124.5 ± 6.4 cm, mass = 29.5 ± 7.6 kg) from 2 second-grade PE classes.

INTERVENTION(S)

The classes were randomized into the PE-plus-INT group (10 boys, 11 girls) or the control group (6 boys, 13 girls) that participated in traditional PE. The INT was performed 2 times per week during the first approximately 15 minutes of each PE class and consisted of body weight exercises.

MAIN OUTCOME MEASURE(S)

Push-up, curl-up, standing long jump, single-legged hop, single-legged balance, sit-and-reach flexibility test, shuttle run, and 0.8-km run.

RESULTS

At baseline, the boys demonstrated higher levels of performance in most of the fitness measurements as evidenced by greater performance on the push-up, standing long jump, single-legged hop, shuttle run, and 0.8-km run (P < .05). In the evaluation of the training effects, we found intervention effects in the girls for enhanced INT-induced gains in performance relative to the control group on the curl-up, long jump, single-legged hop, and 0.8-km run (P < .05) after controlling for baseline. Boys did not demonstrate similar adaptations from the INT program (P ≥ .05).

CONCLUSIONS

These data indicate that INT is an effective and time-efficient addition to PE for enhancing motor skills and promoting physical activity in children. Seven-year-old girls appeared to be more sensitive to the effects of INT than 7-year-old boys. Future research is warranted to confirm these effects in larger cohorts of children.

Formation of cortical plasticity in older adults following tDCS and motor training

Neurodegeneration accompanies the process of natural aging, reducing the ability to perform functional daily activities. Transcranial direct current stimulation (tDCS) alters neuronal excitability and motor performance; however its beneficial effect on the induction of primary motor cortex (M1) plasticity in older adults is unclear. Moreover, little is known as to whether the tDCS electrode arrangement differentially affects M1 plasticity and motor performance in this population. In a double-blinded, cross-over trial, we compared unilateral, bilateral and sham tDCS combined with visuomotor tracking, on M1 plasticity and motor performance of the non-dominant upper limb, immediately post and 30 min following stimulation. We found (a) unilateral and bilateral tDCS decreased tracking error by 12–22% at both time points; with sham decreasing tracking error by 10% at 30 min only, (b) at both time points, motor evoked potentials (MEPs) were facilitated (38–54%) and short-interval intracortical inhibition was released (21–36%) for unilateral and bilateral conditions relative to sham, (c) there were no differences between unilateral and bilateral conditions for any measure. These findings suggest that tDCS modulated elements of M1 plasticity, which improved motor performance irrespective of the electrode arrangement. The results provide preliminary evidence indicating that tDCS is a safe non-invasive tool to preserve or improve neurological function and motor control in older adults.

Can noninvasive brain stimulation enhance function in the ageing brain?

Advancing age is associated with cognitive and motor performance deficits and a reduced capacity for plasticity. Zimerman and colleagues (Zimerman M, Nitsch M, Giraux P, Gerloff C, Cohen LG, Hummel FC. Ann Neurol 73: 10-15, 2013) have recently shown that noninvasive brain stimulation can enhance behavioral improvements following training on a motor sequence task in older adults. The work is of high clinical importance given the rapidly growing ageing population and the accompanying costs to health systems globally.

Contrasting effects of fatigue on multifinger coordination in young and older adults

We investigated the effects of fatigue produced by timed maximal voluntary contraction (MVC) of the index finger of the right hand on performance in MVC and accurate cyclic force production tasks in right-handed young (Young group) and strength-matched elderly (Elderly group) participants. We hypothesized that, before fatigue, the Elderly group would show weaker force-stabilizing synergies and smaller adaptive changes in the synergy index during fatigue. Synergies were defined as covaried adjustments of neural commands to fingers (finger modes) across trials that stabilize total force. Fatigue caused a significant reduction in the MVC, which was larger in the Young group compared with the Elderly group for both fatigued finger (index finger) and four fingers (index, middle, ring, and little fingers pressing together). Indexes of finger enslaving (lack of individuation) increased with fatigue in both groups. The index of force-stabilizing synergies was similar for the two groups before fatigue, while its increase with fatigue was significantly larger in the Elderly group compared with the Young group. We infer that changes in the indexes of finger interaction (enslaving) and coordination (synergy) with age seem to be correlated with changes in muscle strength. This correlation may be causally related to the progressive death of neurons at different levels of the neuromotor hierarchy. The surprisingly large changes in the synergy index with fatigue in older adults suggest that, by itself, aging does not necessarily lead to impairment in synergic control. Strength training may be a method to avoid age-related decrement in finger interaction and coordination.

Induction of cortical plasticity and improved motor performance following unilateral and bilateral transcranial direct current stimulation of the primary motor cortex

Background

Transcranial direct current stimulation (tDCS) is a non-invasive technique that modulates the excitability of neurons within the primary motor cortex (M1). Research shows that anodal-tDCS applied over the non-dominant M1 (i.e. unilateral stimulation) improves motor function of the non-dominant hand. Similarly, previous studies also show that applying cathodal tDCS over the dominant M1 improves motor function of the non-dominant hand, presumably by reducing interhemispheric inhibition. In the present study, one condition involved anodal-tDCS over the non-dominant M1 (unilateral stimulation) whilst a second condition involved applying cathodal-tDCS over the dominant M1 and anodal-tDCS over non-dominant M1 (bilateral stimulation) to determine if unilateral or bilateral stimulation differentially modulates motor function of the non-dominant hand. Using a randomized, cross-over design, 11 right-handed participants underwent three stimulation conditions: 1) unilateral stimulation, that involved anodal-tDCS applied over the non-dominant M1, 2) bilateral stimulation, whereby anodal-tDCS was applied over the non-dominant M1, and cathodal-tDCS over the dominant M1, and 3) sham stimulation. Transcranial magnetic stimulation (TMS) was performed before, immediately after, 30 and 60 minutes after stimulation to elucidate the neural mechanisms underlying any potential after-effects on motor performance. Motor function was evaluated by the Purdue pegboard test.

Results

There were significant improvements in motor function following unilateral and bilateral stimulation when compared to sham stimulation at all-time points (all P < 0.05); however there was no difference across time points between unilateral and bilateral stimulation. There was also a similar significant increase in corticomotor excitability with both unilateral and bilateral stimulation immediately post, 30 minutes and 60 minutes compared to sham stimulation (all P < 0.05). Unilateral and bilateral stimulation reduced short-interval intracortical inhibition (SICI) immediately post and at 30 minutes (all P < 0.05), but returned to baseline in both conditions at 60 minutes. There was no difference between unilateral and bilateral stimulation for SICI (P > 0.05). Furthermore, changes in corticomotor plasticity were not related to changes in motor performance.

Conclusion

These results indicate that tDCS induced behavioural changes in the non-dominant hand as a consequence of mechanisms associated with use-dependant cortical plasticity that is independent of the electrode arrangement.

Transfer of learning between hands to handle a novel object in old age

Transferring information about object weight between hands for use in scaling prehension forces likely depends on the integrity of the structures linking the two sides of the brain. It is unknown whether healthy older adults, who demonstrate a modest decline in this connectivity, transfer fingertip force scaling for object weight between hands. In the present study, healthy older and young adults performed two tasks: gripping and lifting an object, and a ballistic finger abduction movement. For the grip and lift task, participants practiced lifting a novel object using a precision pinch grip with the right hand (RH) and then did so again with the left hand (LH). For the ballistic task, participants were trained to maximally accelerate the right index finger by abducting it. On the grip and lift task, all participants appeared to overestimate the object weight during the 1st RH lift, followed by a progressive reduction on successive lifts. This adaptation was transferred to the LH in both groups on their first lift and remained stable over subsequent lifts. In contrast, the training-induced peak abduction acceleration on the ballistic task transferred poorly to the LH in older with considerably better transfer in young adults. We conclude that the memory representations scaling the lift force for the grip and lift task generalized to the untrained hand, while the greater acceleration that was acquired during practice of the ballistic task showed an incomplete transfer to the opposite hand. These differences may indicate task-dependent interhemispheric transfer of learning in old age.

Assessing brain plasticity across the lifespan with transcranial magnetic stimulation: why, how, and what is the ultimate goal?

Sustaining brain and cognitive function across the lifespan must be one of the main biomedical goals of the twenty-first century. We need to aim to prevent neuropsychiatric diseases and, thus, to identify and remediate brain and cognitive dysfunction before clinical symptoms manifest and disability develops. The brain undergoes a complex array of changes from developmental years into old age, putatively the underpinnings of changes in cognition and behavior throughout life. A functionally “normal” brain is a changing brain, a brain whose capacity and mechanisms of change are shifting appropriately from one time-point to another in a given individual's life. Therefore, assessing the mechanisms of brain plasticity across the lifespan is critical to gain insight into an individual's brain health. Indexing brain plasticity in humans is possible with transcranial magnetic stimulation (TMS), which, in combination with neuroimaging, provides a powerful tool for exploring local cortical and brain network plasticity. Here, we review investigations to date, summarize findings, and discuss some of the challenges that need to be solved to enhance the use of TMS measures of brain plasticity across all ages. Ultimately, TMS measures of plasticity can become the foundation for a brain health index (BHI) to enable objective correlates of an individual's brain health over time, assessment across diseases and disorders, and reliable evaluation of indicators of efficacy of future preventive and therapeutic interventions.

Time of day does not modulate improvements in motor performance following a repetitive ballistic motor training task

Repetitive performance of a task can result in learning. The neural mechanisms underpinning such use-dependent plasticity are influenced by several neuromodulators. Variations in neuromodulator levels may contribute to the variability in performance outcomes following training. Circulating levels of the neuromodulator cortisol change throughout the day. High cortisol levels inhibit neuroplasticity induced with a transcranial magnetic stimulation (TMS) paradigm that has similarities to use-dependent plasticity. The present study investigated whether performance changes following a motor training task are modulated by time of day and/or changes in endogenous cortisol levels. Motor training involving 30 minutes of repeated maximum left thumb abduction was undertaken by twenty-two participants twice, once in the morning (8 AM) and once in the evening (8 PM) on separate occasions. Saliva was assayed for cortisol concentration. Motor performance, quantified by measuring maximum left thumb abduction acceleration, significantly increased by 28% following training. Neuroplastic changes in corticomotor excitability of abductor pollicis brevis, quantified with TMS, increased significantly by 23% following training. Training-related motor performance improvements and neuroplasticity were unaffected by time of day and salivary cortisol concentration. Although similar neural elements and processes contribute to motor learning, training-induced neuroplasticity, and TMS-induced neuroplasticity, our findings suggest that the influence of time of day and cortisol differs for these three interventions.

Improving finger coordination in young and elderly persons

We studied the effects of a single practice session of a variable task with subject-specific adjustments of task difficulty (instability) on indices of multi-finger coordination in young and elderly persons. The main hypothesis was that practicing such a task would lead to contrasting changes in the amounts of two components of variance estimated across repetitive trials within the uncontrolled manifold (UCM) hypothesis: V UCM that had no effect on total force and V ORT that affected total force. In addition, we also expected to see strong transfer effects to a different task. A variable task with graded instability was designed to encourage use of variable solutions during the accurate production of total force with two fingers. The subjects practiced with the index and middle fingers pressing on individual force sensors. Overall, the older subjects showed lower indices of performance and higher indices of both V UCM and V ORT. After about 1 h of practice, both groups showed an increase in the index of involuntary force production by non-task fingers (enslaving). Both groups improved the indices of performance. The two variance indices showed opposite effects of practice: V ORT dropped with practice, while V UCM increased leading to an increase in the total amount of variance in the space of commands to fingers and in the index of force-stabilizing synergy. Performance in a simpler, non-practiced task improved, but there was no transfer of the changes in the structure of variance. Specifically, both variance components, V ORT and V UCM, dropped in the non-practiced task. The results show that the neural system responsible for synergies stabilizing important features of performance is highly adaptable to practice of tasks designed to encourage use of variable solutions. We view the results as highly promising for future use in populations with impaired coordination characterized by low synergy indices.

Aging and muscle: a neuron's perspective

PURPOSE OF REVIEW

Age-related muscle weakness causes a staggering economic, public, and personal burden. Most research has focused on internal muscular mechanisms as the root cause to strength loss. Here, we briefly discuss age-related impairments in the brain and peripheral nerve structures that may theoretically lead to muscle weakness in old age.

RECENT FINDINGS

Neuronal atrophy in the brain is accompanied by electrical noise tied to declines in dopaminergic neurotransmission that degrades communication between neurons. Additionally, sensorimotor feedback loops that help regulate corticospinal excitability are impaired. In the periphery, there is evidence for motor unit loss, axonal atrophy, demyelination caused by oxidative damage to proteins and lipids, and modified transmission of the electrical signal through the neuromuscular junction.

SUMMARY

Recent evidence clearly indicates that muscle weakness associated with aging is not entirely explained by classically postulated atrophy of muscle. In this issue, which focuses on 'Ageing: Biology and Nutrition' we will highlight new findings on how nervous system changes contribute to the aging muscle phenotype. These findings indicate that the ability to communicate neural activity to skeletal muscle is impaired with advancing age, which raises the question of whether many of these age-related neurological changes are mechanistically linked to impaired performance of human skeletal muscle. Collectively, this work suggests that future research should explore the direct link of these 'upstream' neurological adaptions and onset of muscle weakness in elders. In the long term, this new focus might lead to novel strategies to attenuate the age-related loss of muscle strength.

Premotor-motor interhemispheric inhibition is released during movement initiation in older but not young adults

Neural interactions between contralateral motor regions are thought to be instrumental in the successful preparation, and execution, of volitional movements. Here we investigated whether healthy ageing is associated with a change in functional connectivity, as indicated by the ability to modulate interhemispheric interactions during movement preparation in a manner that assists rapid movement responses. Thirteen young (mean age 22.2 years) and thirteen older (68.5 years) adults rapidly abducted their left index finger as soon as possible in response to a visual imperative signal, presented 500 ms after a visual warning signal.

Interactions between left dorsal premotor cortex (LPMd) and right primary motor cortex (RM1) and between left primary motor cortex (LM1) and RM1 were investigated at six time points between the warning signal and the volitional response using paired-pulse transcranial magnetic stimulation. Relative to the inhibitory interactions measured at rest, both young and older adults released LM1-RM1 inhibition beginning 250 ms after the warning signal, with no significant differences between groups. LPMd-RM1 interactions became facilitatory (from the onset of the imperative signal onwards) in the older, but not the young, group. Regression analyses revealed that for the older adults, modulation of LPMd-RM1 interactions early in the preparation period was associated with faster responses, suggesting that specifically timed modulation of these pathways may be a compensatory mechanism to offset, at least in part, slowing of motor responses. The results suggest a greater reliance on premotor regions during the preparation of simple motor actions with advancing age.

The BDNF val(66)met polymorphism is not related to motor function or short-term cortical plasticity in elderly subjects

The brain derived neurotrophic factor (BDNF) val(66)met polymorphism affects function of the motor system in young subjects, but little is known about motor system effects in the elderly. The current study assessed motor system physiology and behavior, plus a measure of short-term motor cortex plasticity using transcranial magnetic stimulation, in 38 elderly subjects, then examined whether findings varied in relation to BDNF genotype. Baseline data were also collected from 14 young subjects. At baseline, elderly subjects had poorer motor performances, larger motor cortex maps, and smaller motor evoked potentials compared to young subjects. Degree of age-related differences in neurophysiology correlated inversely with motor performance, for example, larger map area correlated with weaker pinch grip force (r=-0.42, P=0.01). In elderly subjects, baseline behavior and neurophysiology did not differ in relation to BDNF genotype. In addition, although map area increased significantly (P=0.03) across 30 min of exercise, this change did not vary according to BDNF genotype. Aging is associated with changes in neurophysiology that might represent a compensatory response. The data do not support an association between BDNF genotype and behavior, neurophysiology, or short-term cortical plasticity in the motor system of healthy elderly subjects.

Influence of the amount of use on hand motor cortex representation: effects of immobilization and motor training

Converging evidence from animal and human studies has revealed that increased or decreased use of an extremity can lead to changes in cortical representation of the involved muscles. However, opposite experimental manipulations such as immobilization and motor training have sometimes been associated with similar cortical changes. Therefore, the behavioral relevance of these changes remains unclear. The purpose of this study was to observe the effect of the amount of use on hand muscle motor cortex representation by contrasting the effect of unspecific motor training and immobilization. Nine healthy volunteers were tested prior and after a 4-day exposure to two experimental conditions using a randomized cross-over design: a motor training condition (to play Guitar Hero 2h/day with the tested (nondominant) hand on the fret board) and an immobilization condition (to wear an immobilization splint 24h/day). Before and after each condition, motor cortex representation of the nondominant first dorsal interosseous (FDI) muscle was mapped using image-guided transcranial magnetic stimulation (TMS). At the behavioral level, results show that the training condition led to a 20% improvement in the trained task, while the immobilization condition resulted in a 36% decrease in the FDI maximal voluntary contraction. At the neurophysiological level, corticospinal excitability (e.g. Motor-evoked potential amplitude) was found to be decreased in response to immobilization, while no change was observed in response to motor training. No change was found for other TMS variables (motor thresholds or map location/volume/area) in either condition. In conclusion, our results indicate that a 4-day decrease, but not increase, in the amount of use of nondominant hand muscles is sufficient to induce a change in corticospinal excitability. The lack of a training effect might be explained by the use of an unspecific task (that is nevertheless representative of "real-life" training situations) and/or by insufficient duration/intensity to induce long-lasting changes.

Differential modulation of motor cortex excitability in BDNF Met allele carriers following experimentally induced and use-dependent plasticity

The purpose of this study was to investigate how healthy young subjects with one of three variants of the brain-derived neurotrophic factor (BDNF) gene modulate motor cortex excitability following experimentally induced and use-dependent plasticity interventions. Electromyographic recordings were obtained from the right first dorsal interosseous (FDI) muscle of 12 Val/Val, ten Val/Met and seven Met/Met genotypes (aged 18-39 years). Transcranial magnetic stimulation of the left hemisphere was used to assess changes in FDI motor-evoked potentials (MEPs) following three separate interventions involving paired associative stimulation, a simple ballistic task and complex visuomotor tracking task using the index finger. Val/Val subjects increased FDI MEPs following all interventions (≥ 25%, P < 0.01), whereas the Met allele carriers only showed increased MEPs after the simple motor task (≥ 26%, P < 0.01). In contrast to the simple motor task, there was no significant change in MEPs for the Val/Met subjects (7%, P = 0.50) and a reduction in MEPs for the Met/Met group (-38%, P < 0.01) following the complex motor task. Despite these differences in use-dependent plasticity, the performance of both motor tasks was not different between BDNF genotypes. We conclude that modulation of motor cortex excitability is strongly influenced by the BDNF polymorphism, with the greatest differences observed for the complex motor task. We also found unique motor cortex plasticity in the rarest form of the BDNF polymorphism (Met/Met subjects), which may have implications for functional recovery after disease or injury to the nervous system in these individuals.

Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation

Stroke is the leading cause of long-term disability. Understanding how people recover from stroke and other brain lesions remain one of the biggest conundrums in neuroscience. As a result, concerted efforts in recent years have focused on investigating the neurophysiological changes that occur in the brain after stroke, and in developing novel strategies to enhance motor recovery. In particular, transcranial magnetic stimulation (TMS) is a non-invasive tool that has been used to investigate the brain plasticity changes resulting from stroke and as a therapeutic modality to safely improve motor function. In this review, we discuss the contributions of TMS to understand how different motor areas, such as the ipsilesional hemisphere, secondary motor areas, and contralesional hemisphere are involved in motor recovery. We also consider recent studies using repetitive TMS (rTMS) in stroke patients to enhance upper extremity function. Although further studies are needed, these investigations provide an important starting point to understand the stimulation parameters and patient characteristics that may influence the optimal response to non-invasive brain stimulation. Future directions of rTMS are discussed in the context of post-stroke motor recovery.

Training in a ballistic task but not a visuomotor task increases responses to stimulation of human corticospinal axons

Short periods of training in motor tasks can increase motor cortical excitability. This study investigated whether changes also occur at a subcortical level. Subjects trained in ballistic finger abduction or visuomotor tracking. The right index finger rotated around the metacarpophalangeal (MCP) joint in a splint. Surface EMG was recorded from the first dorsal interosseous. Transcranial magnetic stimulation over the back of the head (double-cone coil) elicited cervicomedullary motor evoked potentials (CMEPs) by stimulation of corticospinal axons. Responses were recorded from the relaxed muscle before, between, and after two sets of training. In study 1 ( n = 7), training comprised two sets of 150 maximal finger abductions. Feedback of acceleration was provided. With training, acceleration increased significantly. CMEPs increased to 248 ± 152% (± SD) of baseline immediately after training ( P = 0.007) but returned to control level (155 ± 141%) 10 min later. In study 2 ( n = 7), subjects matched MCP joint angle to a target path on a computer screen. After ∼30 min of training, tracking improved as shown by increased correlation between joint angle and the target pathway, reduced time lag, and reduced EMGrms. However, CMEPs remained unchanged. These results show that transmission through the corticospinal pathway at a spinal level increased after repeated ballistic movements but not after training in a visuomotor task. Thus, changes at a spinal level may contribute to improved performance in some motor tasks.

Cutaneous afferent input does not modulate motor intracortical inhibition in ageing men

Afferent input has been shown to be a powerful modulator of cortical inhibition. Such modulation is likely to be important for the control of ongoing movement, but may also play a role in facilitating neuroplastic reorganisation. Human motor control and neuroplasticity both decline with ageing, whereas the efficacy of short-interval intracortical inhibition (SICI) appears not to. We examined if ageing alters the efficacy of afferent modulation of SICI. Previously, electrical cutaneous stimulation of a finger has been shown to reduce SICI in the motor cortices of young adults. Paired-pulse transcranial magnetic stimulation was used to assess SICI in the cortical representation of the first dorsal interosseous muscle. SICI was assessed separately under two conditions: with and without prior afferent input from electrical cutaneous stimulation of the index finger. Fifteen 'young' (20.1 ± 2.1 years) and 15 'old' male humans (65.5 ± 3.9 years) were studied. SICI did not differ when young and old males were compared. However, when preceded by electrical cutaneous finger stimulation, SICI was reduced in young men but not old men. Reflex testing indicated preservation of the afferent volley to the cortex. These findings suggest that a contributing factor in the decline of motor function, and possibly neuroplasticity, with ageing is loss of SICI modulation, probably due to altered cortical sensorimotor integration of afferent input.

Evidence for motor cortex dedifferentiation in older adults

Older adults (OA) show more diffuse brain activity than young adults (YA) during the performance of cognitive, motor, and perceptual tasks. It is unclear whether this overactivation reflects compensation or dedifferentiation. Typically, these investigations have not evaluated the organization of the resting brain, which can help to determine whether more diffuse representations reflect physiological or task-dependent effects. In the present study we used transcranial magnetic stimulation (TMS) to determine whether there are differences in motor cortex organization of both brain hemispheres in young and older adults. We measured resting motor threshold, motor evoked potential (MEP) latency and amplitude, and extent of first dorsal interosseous representations, in addition to a computerized measure of reaction time. There was no significant age difference in motor threshold, but we did find that OA had larger contralateral MEP amplitudes and a longer contralateral MEP latency. Furthermore, the spatial extent of motor representations in OA was larger. We found that larger dominant hemisphere motor representations in OA were associated with higher reaction times, suggesting dedifferentiation rather than compensation effects.

When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth?

Regular participation in organized youth sports does not ensure adequate exposure to skill- and health-related fitness activities, and sport training without preparatory conditioning does not appear to reduce risk of injury in young athletes. Current trends indicate that widespread participation in organized youth sports is occurring at a younger age, especially in girls. Current public health recommendations developed to promote muscle strengthening and bone building activities for youth aged 6 yr and older, along with increased involvement in competitive sport activities at younger ages, has increased interest and concern from parents, clinicians, coaches, and teachers regarding the optimal age to encourage and integrate more specialized physical training into youth development programs. This review synthesizes the latest literature and expert opinion regarding when to initiate neuromuscular conditioning in youth and presents a how-to integrative training conceptual model that could maximize the potential health-related benefits for children by reducing sports-related injury risk and encouraging lifelong, regular physical activity.

Changes in cortical plasticity across the lifespan

Deterioration of motor and cognitive performance with advancing age is well documented, but its cause remains unknown. Animal studies dating back to the late 1970s reveal that age-associated neurocognitive changes are linked to age-dependent changes in synaptic plasticity, including alterations of long-term potentiation and depression (LTP and LTD). Non-invasive brain stimulation techniques enable measurement of LTP- and LTD-like mechanisms of plasticity, in vivo, in humans, and may thus provide valuable insights. We examined the effects of a 40-s train of continuous theta-burst stimulation (cTBS) to the motor cortex (600 stimuli, three pulses at 50 Hz applied at a frequency of 5 Hz) on cortico-spinal excitability as measured by the motor evoked potentials (MEPs) induced by single-pulse transcranial magnetic stimulation before and after cTBS in the contralateral first dorsal interosseus muscle. Thirty-six healthy individuals aged 19–81 years old were studied in two sites (Boston, USA and Barcelona, Spain). The findings did not differ across study sites. We found that advancing age is negatively correlated with the duration of the effect of cTBS (r = −0.367; p = 0.028) and the overall amount of corticomotor suppression induced by cTBS (r = −0.478; p = 0.003), and positively correlated with the maximal suppression of amplitude on motor evoked responses in the target muscle (r = 0.420; p = 0.011). We performed magnetic resonance imaging (MRI)-based individual morphometric analysis in a subset of subjects to demonstrate that these findings are not explained by age-related brain atrophy or differences in scalp-to-brain distance that could have affected the TBS effects. Our findings provide empirical evidence that the mechanisms of cortical plasticity area are altered with aging and their efficiency decreases across the human lifespan. This may critically contribute to motor and possibly cognitive decline.

Non-invasive brain stimulation: enhancing motor and cognitive functions in healthy old subjects

Healthy aging is accompanied by changes in cognitive and motor functions that result in impairment of activities of daily living. This process involves a number of modifications in the brain and is associated with metabolic, structural, and physiological changes; some of these serving as adaptive responses to the functional declines. Up to date there are no universally accepted strategies to ameliorate declining functions in this population. An essential basis to develop such strategies is a better understanding of neuroplastic changes during healthy aging. In this context, non-invasive brain stimulation techniques, such as transcranial direct current or transcranial magnetic stimulation, provide an attractive option to modulate cortical neuronal assemblies, even with subsequent changes in neuroplasticity. Thus, in the present review we discuss the use of these techniques as a tool to study underlying cortical mechanisms during healthy aging and as an interventional strategy to enhance declining functions and learning abilities in aged subjects.

Absence of cross-limb transfer of performance gains following ballistic motor practice in older adults

The phenomenon of cross-limb transfer, in which unilateral strength training can result in bilateral strength gains, has recently been tested for ballistic movements. Performance gains associated with repetitive motor practice, and the associated transfer, occur within a few minutes. In this study, young and older adults were trained to perform ballistic abductions of their dominant (right) index finger as quickly as possible. Performance was assessed bilaterally before, during, and after this training. Both groups exhibited large performance gains in the right hand as a result of training (P < 0.001; young 84% improvement, older 70% improvement), which were not significantly different between groups (P = 0.40). Transcranial magnetic stimulation revealed that the performance improvements were accompanied by increases in excitability, together with decreases in intracortical inhibition, of the projections to both the trained muscle and the homologous muscle in the contralateral limb (P < 0.05). The young group also exhibited performance improvements as a result of cross-limb transfer in the left (untrained) hand (P < 0.005), equivalent to 75% of the performance increase in the trained hand. In contrast, there were no significant performance gains in the left hand for the older group (P = 0.23). This was surprising given that the older group exhibited a significantly greater degree of mirror activity than the young group (P < 0.01) in the left first dorsal interosseus muscle (FDI) during right hand movements. Our findings suggest that older adults exhibit a reduced capacity for cross-limb transfer, which may have implications for motor rehabilitation programs after stroke.