Motor unit

Fascicle-selective kilohertz-frequency neural conduction block with longitudinal intrafascicular electrodes

Objective.Electrical stimulation of peripheral nerves is used to treat a variety of disorders and conditions. While conventional biphasic pulse stimulation typically induces neural activity in fibers, kilohertz (kHz) continuous stimulation can block neural conduction, offering a promising alternative to drug-based therapies for alleviating abnormal neural activity. This study explores strategies to enhance the selectivity and control of high-frequency neural conduction block using intrafascicular electrodes.Approach. In vivoexperiments were conducted in a rodent model to assess the effects of kHz stimulation delivered via longitudinal intrafascicular electrodes (LIFEs) on motor axons within the tibial and common peroneal fascicles of the sciatic nerve.Main results.We demonstrated that a progressive and selective block of neural conduction is achievable with LIFEs. We showed that the amount of neural conduction block can be tuned by adjusting the amplitude and frequency of kHz stimulation. Additionally, we achieved interfascicular selectivity with intrafascicular electrodes, with this selectivity being modulated by the kHz stimulation frequency. We also observed a small amount of onset response spillover, which could be minimized by increasing the blocking stimulus frequency. Muscle fatigue was quantified during kHz continuous stimulation and compared to control scenarios, revealing that the muscle was able to recover from fatigue during the block, confirming a true block of motor neurons.Significance.Our findings show that kHz stimulation using LIFEs can be precisely controlled to achieve selective conduction block. By leveraging existing knowledge from conventional stimulation techniques, this approach allows for the development of stimulation protocols that effectively block abnormal neural patterns with reduced side effects.

Motor unit discharge behavior in human muscles throughout force gradation: a systematic review and meta-analysis with meta-regression

The analysis of motor unit (MU) discharge behavior provides an effective way of assembling information about the generation and control of movement. In this systematic review and meta-analysis, we identified and summarized the literature investigating MU discharge rate and discharge rate variability (CoV-ISI) during voluntary isometric contractions at various force levels. Databases were searched up to January 7, 2025, and a total of 262 studies were included. The meta-means of MU discharge rate and CoV-ISI were estimated and compared across human muscles. The influence of contraction intensity on MU discharge behavior was assessed through linear meta-regressions. At low-to-moderate forces [<60% maximal voluntary contraction (MVC)], the first dorsal interosseous, biceps brachii (BB), and forearm extensors (FEs) had the highest discharge rate, whereas the soleus had the lowest. At high force levels (>60% MVC), the tibialis anterior (TA) had the highest mean discharge rate compared with all other muscles, with the soleus maintaining the lowest. Regarding CoV-ISI results at low forces (<30% MVC), the TA had the lowest CoV-ISI values, except in comparison with the vastii. In addition, the vastii had lower CoV-ISI values than the FE, gastrocnemius medialis, and soleus. Contraction intensity was positively associated with the mean discharge rates in all muscles investigated, although some muscles showed steeper slopes than others. Similar results were observed for CoV-ISI meta-regressions, with muscle-specific differences in slope. These findings suggest potential variations in neural control strategies across muscles during force gradation, such as differences in the relative contribution of rate coding to facilitate increasing force demands.

Spatial-Temporal Dynamics of Evoked Action in Finger Flexors: Implications for Optimizing Transcutaneous Nerve Stimulation

OBJECTIVE

Transcutaneous nerve stimulation (TNS) is a promising approach for the neurorehabilitation of hand function; however, its effects on muscle activation patterns remain poorly understood. To investigate the spatial and temporal distributions of H-reflexes and M-waves in finger flexor muscles using multichannel TNS and high-density electromyography.

METHODS

Fifteen healthy participants underwent stimulation of the median and ulnar nerves, and the muscle activity and finger forces were recorded. Recruitment curves and spatial activation maps were constructed for the H-reflexes and M-waves across stimulation intensities and locations.

RESULTS

Considerable inter-individual variability was observed in the recruitment patterns and spatial distributions. Higher spatial congruence between the H-reflex and M-wave activation patterns in extrinsic arm muscles than in intrinsic hand muscles was associated with more efficient force production. The relationship between spatial activation patterns and force outputs varied across fingers, with earlier recruitment of index finger muscles.

CONCLUSION

This study provides new insights into the complex interplay between the afferent and efferent pathways in hand motor control. The associations between spatial congruence, recruitment patterns, and force production efficiency enhance our understanding of the neuromuscular activation mechanisms.

SIGNIFICANCE

These findings have implications for optimizing TNS protocols in neurorehabilitation and developing personalized interventions for individuals with impaired hand function.

Matching dynamically varying forces with multi-motor-unit muscle models: a simulation study

Human muscles exhibit great versatility, not only generating forces for demanding athleticism, but also for fine motor tasks. While standard musculoskeletal models may reproduce this versatility, they often lack multiple motor units (MUs) and rate-coded control. To investigate how these features affect a muscle's ability to generate desired force profiles, we performed simulations with nine alternative MU pool models for two cases: (i) a tibialis anterior muscle generating an isometric trapezoidal force profile, and (ii) a generic shoulder muscle generating force for a reaching movement whilst undergoing predetermined length changes. We implemented two control strategies, pure feedforward and combined feedforward-feedback, each parameterized using elementary tasks. The results suggest that the characteristics of MU pools have relatively little impact on the pools' overall ability to match forces across all tasks, although performances for individual tasks varied. Feedback improved performance for nearly all MU pools and tasks, but the physiologically more relevant MU pool types were more responsive to feedback particularly during reaching. While all MU pool models performed well in the conditions tested, we highlight the need to consider the functional characteristics of the control of rate-coded MU pools given the vast repertoire of dynamic tasks performed by muscles.

Intrinsic properties of spinal motoneurons degrade ankle torque control in humans

Motoneurons are the final common pathway for all motor commands and possess intrinsic electrical properties that must be tuned to control muscle across the full range of motor behaviours. Neuromodulatory input from the brainstem is probably essential for adapting motoneuron properties to match this diversity of motor tasks. A primary mechanism of this adaptation, control of dendritic persistent inward currents (PICs) in motoneurons by brainstem monoaminergic systems, generates both amplification and prolongation of synaptic inputs. While essential, there is an inherent tension between this amplification and prolongation. Although amplification by PICs allows for quick recruitment and acceleration of motoneuron discharge, PICs must be deactivated to derecruit motoneurons upon movement cessation. In contrast, during stabilizing or postural tasks, PIC-induced prolongation of synaptic inputs is critical for sustained motoneuron discharge. Here, we designed two motor tasks that challenged the inhibitory control of PICs, generating unduly PIC prolongation that increases variability in human torque control. This included a paradigm combining a discrete motor task with a stabilizing task and another involving muscle length-induced changes to the balance of excitatory and inhibitory inputs available for controlling PICs. We show that prolongation from PICs introduces difficulties in ankle torque control and that these difficulties are further degraded at shorter muscle lengths when PIC prolongation is greatest. These results highlight the necessity for inhibitory control of PICs and showcase issues introduced when inhibitory control is constrained. Our findings suggest that, like sensory systems, errors are inherent in motor systems. These errors are not due to problems in the perception of movement-related sensory input but are embedded in the final stage of motor output. This has many implications relevant to clinical conditions (e.g. chronic stroke) where pathological shifts in monoamines may further amplify these errors. KEY POINTS: All motor commands are processed via spinal motoneurons, whose intrinsic electrical properties are adapted by brainstem neuromodulatory input. The effects of these neuromodulatory inputs (i.e. persistent inward currents; PICs) must be tightly regulated by inhibitory inputs to allow for the large repertoire of human motor behaviours. We designed two motor tasks to restrict the ability of inhibitory synaptic inputs to control PICs and show that this generates substantial errors that reduce the precision of motor output in humans. Our findings suggest that errors are inherent in motor systems and embedded in the final stage of motor output. This has many implications relevant to clinical conditions (e.g. chronic stroke) and may, speculatively, shed light on contributing factors to muscle cramps.

Skeletal muscle innervation: Reactive oxygen species as regulators of neuromuscular junction dynamics and motor unit remodeling

This review explores the intricate processes of motor unit remodeling with a specific focus on the influence of reactive oxygen species (ROS) and oxidative stress on the primary cellular components: nerves/axons, muscle fibers, and muscle-resident glial cells. Emphasizing the role of redox biology, we highlight how oxidative stress impacts motor unit adaptation, injury response, and aging. By synthesizing findings from recent studies with seminal works, including investigations of myelin and terminal Schwann cells and neuromuscular junction (NMJ) dynamics, this review provides a comprehensive understanding of the molecular mechanisms underpinning motor unit maintenance and repair. The goal is to elucidate how oxidative stress influences these processes and to explore potential therapeutic strategies for neuromuscular disorders.

A motor unit action potential-based method for surface electromyography decomposition

OBJECTIVE

Surface electromyography (EMG) decomposition is crucial for identifying motor neuron activities by analyzing muscle-generated electrical signals. This study aims to develop and validate a novel motor unit action potential (MUAP)-based method for surface EMG decomposition, addressing the limitations of traditional blind source separation (BSS)-based techniques in computation complexity and motor unit (MU) tracking.

METHODS

Within the framework of the convolution kernel compensation algorithm, we developed a MUAP-based decomposition algorithm by reconstructing the MU filters from MUAPs and evaluated its performance using both simulated and experimental datasets. A systematic analysis was conducted on various factors affecting decomposition performance, including MU filter reconstruction methods, EMG covariance matrices, MUAP extraction techniques, and extending factors. The proposed method was subsequently compared to representative BSS-based techniques, such as convolution kernel compensation.

MAIN RESULTS

The MUAP-based method significantly outperformed traditional BSS-based techniques in identifying more MUs and achieving better accuracy, particularly under noisy conditions. It demonstrated superior performance with increased signal complexity and effectively tracked motor units consistently across decompositions. In addition, directly applying the MU filters reconstructed from MUAPs to decomposition exhibited marked computational efficiency.

CONCLUSION AND SIGNIFICANCE

The MUAP-based method enhances EMG decomposition accuracy, robustness, and efficiency, offering reliable motor unit tracking and real-time processing capabilities. These advancements highlight its potential for clinical diagnostics and neurorehabilitation, representing a promising step forward in non-invasive motor neuron analysis.

Higher dominant muscle strength is mediated by motor unit discharge rates and proportion of common synaptic inputs

Neural determinants explaining the asymmetrical force and skill observed in limb dominance still need to be comprehensively investigated. To address this gap, we recorded myoelectrical activity from biceps brachii using high-density surface electromyography in twenty participants, identifying the maximal voluntary force (MVF) and performing isometric ramp contractions at 35% and 70%MVF and sustained contractions at 10%MVF. Motor unit discharge characteristics were assessed during ramp contractions, the proportion of common synaptic input to motoneurons was calculated with coherence analysis, and the firing rate hysteresis (∆F) was used to estimate spinal motoneuron intrinsic properties. The dominant limbs presented a greater MVF compared to the non-dominant side (+ 9%, p = 0.001), with similar relative recruitment and derecruitment thresholds of motor units (p > 0.05). The discharge rate was significantly higher on the dominant side (p < 0.001), along with a greater proportion of common synaptic input (+ 14%, p = 0.002). No significant differences were observed in the ∆F (p > 0.05). Our findings suggest that greater strength on the dominant side is associated with higher neural drive to muscles due to a greater proportion of common synaptic inputs rather than differences in motoneuron intrinsic properties. These results underscore neural asymmetries at the motor unit level, corresponding to different mechanical outputs underlying limb dominance.

A wearable approach for Sarcopenia diagnosis using stimulated muscle contraction signal

Sarcopenia is a rapidly rising health concern in the fast-aging countries, but its demanding diagnostic process is a hurdle for making timely responses and devising active strategies. To address this, our study developed and evaluated a novel sarcopenia diagnosis system using Stimulated Muscle Contraction Signals (SMCS), aiming to facilitate rapid and accessible diagnosis in community settings. We recruited 199 adults from Wonju Severance Christian Hospital between July 2022 and October 2023. SMCS data were collected using surface electromyography sensors with the wearable device exoPill. Their skeletal muscle mass index, handgrip strength, and gait speed were also measured as the reference. Binary classification models were trained to classify each criterion for diagnosing sarcopenia based on the AWGS cutoffs. The binary classification models achieved high discriminative abilities with an AUC score near 0.9 in each criterion. When combining these criteria evaluations, the proposed sarcopenia diagnosis system performance achieved an accuracy of 89.4% in males and 92.4% in females, sensitivities of 81.3% and 87.5%, and specificities of 91.0% and 93.8%, respectively. This system significantly enhances sarcopenia diagnostics by providing a quick, reliable, and non-invasive method, suitable for broad community use. The promising result indicates that SMCS contains extensive information about the neuromuscular system, which could be crucial for understanding and managing muscle health more effectively. The potential of SMCS in remote patient care and personal health management is significant, opening new avenues for non-invasive health monitoring and proactive management of sarcopenia and potentially other neuromuscular disorders.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13534-025-00461-z.

Flexible control of motor units: is the multidimensionality of motor unit manifolds a sufficient condition?

Understanding flexibility in the neural control of movement requires identifying the distribution of common inputs to the motor units. In this study, we identified large samples of motor units from two lower limb muscles: the vastus lateralis (VL; up to 60 motor units per participant) and the gastrocnemius medialis (GM; up to 67 motor units per participant). First, we applied a linear dimensionality reduction method to assess the dimensionality of the manifolds underlying the motor unit activity. We subsequently investigated the flexibility in motor unit control under two conditions: sinusoidal contractions with torque feedback, and online control with visual feedback on motor unit firing rates. Overall, we found that the activity of GM motor units was effectively captured by a single latent factor defining a unidimensional manifold, whereas the VL motor units were better represented by three latent factors defining a multidimensional manifold. Despite this difference in dimensionality, the recruitment of motor units in the two muscles exhibited similarly low levels of flexibility. Using a spiking network model, we tested the hypothesis that dimensionality derived from factorization does not solely represent descending cortical commands but is also influenced by spinal circuitry. We demonstrated that a heterogeneous distribution of inputs to motor units, or specific configurations of recurrent inhibitory circuits, could produce a multidimensional manifold. This study clarifies an important debated issue, demonstrating that while motor unit firings of a non-compartmentalized muscle can lie in a multidimensional manifold, the CNS may still have limited capacity for flexible control of these units. KEY POINTS: To generate movement, the CNS distributes both excitatory and inhibitory inputs to the motor units. The level of flexibility in the neural control of these motor units remains a topic of debate with significant implications for identifying the smallest unit of movement control. By combining experimental data and in silico models, we demonstrated that the activity of a large sample of motor units from a single muscle can be represented by a multidimensional linear manifold; however, these units show very limited flexibility in their recruitment. The dimensionality of the linear manifold may not directly reflect the dimensionality of descending inputs but could instead relate to the organization of local spinal circuits.

Physiological mechanisms of neuromuscular impairment in diabetes-related complications: Can physical exercise help prevent it?

Diabetes mellitus is a chronic disorder that progressively induces complications, compromising daily independence. Among these, diabetic neuropathy is particularly prevalent and contributes to substantial neuromuscular impairments in both types 1 and 2 diabetes. This condition leads to structural damage affecting both the central and peripheral nervous systems, resulting in a significant decline in sensorimotor functions. Alongside neuropathy, diabetic myopathy also contributes to muscle impairment and reduced motor performance, intensifying the neuromuscular decline. Diabetic neuropathy typically implicates neurogenic muscle atrophy, motoneuron loss and clustering of muscle fibres as a result of aberrant denervation-reinervation processes. These complications are associated with compromised neuromuscular junctions, where alterations occur in pre-synaptic vesicles, mitochondrial content and post-synaptic signalling. Neural damage is intensified by chronic hyperglycaemia and oxidative stress, exacerbating vascular dysfunction and reducing oxygen delivery. These complications imply a severe decline in neuromuscular performance, evidenced by reductions in maximal force and power output, rate of force development and muscle endurance. Furthermore, diabetes-related complications are compounded by age-related degenerative changes in long-term patients. Aerobic and resistance training offer promising approaches for managing blood glucose levels and neuromuscular function. Aerobic exercise promotes mitochondrial biogenesis and angiogenesis, supporting metabolic and cardiovascular health. Resistance training primarily enhances neural plasticity, muscle strength and hypertrophy, which are crucial factors for mitigating sarcopenia and preserving functional independence. This topical review examines current evidence on the physiological mechanisms underlying diabetic neuropathy and the potential impact of physical activity in counteracting this decline.

Influence of the variability in motor unit discharge times and neural drive on force steadiness during submaximal contractions with a hand muscle

Our purpose was to compare the influence of the spectral content of motor unit recordings on the calculation of electromechanical delay and on the prediction of force fluctuations from measures of the variability in discharge times and neural drive during steady isometric contractions with the first dorsal interosseus muscle. Participants (n = 42; 60 ± 13 yr) performed contractions at 5% and 20% MVC. After satisfying the inclusion criteria, high-density surface EMG recordings from a subset of 23 participants were decomposed into the discharge times of 530 motor units. The force and cumulative spike train (CST) signals were cross-correlated with a novel filtering approach to determine the electromechanical delay. Force and CST signals were bandpass filtered with three bandwidths (0.75-5 Hz, 0.75-2 Hz, and 2-5 Hz) to determine the influence of spectral content on the precision of the electromechanical delay measurement. Subsequently, the variability in the discharge times of motor units was quantified as the coefficient of variation for interspike interval (CVISI), and the variability in neural drive was represented as the standard deviation of the cumulative spike train (SDCST). The main findings were that all frequencies (0.75-5 Hz) were needed to determine the electromechanical delay and that the force fluctuations were best explained by measures of variability in both discharge times and neural drive (CVISI and SDCST) at 5% MVC force but only the variability in neural drive (SDCST) at 20% MVC force. These findings indicate that the source of the force fluctuations during the steady submaximal contractions with the hand muscle differed for the two target forces.NEW & NOTEWORTHY The fluctuations in force during steady submaximal contractions can be caused by either or both the variability in discharge times of individual motor units and in the neural drive. After careful alignment of the force and discharge times within an optimal bandwidth (0.75-5 Hz), the fluctuations in force at the lower target force were strongly correlated with both measures of variability, whereas those at the higher target force were best explained by the variability in neural drive.

Spatially ordered recruitment of fast muscles in accordance with movement strengths in larval zebrafish

In vertebrates, skeletal muscle comprises fast and slow fibers. Slow and fast muscle cells in fish are spatially segregated; slow muscle cells are located only in a superficial region, and comprise a small fraction of the total muscle cell mass. Slow muscles support low-speed, low-force movements, while fast muscles are responsible for high-speed, high-force movements. However, speed and strength of movement are not binary states, but rather fall on a continuum. This raises the question of whether any recruitment patterns exist within fast muscles, which constitute the majority of muscle cell mass. In the present study, we investigated activation patterns of trunk fast muscles during movements of varying speeds and strengths using larval zebrafish. We employed two complementary methods: calcium imaging and electrophysiology. The results obtained from both methods supported the conclusion that there are spatially-ordered recruitment patterns in fast muscle cells. During weaker/slower movements, only the lateral portion of fast muscle cells is recruited. As the speed or strength of the movements increases, more fast muscle cells are recruited in a spatially-ordered manner, progressively from lateral to medial. We also conducted anatomical studies to examine muscle fiber size. The results of those experiments indicated that muscle fiber size increases systematically from lateral to medial. Therefore, the spatially ordered recruitment of fast muscle fibers, progressing from lateral to medial, correlates with an increase in fiber size. These findings provide significant insights into the organization and function of fast muscles in larval zebrafish, illustrating how spatial recruitment and fiber size interact to optimize movement performance.

Sex disparities of human neuromuscular decline in older humans

Females typically live longer than males but, paradoxically, spend a greater number of later years in poorer health. The neuromuscular system is a critical component of the progression to frailty, and motor unit (MU) characteristics differ by sex in healthy young individuals and may adapt to ageing in a sex-specific manner due to divergent hormonal profiles. The purpose of this study was to investigate sex differences in vastus lateralis (VL) MU structure and function in early to late elderly humans. Intramuscular electromyography signals from 50 healthy older adults (M/F: 26/24) were collected from VL during standardized submaximal contractions and decomposed to quantify MU characteristics. Muscle size and neuromuscular performance were also measured. Females had higher MU firing rate (FR) than males (P = 0.025), with no difference in MU structure or neuromuscular junction transmission (NMJ) instability. All MU characteristics increased from low- to mid-level contractions (P < 0.05) without sex × level interactions. Females had smaller cross-sectional area of VL, lower strength and poorer force steadiness (P < 0.05). From early to late elderly, both sexes showed decreased neuromuscular function (P < 0.05) without sex-specific patterns. Higher VL MUFRs at normalized contraction levels previously observed in young are also apparent in old individuals, with no sex-based difference of estimates of MU structure or NMJ transmission instability. From early to late elderly, the deterioration of neuromuscular function and MU characteristics did not differ between sexes, yet function was consistently greater in males. These parallel trajectories underscore the lower initial level for older females and may offer insights into identifying critical intervention periods. KEY POINTS: Females generally exhibit an extended lifespan when compared to males, yet this is accompanied by a poorer healthspan and higher rates of frailty. In healthy young people, motor unit firing rate (MUFR) at normalized contraction intensities is widely reported to be higher in females than in age-matched males. Here we show in 50 people that older females have higher MUFR than older males with little difference in other MU parameters. The trajectory of decline from early to late elderly does not differ between sexes, yet function is consistently lower in females. These findings highlight distinguishable sex disparities in some MU characteristics and neuromuscular function, and suggest early interventions are needed for females to prevent functional deterioration to reduce the ageing health-sex paradox.

The identification of extensive samples of motor units in human muscles reveals diverse effects of neuromodulatory inputs on the rate coding

Movements are performed by motoneurons transforming synaptic inputs into an activation signal that controls muscle force. The control signal emerges from interactions between ionotropic and neuromodulatory inputs to motoneurons. Critically, these interactions vary across motoneuron pools and differ between muscles. To provide the most comprehensive framework to date of motor unit activity during isometric contractions, we identified the firing activity of extensive samples of motor units in the tibialis anterior (129 ± 44 per participant; n=8) and the vastus lateralis (130 ± 63 per participant; n=8) muscles during isometric contractions of up to 80% of maximal force. From this unique dataset, the rate coding of each motor unit was characterised as the relation between its instantaneous firing rate and the applied force, with the assumption that the linear increase in isometric force reflects a proportional increase in the net synaptic excitatory inputs received by the motoneuron. This relation was characterised with a natural logarithm function that comprised two stages. The initial stage was marked by a steep acceleration of firing rate, which was greater for low- than medium- and high-threshold motor units. The second stage comprised a linear increase in firing rate, which was greater for high- than medium- and low-threshold motor units. Changes in firing rate were largely non-linear during the ramp-up and ramp-down phases of the task, but with significant prolonged firing activity only evident for medium-threshold motor units. Contrary to what is usually assumed, our results demonstrate that the firing rate of each motor unit can follow a large variety of trends with force across the pool. From a neural control perspective, these findings indicate how motor unit pools use gain control to transform inputs with limited bandwidths into an intended muscle force.

Wrist torque estimation by combining motor unit discharges with musculoskeletal model

OBJECTIVE

The application of electromyography (EMG) decomposition techniques in myoelectric control has gradually increased. However, most decomposition-based control schemes rely on machine learning, lacking interpretation of the biological mechanisms underlying movement generation and requiring large datasets for training. As neuromusculoskeletal modeling provides a promising alternative, this study proposes a decomposition-based musculoskeletal model for simultaneous and proportional myoelectric control.

METHODS

Sixteen able-bodied subjects participated in two experiments involving isometric wrist contractions in two degrees of freedom (DoF). High-density surface EMG signals and torques were recorded simultaneously. The EMG signals were decomposed into motor unit action potential trains (MUAPts). We proposed four clustering methods (two activation-based and two action potential-based) to group MUAPts, from which three neural features were extracted as neural excitations and input to the musculoskeletal model.

MAIN RESULTS

An activation-based clustering method with the twitch feature achieved a relatively high accuracy (R2 = 0.791 ± 0.101 and 0.622 ± 0.148 in the two experiments) with the highest smoothness (Roughness = 1.389 ± 0.211 and 1.140 ± 0.159).

CONCLUSION AND SIGNIFICANCE

The proposed MUAPt-based musculoskeletal model achieved promising accuracy in estimating continuous 2-DoF wrist torques, providing a novel approach for understanding the neuromechanical properties of multi-DoF movements and advancing the development of dexterous rehabilitation and robotic control.

Hypercapnia impacts neural drive and timing of diaphragm neuromotor control

The neuromotor control of the diaphragm muscle (DIAm) involves motor unit recruitment, sustained activity (incrementing and decrementing), and motor unit derecruitment, phases that may be modified to maintain ventilation across conditions. The primary goal of the present study was to investigate the effects of hypercapnia, which increases respiratory rate and tidal volume, on DIAm neuromotor control in awake rats. We recorded DIAm electromyography (EMG) with implanted chronic fine-wire electrodes in nine Sprague-Dawley rats during normocapnia and hypercapnia (7% CO2). The durations of motor unit recruitment/derecruitment were estimated by evaluating stationarity of DIAm EMG activity during normocapnia and hypercapnia; the motor unit recruitment/derecruitment durations were used to evaluate root mean square (RMS) EMG recruitment/derecruitment amplitudes. Overall, hypercapnia reduced the burst duration by ∼40% and increased respiratory rate by ∼50%. The change in the burst duration was primarily attributable to a 57% decrease in the peak-to-offset duration of the DIAm RMS EMG signal, suggesting a suppression of postinspiratory activity. Although neither the recruitment duration nor the onset-to-peak duration changed with hypercapnia, both the recruitment and peak amplitudes increased, by 11% and 23%, respectively. Therefore, although hypercapnia increases the number of motor units being recruited and their discharge rates, ventilation is primarily increased by increasing respiratory rate. Additionally, hypercapnia eliminated the decrementing sustained activity phase and consequently increased derecruitment amplitude by 171%. The results of the present study reveal that respiratory rate is increased chiefly by reducing the decrementing (i.e. "postinspiratory") phase of DIAm EMG activity.NEW & NOTEWORTHY The neuromotor control of the diaphragm muscle (DIAm) in response to hypercapnia is not well understood. We show that both the number of motor units recruited and their discharge rates increase with hypercapnia, consistent with increased respiratory drive during hypercapnia. Potentially in response to this increased drive, the greatest effect of hypercapnia is on during the postinspiratory (descending) ramp of DIAm EMG activity, which shortens to facilitate higher respiratory rates.

Lower creatinine-to-cystatin c ratio associated with increased risk of incident amyotrophic lateral sclerosis in the prospective UK biobank cohort

Reduced muscle mass has been associated with the progression and prognosis of amyotrophic lateral sclerosis (ALS). However, it remains unclear whether decreased muscle mass is a risk factor for ALS or a consequence of motor neuron degeneration. Recently, serum creatinine-to-cystatin C ratio (CCR) have emerged as promising biomarkers for assessing muscle mass. We aimed to explore the association between CCR and the incidence of ALS using data from the UK Biobank. Between 2006 and 2010, 446,945 participants were included in the baseline. CCR was calculated as the ratio of serum creatinine to cystatin C. Cox regression models were used to analyze the relationship between CCR and ALS incidence. Furthermore, subgroup analyses were conducted to investigate potential covariates in these relationships. After adjusting for all covariates, the multivariate Cox regression analysis revealed a significant association between decreased CCR and an increased risk of ALS (hazard ratio (HR) = 0.990, 95% confidence interval (CI): 0.982-0.999, P = 0.026). Participants were stratified into groups based on CCR tertiles. Compared with participants in the highest tertiles of CCR, those in the lowest (HR = 1.388, 95% CI: 1.032-1.866, P = 0.030) and medium tertiles (HR = 1.348, 95% CI: 1.045-1.739, P = 0.021) had an increased risk of ALS incidence. Subgroup analysis showed that the relationship between CCR and ALS incidence was particularly significant among participants aged < 65 years (CCR tertile 1: HR = 1.916, 95% CI: 1.366-2.688, P < 0.001; CCR tertile 2: HR = 1.699, 95% CI: 1.267-2.278, P < 0.001). The present results demonstrate that lower CCR is significantly associated with a higher risk of ALS.

Increased muscle coactivation is linked with fast feedback control when reaching in unpredictable visual environments

Humans encounter unpredictable disturbances in daily activities and sports. When encountering unpredictable physical disturbances, healthy participants increase the peak velocity of their reaching movements, muscle coactivation, and responses to sensory feedback. Emerging evidence suggests that muscle coactivation may facilitate responses to sensory feedback and may not solely increase stiffness to resist displacements. We tested this idea by examining how healthy participants alter the control of reaching movements and responses to sensory feedback when encountering variable visuomotor rotations. The rotations changed amplitude and direction between movements, creating unpredictable errors that required fast online corrections. Participants increased the peak velocity of their movements, muscle coactivation, and responses to visual and proprioceptive feedback with the variability of the visuomotor rotations. The findings highlight an increase in neural responsiveness to sensory feedback and suggest that muscle coactivation may prime the nervous system for fast responses to sensory feedback that accommodate properties of unpredictable visual environments.

Acute intermittent hypoxia increases maximal motor unit discharge rates in people with chronic incomplete spinal cord injury

Acute intermittent hypoxia (AIH) is an emerging technique for enhancing neuroplasticity and motor function in respiratory and limb musculature. Thus far, AIH-induced improvements in strength have been reported for upper and lower limb muscles after chronic incomplete cervical spinal cord injury (iSCI), but the underlying mechanisms have been elusive. We used high-density surface EMG (HDsEMG) to determine if motor unit discharge behaviour is altered after 15 × 60 s exposures to 9% inspired oxygen, interspersed with 21% inspired oxygen (AIH), compared to breathing only 21% air (SHAM). We recorded HDsEMG from the biceps and triceps brachii of seven individuals with iSCI during maximal elbow flexion and extension contractions, and motor unit spike trains were identified using convolutive blind source separation. After AIH, elbow flexion and extension torque increased by 54% and 59% from baseline (P = 0.003), respectively, whereas there was no change after SHAM. Across muscles, motor unit discharge rates increased by ∼4 pulses per second (P = 0.002) during maximal efforts, from before to after AIH. These results suggest that excitability and/or activation of spinal motoneurons is augmented after AIH, providing a mechanism to explain AIH-induced increases in voluntary strength. Pending validation, AIH may be helpful in conjunction with other therapies to enhance rehabilitation outcomes after incomplete spinal cord injury, due to these enhancements in motor unit function and strength. KEY POINTS: Acute intermittent hypoxia (AIH) causes increases in muscular strength and neuroplasticity in people living with chronic incomplete spinal cord injury (SCI), but how it affects motor unit discharge rates is unknown. Motor unit spike times were identified from high-density surface electromyograms during maximal voluntary contractions and tracked from before to after AIH. Motor unit discharge rates were increased following AIH. These findings suggest that AIH can facilitate motoneuron function in people with incomplete SCI.

Motoneuron persistent inward current contribution to increased torque responses to wide-pulse high-frequency neuromuscular electrical stimulation

PURPOSE

To assess the effect of a remote handgrip contraction during wide-pulse high-frequency (WPHF) neuromuscular electrical stimulation (NMES) on the magnitude of extra torque, progressive increase in torque during stimulation, and estimates of the persistent inward current (PIC) contribution to motoneuron firing in the plantar flexors.

METHODS

Ten participants performed triangular shaped contractions to 20% of maximal plantar flexion torque before and after WPHF NMES with and without a handgrip contraction, and control conditions. Extra torque, the relative difference between the initial and final torque during stimulation, and sustained electromyographic (EMG) activity were assessed. High-density EMG was recorded during triangular shaped contractions to calculate ∆F, an estimate of PIC contribution to motoneuron firing, and its variation before vs after the intervention referred to as ∆F change score.

RESULTS

While extra torque was not significantly increased with remote contraction (WPHF + remote) vs WPHF (+ 37 ± 63%, p = 0.112), sustained EMG activity was higher in this condition than WPHF (+ 3.9 ± 4.3% MVC EMG, p = 0.017). Moreover, ∆F was greater (+ 0.35 ± 0.30 Hz) with WPHF + remote than control (+ 0.03 ± 0.1 Hz, p = 0.028). A positive correlation was found between ∆F change score and extra torque in the WPHF + remote (r = 0.862, p = 0.006).

DISCUSSION

The findings suggest that the addition of remote muscle contraction to WPHF NMES enhances the central contribution to torque production, which may be related to an increased PIC contribution to motoneuron firing. Gaining a better understanding of these mechanisms should enable NMES intervention optimization in clinical and rehabilitation settings, improving neuromuscular function in clinical populations.

Alpha band oscillations in common synaptic input are explanatory of the complexity of isometric knee extensor muscle torque signals

We investigated whether the strength of oscillations in common synaptic input was explanatory of knee extensor (KE) torque signal complexity during fresh and fatigued submaximal isometric contractions, in adults aged from 18 to 90 years. The discharge times of motor units were derived from the vastus lateralis muscle of 60 participants using high-density surface EMG, during 20 s isometric KE contractions at 20% of maximal voluntary contraction, performed before and after a fatiguing repeated isometric KE contraction protocol at 60% of maximal voluntary contraction. Within-muscle coherence Z-scores were estimated using frequency-domain coherence analysis, and muscle torque complexity was assessed using multiscale entropy analysis and detrended fluctuation analysis. Alpha band (5-15 Hz) coherence was found to predict 23.1% and 31.4% of the variance in the complexity index under 28-scales (CI-28) and detrended fluctuation analysis α complexity metrics, respectively, during the fresh contractions. Delta, alpha and low beta band coherence were significantly increased due to fatigue. Fatigue-related changes in alpha coherence were significantly predictive of the fatigue-related changes in CI-28 and detrended fluctuation analysis α. The fatigue-related increase in sample entropy from scales 11 to 28 of the multiscale entropy analysis curves was significantly predicted by the increase in the alpha band coherence. Age was not a contributory factor to the fatigue-related changes in within-muscle coherence and torque signal complexity. These findings indicate that the strength of alpha band oscillations in common synaptic input can explain, in part, isometric KE torque signal complexity and the fatigue-related changes in torque signal complexity.

Neuro-Musculoskeletal Modeling for Online Estimation of Continuous Wrist Movements from Motor Unit Activities

Decoding movement intentions from motor unit (MU) activities remains an ongoing challenge, which restricts our comprehension of the intricate transition mechanism from microscopic neural drive to macroscopic movements. This study presents an innovative neuro-musculoskeletal (NMS) model driven by MU activities for online estimation of continuous wrist movements. The proposed model employs a physiological and comprehensive utilization of MU firings and waveforms, thus facilitating the localization of MUs to muscle-tendon units (MTU) as well as the computation of MU-specific neural excitation. Subsequently, the MU-specific neural excitation was integrated to form the MTU-specific neural excitation, which were then inputted into a musculoskeletal model to accomplish the joint angle estimation. To assess the effectiveness of this model, high-density surface electromyography and angular data were collected from the forearms of eight subjects during their performance of wrist flexion-extension task. Two pieces of 8×8 electrode arrays and a motion capture system were employed for data acquisition. Following offline model calibration with a global optimization algorithm, online angle estimation results demonstrated a significant superiority of the proposed model over the state-of-the-art NMS models (p < 0.05), yielding the lowest normalized root mean square error ( 0.10 ± 0.02 ) and the highest determination coefficient ( 0.87 ± 0.06 ). This study provides a novel idea for the decoding of joint movements from MU activities. The research findings hold the potential to advance the development of NMS models towards the control of multiple degrees of freedom, with promising applications in the fields of motor control, biomechanics, and neuro-rehabilitation engineering.

Centrally mediated responses to NMES are influenced by muscle group and stimulation parameters

Wide-pulse high-frequency neuromuscular electrical stimulation (WPHF NMES) can generate a progressive increase in tetanic force through reflexive recruitment of motor units, called extra force. This phenomenon has previously been observed on different muscle groups, but little is known on potential inter-muscle differences. We compared extra force and sustained electromyographic (EMG) activity induced by NMES between plantar flexors, knee extensors, elbow flexors and within muscle groups using pulse durations of 0.2, 1 and 2 ms and stimulation frequencies of 20, 50, 100 and 147 Hz. Extra force production and sustained EMG activity were higher for plantar flexors compared to elbow flexors at all tested parameters (except 0.2 ms for extra force). When compared to elbow flexors, extra force of the knee extensors was only higher at 100 Hz and with 1 ms while sustained EMG activity was higher at all frequencies with pulse durations of 0.2 and 2 ms. Peripheral nerve architecture as well as muscle typology and function could influence the occurrence and magnitude of centrally-mediated responses to NMES. The present findings suggest that the use of wide-pulse high-frequency NMES to promote reflexive recruitment seems to be more pertinent for lower limb muscles, plantar flexors in particular.

Supercomputer framework for reverse engineering firing patterns of neuron populations to identify their synaptic inputs

In this study, we develop new reverse engineering (RE) techniques to identify the organization of the synaptic inputs generating firing patterns of populations of neurons. We tested these techniques in silico to allow rigorous evaluation of their effectiveness, using remarkably extensive parameter searches enabled by massively-parallel computation on supercomputers. We chose spinal motoneurons as our target neural system, since motoneurons process all motor commands and have well-established input-output properties. One set of simulated motoneurons was driven by 300,000+ simulated combinations of excitatory, inhibitory, and neuromodulatory inputs. Our goal was to determine if these firing patterns had sufficient information to allow RE identification of the input combinations. Like other neural systems, the motoneuron input-output system is likely non-unique. This non-uniqueness could potentially limit this RE approach, as many input combinations can produce similar outputs. However, our simulations revealed that firing patterns contained sufficient information to sharply restrict the solution space. Thus, our RE approach successfully generated estimates of the actual simulated patterns of excitation, inhibition, and neuromodulation, with variances accounted for ranging from 75-90%. It was striking that nonlinearities induced in firing patterns by the neuromodulation inputs did not impede RE, but instead generated distinctive features in firing patterns that aided RE. These simulations demonstrate the potential of this form of RE analysis. It is likely that the ever-increasing capacity of supercomputers will allow increasingly accurate RE of neuron inputs from their firing patterns from many neural systems.

Research on the effect of post-activation potentiation under different velocity loss thresholds on boxer's punching ability

This study was conducted in accordance with the principles of velocity-based training theory, with the objective of investigating the effects of post-activation potentiation (PAP) induced by different velocity loss (VL) thresholds (10% vs. 20%) on the punching ability of boxers. In addition, the aim was to determine the velocity loss thresholds and time nodes that produced the optimal activation effect. Twenty-four male elite boxers were randomly assigned to three groups: CON, 10 VL, and 20 VL. All subjects in the three groups underwent an activation intervention involving an 85% of the one-repetition maximum (1RM) squat, with 6-8 repetitions performed in the CON. The number of repetitions in the 20%VL and 10 VL was determined based on the velocity loss monitored by the GymAware PowerTool system. Four time points were selected for observation: the 4th, 8th, 12th and 16th minutes. These were chosen to test the subjects' punching ability. The results demonstrated that activation training at different VL induced a post-activation potentiation in boxers, improving punching ability bilaterally and to a greater extent than in the CON. The dominant side demonstrated the greatest efficacy at the 12th minute under the 20% velocity loss threshold, while the non-dominant side exhibited the greatest efficacy at the 8th minute under the 10% velocity loss threshold.

A direct spinal cord-computer interface enables the control of the paralysed hand in spinal cord injury

Paralysis of the muscles controlling the hand dramatically limits the quality of life for individuals living with spinal cord injury (SCI). Here, with a non-invasive neural interface, we demonstrate that eight motor complete SCI individuals (C5-C6) are still able to task-modulate in real-time the activity of populations of spinal motor neurons with residual neural pathways. In all SCI participants tested, we identified groups of motor units under voluntary control that encoded various hand movements. The motor unit discharges were mapped into more than 10 degrees of freedom, ranging from grasping to individual hand-digit flexion and extension. We then mapped the neural dynamics into a real-time controlled virtual hand. The SCI participants were able to match the cue hand posture by proportionally controlling four degrees of freedom (opening and closing the hand and index flexion/extension). These results demonstrate that wearable muscle sensors provide access to spared motor neurons that are fully under voluntary control in complete cervical SCI individuals. This non-invasive neural interface allows the investigation of motor neuron changes after the injury and has the potential to promote movement restoration when integrated with assistive devices.

Neuroplastic alterations in common synaptic inputs and synergistic motor unit clusters controlling the vastii muscles of individuals with ACL reconstruction

This cross-sectional study aims to elucidate the neural mechanisms underlying the control of knee extension forces in individuals with anterior cruciate ligament reconstruction (ACLR). Eleven soccer players with ACLR and nine control players performed unilateral isometric knee extensions at 10% and 30% of their maximum voluntary force (MVF). Simultaneous recordings of high-density surface electromyography (HDEMG) and force output were conducted for each lower limb, and HDEMG data from the vastus lateralis (VL) and vastus medialis (VM) muscles were decomposed into individual motor unit spike trains. Force steadiness was estimated using the coefficient of variation of force. An intramuscular coherence analysis was adopted to estimate the common synaptic input (CSI) converging to each muscle. A factor analysis was applied to investigate the neural strategies underlying the control of synergistic motor neuron clusters, referred to as motor unit modes. Force steadiness was similar between lower limbs. However, motor neurons innervating the VL on the reconstructed side received a lower proportion of CSI at low-frequency bandwidths (<5 Hz) compared with the unaffected lower limbs (P < 0.01). Furthermore, the reconstructed side demonstrated a higher proportion of motor units associated with the neural input common to the synergistic muscle, as compared with the unaffected lower limbs (P < 0.01). These findings indicate that the VL muscle of reconstructed lower limbs contribute marginally to force steadiness and that a plastic rearrangement in synergistic clusters of motor units involved in the control of knee extension forces is evident following ACLR.NEW & NOTEWORTHY Chronic quadriceps dysfunction is common after anterior cruciate ligament reconstruction (ACLR). We investigated voluntary force control strategies by estimating common inputs to motor neurons innervating the vastii muscles. Our results showed attenuated common inputs to the vastus lateralis and plastic rearrangements in functional clusters of motor neurons modulating knee extension forces in the reconstructed limb. These findings suggest neuroplastic adjustments following ACLR that may occur to fine-tune the control of quadriceps forces.

Persistent inward currents in human motoneurons: emerging evidence and future directions

The manner in which motoneurons respond to excitatory and inhibitory inputs depends strongly on how their intrinsic properties are influenced by the neuromodulators serotonin and noradrenaline. These neuromodulators enhance the activation of voltage-gated channels that generate persistent (long-lasting) inward sodium and calcium currents (PICs) into the motoneurons. PICs are crucial for initiating, accelerating, and maintaining motoneuron firing. A greater accessibility to state-of-the-art techniques that allows both the estimation and examination of PIC modulation in tens of motoneurons in vivo has rapidly evolved our knowledge of how motoneurons amplify and prolong the effects of synaptic input. We are now in a position to gain substantial mechanistic insight into the role of PICs in motor control at an unprecedented pace. The present review briefly describes the effects of PICs on motoneuron firing and the methods available for estimating them before presenting the emerging evidence of how PICs can be modulated in health and disease. Our rapidly developing knowledge of the potent effects of PICs on motoneuron firing has the potential to improve our understanding of how we move, and points to new approaches to improve motor control. Finally, gaps in our understanding are highlighted and methodological advancements are suggested to encourage readers to explore outstanding questions to further elucidate PIC physiology.

Voluntary co-contraction of ankle muscles alters motor unit discharge characteristics and reduces estimates of persistent inward currents

Motoneuronal persistent inward currents (PICs) are facilitated by neuromodulatory inputs but are highly sensitive to local inhibitory circuits. Estimates of PICs are reduced by group Ia reciprocal inhibition, and increased with the diffuse actions of neuromodulators released during remote muscle contraction. However, it remains unknown how motoneurons function in the presence of simultaneous excitatory and inhibitory commands. To probe this topic, we investigated motor unit discharge patterns and estimated PICs during voluntary co-contraction of ankle muscles, which simultaneously demands the contraction of agonist-antagonist pairs. Twenty participants performed triangular ramps of both co-contraction (simultaneous dorsiflexion and plantar flexion) and isometric dorsiflexion to a peak of 30% of their maximum muscle activity from a maximal voluntary contraction. Motor unit spike trains were decomposed from high-density surface EMG activity recorded from tibialis anterior using blind source separation algorithms. Voluntary co-contraction altered motor unit discharge rate characteristics. Discharge rate at recruitment and peak discharge rate were modestly reduced (∼6% change; P < 0.001; d = 0.22) and increased (∼2% change; P = 0.001, d = -0.19), respectively, in the entire dataset but no changes were observed when motor units were tracked across conditions. The largest effects during co-contraction were that estimates of PICs (ΔF) were reduced by ∼20% (4.47 vs. 5.57 pulses per second during isometric dorsiflexion; P < 0.001, d = 0.641). These findings suggest that, during voluntary co-contraction, the inhibitory input from the antagonist muscle overcomes the additional excitatory and neuromodulatory drive that may occur due to the co-contraction of the antagonist muscle, which constrains PIC behaviour. KEY POINTS: Voluntary co-contraction is a unique motor behaviour that concurrently provides excitatory and inhibitory synaptic input to motoneurons. Co-contraction of agonist-antagonist pairs alters agonist motor unit discharge characteristics, consistent with reductions in persistent inward current magnitude.

The effect of optimal load training on punching ability in elite female boxers

Optimal load training is a method of training that aims to maximize power output. This is achieved by arranging optimal loads (optimal ratios of load intensity and load volume) during strength training. The fixed load intensity and number of repetitions employed in traditional strength training. The present study will investigate the applicability of these two load arrangements to female elite boxers. Twenty-four elite female boxers were divided into three groups [optimal load (OL = 8), traditional load (TL = 8) and control group (CG = 8)]. The six-week intervention consisted of strength training with different loading arrangements. The punching ability and strength were tested before and after the intervention. We found that optimal load training enhances a boxer's punching ability and economy, which aligns with the demands of boxing and is suitable for high-level athletes, whose strength training loads require a more individualised and targeted approach.

Central and peripheral neuromuscular fatigue following ramp and rapid maximal voluntary isometric contractions

Introduction

Maximal voluntary isometric contractions (MVICs) as a fatiguing modality have been widely studied, but little attention has been given to the influence of the rate of torque development. Given the established differences in motor command and neuromuscular activation between ramp and rapid MIVCs, it is likely performance fatigue differs as well as the underlying physiological mechanisms.

Purpose

To compare responses for rapid and maximal torque following ramp and rapid MVICs, and the corresponding neuromuscular and corticospinal alterations.

Methods

On separate visits, twelve healthy males (22.8 ± 2.5 years) performed fatiguing intermittent MVICs of the knee extensors with either 2 s (RAMP) or explosive (RAPID) ramp-ups until a 50% reduction in peak torque was achieved. Before and after each condition, maximal and rapid torque measures were determined from an MVIC. Additionally, peripheral (twitch parameters) and central (voluntary activation) fatigue, as well as rapid muscle activation, and cortical-evoked twitch and electromyographic responses were recorded.

Results

Maximal and late-phase rapid torque measures (p ≤ 0.001;η p   2 = 0.635-0.904) were reduced similarly, but early rapid torque capacity (0-50 ms) (p = 0.003; d = 1.11 vs. p = 0.054; d = 0.62) and rapid muscle activation (p = 0.008; d = 1.07 vs. p = 0.875; d = 0.06) decreased more after RAMP. Changes in peripheral fatigue, as indicated by singlet and doublet contractile parameters (p < 0.001 for all;η p   2 = 0.752-0.859), and nerve-evoked voluntary activation (p < 0.001;η p   2 = 0.660) were similar between conditions. Corticospinal inhibition (via silent period) was only increased after RAPID (p = 0.007; d = 0.94 vs. p = 0.753; d = 0.09), whereas corticospinal voluntary activation and excitability were unchanged.

Conclusion

Ramp, fatiguing MVICs impaired early rapid torque capacity more than rapid MVICs, and this was accompanied by decrements in rapid muscle activation. Responses for peripheral and central fatigue (nerve and cortical stimulation) were largely similar between conditions, except that rapid MVICs increased corticospinal inhibition.

We need to talk-how muscle stem cells communicate

Skeletal muscle is one of the tissues with the highest ability to regenerate, a finely controlled process which is critically depending on muscle stem cells. Muscle stem cell functionality depends on intrinsic signaling pathways and interaction with their immediate niche. Upon injury quiescent muscle stem cells get activated, proliferate and fuse to form new myofibers, a process involving the interaction of multiple cell types in regenerating skeletal muscle. Receptors in muscle stem cells receive the respective signals through direct cell-cell interaction, signaling via secreted factors or cell-matrix interactions thereby regulating responses of muscle stem cells to external stimuli. Here, we discuss how muscle stem cells interact with their immediate niche focusing on how this controls their quiescence, activation and self-renewal and how these processes are altered in age and disease.

Neuromuscular consequences of spinal cord injury: New mechanistic insights and clinical considerations

The spinal cord facilitates communication between the brain and the body, containing intrinsic systems that work with lower motor neurons (LMNs) to manage movement. Spinal cord injuries (SCIs) can lead to partial paralysis and dysfunctions in muscles below the injury. While traditionally this paralysis has been attributed to disruptions in the corticospinal tract, a growing body of work demonstrates LMN damage is a factor. Motor units, comprising the LMN and the muscle fibers with which they connect, are essential for voluntary movement. Our understanding of their changes post-SCI is still emerging, but the health of motor units is vital, especially when considering innovative SCI treatments like nerve transfer surgery. This review seeks to collate current literature on how SCI impact motor units and explore neuromuscular clinical implications and treatment avenues. SCI reduced motor unit number estimates, and surviving motor units had impaired signal transmission at the neuromuscular junction, force-generating capacity, and excitability, which have the potential to recover chronically, yet the underlaying mechanisms are unclear. Furthermore, electrodiagnostic evaluations can aid in assessing the health lower and upper motor neurons, identify suitable targets for nerve transfer surgeries, and detect patients with time sensitive injuries. Lastly, many electrodiagnostic abnormalities occur in both chronic and acute SCI, yet factors contributing to these abnormalities are unknown. Future studies are required to determine how motor units adapt following SCI and the clinical implications of these adaptations.

Relationships among motor unit discharge parameters used to estimate synaptic inputs to motoneurons

The motor unit, consisting of a single α-motoneuron and the muscle fibers it innervates, is a neuromechanical transducer that transforms neural inputs from afferent, spinal, and descending sources into motoneuron discharge patterns and resulting muscle forces. The neural inputs that converge on the motoneuron constitute the motor command and are classified into three types: excitatory, inhibitory, and neuromodulatory. Motoneurons have complex and malleable input/output functions that depend on the mixture of excitatory, inhibitory, and neuromodulatory input. Recently, a reverse engineering paradigm was developed to identify temporal features of motoneuron discharge that can estimate aspects of excitatory, inhibitory, and neuromodulatory input. However, the common parameters used are sensitive to more than one type of input. The purpose of this study was to explore relationships among the reverse engineering parameters and to determine if the parameter set can be reduced to a smaller number of dimensions that summarize patterns in the data. We performed principal component (PC) analysis on seven reverse engineering parameters and found PCs corresponding to the amplification aspect of neuromodulation, the prolongation aspect of neuromodulation, and the pattern of inhibition.

Developmental changes in motor unit activity patterns: child-adult comparison using discrete motor unit analysis

Using global surface electromyography (sEMG) and the sEMG threshold it has been suggested that children activate their type-II motor unit (MU) to a lesser extent compared with adults. However, when age-related differences in discrete MU activation are examined using sEMG decomposition this phenomenon is not observed. Furthermore, findings from these studies are inconsistent and conflicting. Therefore, the purpose of this study was to examine differences in discrete MU activation of the vastus lateralis (VL) between boys and men during moderate-intensity knee extensions. Seventeen boys and 20 men completed two laboratory sessions. Following a habituation session, maximal voluntary isometric knee extension (MVIC) torque was determined before completing trapezoidal contractions at 70% MVIC. sEMG of the VL was captured and mathematically decomposed into individual MU action potential trains. Motor unit action potential amplitude (MUAPamp), recruitment threshold (RT), and MU firing rates (MUFR) were calculated. We observed that MUAPamp-RT slope was steeper in men compared with boys (p < 0.05) even after accounting for fat thickness and quadriceps muscle depth. The mean MUFR and y-intercept of the MUFR-RT relationship were significantly (p < 0.001) lower in boys than in men. The slope of the MUFR-RT relationship tended to be steeper in men, but the differences did not reach statistical significance (p = 0.056). Overall, our results suggest that neural strategies used to produce torque are different among boys and men. Such differences may be related, in part, to boys' lower MUFR and lesser ability to activate their higher-threshold MUs. Although, other factors (e.g., muscle composition) likely also play a role.

Onion skin is not a universal firing pattern for spinal motoneurons: simulation study

Muscle force is modulated by sequential recruitment and firing rates of motor units (MUs). However, discrepancies exist in the literature regarding the relationship between MU firing rates and their recruitment, presenting two contrasting firing-recruitment schemes. The first firing scheme, known as "onion skin," exhibits low-threshold MUs firing faster than high-threshold MUs, forming separate layers akin to an onion. This contradicts the other firing scheme, known as "reverse onion skin" or "afterhyperpolarization (AHP)," with low-threshold MUs firing slower than high-threshold MUs. To study this apparent dichotomy, we used a high-fidelity computational model that prioritizes physiological fidelity and heterogeneity, allowing versatility in the recruitment of different motoneuron types. Our simulations indicate that these two schemes are not mutually exclusive but rather coexist. The likelihood of observing each scheme depends on factors such as the motoneuron pool activation level, synaptic input activation rates, and MU type. The onion skin scheme does not universally govern the encoding rates of MUs but tends to emerge in unsaturated motoneurons (cells firing < their fusion frequency that generates peak force), whereas the AHP scheme prevails in saturated MUs (cells firing at their fusion frequency), which is highly probable for slow (S)-type MUs. When unsaturated, fast fatigable (FF)-type MUs always show the onion skin scheme, whereas S-type MUs do not show either one. Fast fatigue-resistant (FR)-type MUs are generally similar but show weaker onion skin behaviors than FF-type MUs. Our results offer an explanation for the longstanding dichotomy regarding MU firing patterns, shedding light on the factors influencing the firing-recruitment schemes.NEW & NOTEWORTHY The literature reports two contrasting schemes, namely the onion skin and the afterhyperpolarization (AHP) regarding the relationship between motor units (MUs) firing rates and recruitment order. Previous studies have examined these schemes phenomenologically, imposing one scheme on the firing-recruitment relationship. Here, we used a high-fidelity computational model that prioritizes biological fidelity and heterogeneity to investigate motoneuron firing schemes without bias toward either scheme. Our objective findings offer an explanation for the longstanding dichotomy on MU firing patterns.

Dendritic morphology of motor neurons and interneurons within the compact, semicompact, and loose formations of the rat nucleus ambiguus

Introduction

Motor neurons (MNs) within the nucleus ambiguus innervate the skeletal muscles of the larynx, pharynx, and oesophagus. These muscles are activated during vocalisation and swallowing and must be coordinated with several respiratory and other behaviours. Despite many studies evaluating the projections and orientation of MNs within the nucleus ambiguus, there is no quantitative information regarding the dendritic arbours of MNs residing in the compact, and semicompact/loose formations of the nucleus ambiguus..

Methods

In female and male Fischer 344 rats, we evaluated MN number using Nissl staining, and MN and non-MN dendritic morphology using Golgi-Cox impregnation Brightfield imaging of transverse Nissl sections (15 μm) were taken to stereologically assess the number of nucleus ambiguus MNs within the compact and semicompact/loose formations. Pseudo-confocal imaging of Golgi-impregnated neurons within the nucleus ambiguus (sectioned transversely at 180 μm) was traced in 3D to determine dendritic arbourisation.

Results

We found a greater abundance of MNs within the compact than the semicompact/loose formations. Dendritic lengths, complexity, and convex hull surface areas were greatest in MNs of the semicompact/loose formation, with compact formation MNs being smaller. MNs from both regions were larger than non-MNs reconstructed within the nucleus ambiguus.

Conclusion

Adding HBLS to the diet could be a potentially effective strategy to improve horses' health.

Muscle contractile properties directly influence shared synaptic inputs to spinal motor neurons

Alpha band oscillations in shared synaptic inputs to the alpha motor neuron pool can be considered an involuntary source of noise that hinders precise voluntary force production. This study investigated the impact of changing muscle length on the shared synaptic oscillations to spinal motor neurons, particularly in the physiological tremor band. Fourteen healthy individuals performed low-level dorsiflexion contractions at ankle joint angles of 90° and 130°, while high-density surface electromyography (HDsEMG) was recorded from the tibialis anterior (TA). We decomposed the HDsEMG into motor units spike trains and calculated the motor units' coherence within the delta (1-5 Hz), alpha (5-15 Hz), and beta (15-35 Hz) bands. Additionally, force steadiness and force spectral power within the tremor band were quantified. Results showed no significant differences in force steadiness between 90° and 130°. In contrast, alpha band oscillations in both synaptic inputs and force output decreased as the length of the TA was moved from shorter (90°) to longer (130°), with no changes in delta and beta bands. In a second set of experiments (10 participants), evoked twitches were recorded with the ankle joint at 90° and 130°, revealing longer twitch durations in the longer TA muscle length condition compared to the shorter. These experimental results, supported by a simple computational simulation, suggest that increasing muscle length enhances the muscle's low-pass filtering properties, influencing the oscillations generated by the Ia afferent feedback loop. Therefore, this study provides valuable insights into the interplay between muscle biomechanics and neural oscillations. KEY POINTS: We investigated whether changes in muscle length, achieved by changing joint position, could influence common synaptic oscillations to spinal motor neurons, particularly in the tremor band (5-15 Hz). Our results demonstrate that changing muscle length from shorter to longer induces reductions in the magnitude of alpha band oscillations in common synaptic inputs. Importantly, these reductions were reflected in the oscillations of muscle force output within the alpha band. Longer twitch durations were observed in the longer muscle length condition compared to the shorter, suggesting that increasing muscle length enhances the muscle's low-pass filtering properties. Changes in the peripheral contractile properties of motor units due to changes in muscle length significantly influence the transmission of shared synaptic inputs into muscle force output. These findings prove the interplay between muscle mechanics and neural adaptations.

Supraspinal, spinal, and motor unit adjustments to fatiguing isometric contractions of the knee extensors at low and high submaximal intensities in males

Contraction intensity is a key factor determining the development of muscle fatigue, and it has been shown to induce distinct changes along the motor pathway. The role of cortical and spinal inputs that regulate motor unit (MU) behavior during fatiguing contractions is poorly understood. We studied the cortical, spinal, and neuromuscular response to sustained fatiguing isometric tasks performed at 20% and 70% of the maximum isometric voluntary contraction (MVC), together with MU behavior of knee extensors in healthy active males. Neuromuscular function was assessed before and after performance of both tasks. Cortical and spinal responses during exercise were measured via stimulation of the motor cortex and spinal cord. High-density electromyography was used to record individual MUs from the vastus lateralis (VL). Exercise at 70%MVC induced greater decline in MVC (P = 0.023) and potentiated twitch force compared with 20%MVC (P < 0.001), with no difference in voluntary activation (P = 0.514). Throughout exercise, corticospinal responses were greater during the 20%MVC task (P < 0.001), and spinal responses increased over time in both tasks (P ≤ 0.042). MU discharge rate increased similarly after both tasks (P ≤ 0.043), whereas recruitment and derecruitment thresholds were unaffected (P ≥ 0.295). These results suggest that increased excitability of cortical and spinal inputs might be responsible for the increase in MU discharge rate. The increase in evoked responses together with the higher MU discharge rate might be required to compensate for peripheral adjustments to sustain fatiguing contractions at different intensities.NEW & NOTEWORTHY Changes in central nervous system and muscle function occur in response to fatiguing exercise and are specific to exercise intensity. This study measured corticospinal, neuromuscular, and motor unit behavior to fatiguing isometric tasks performed at different intensities. Both tasks increased corticospinal excitability and motor unit discharge rate. Our findings suggest that these acute adjustments are required to compensate for the exercise-induced decrements in neuromuscular function caused by fatiguing tasks.

NeuroMechanics: Electrophysiological and computational methods to accurately estimate the neural drive to muscles in humans in vivo

The ultimate neural signal for muscle control is the neural drive sent from the spinal cord to muscles. This neural signal comprises the ensemble of action potentials discharged by the active spinal motoneurons, which is transmitted to the innervated muscle fibres to generate forces. Accurately estimating the neural drive to muscles in humans in vivo is challenging since it requires the identification of the activity of a sample of motor units (MUs) that is representative of the active MU population. Current electrophysiological recordings usually fail in this task by identifying small MU samples with over-representation of higher-threshold with respect to lower-threshold MUs. Here, we describe recent advances in electrophysiological methods that allow the identification of more representative samples of greater numbers of MUs than previously possible. This is obtained with large and very dense arrays of electromyographic electrodes. Moreover, recently developed computational methods of data augmentation further extend experimental MU samples to infer the activity of the full MU pool. In conclusion, the combination of new electrode technologies and computational modelling allows for an accurate estimate of the neural drive to muscles and opens new perspectives in the study of the neural control of movement and in neural interfacing.

Common synaptic inputs and persistent inward currents of vastus lateralis motor units are reduced in older male adults

Although muscle atrophy may partially account for age-related strength decline, it is further influenced by alterations of neural input to muscle. Persistent inward currents (PIC) and the level of common synaptic inputs to motoneurons influence neuromuscular function. However, these have not yet been described in the aged human quadriceps. High-density surface electromyography (HDsEMG) signals were collected from the vastus lateralis of 15 young (mean ± SD, 23 ± 5 y) and 15 older (67 ± 9 y) men during submaximal sustained and 20-s ramped contractions. HDsEMG signals were decomposed to identify individual motor unit discharges, from which PIC amplitude and intramuscular coherence were estimated. Older participants produced significantly lower knee extensor torque (p < 0.001) and poorer force tracking ability (p < 0.001) than young. Older participants also had lower PIC amplitude (p = 0.001) and coherence estimates in the alpha frequency band (p < 0.001) during ramp contractions when compared to young. Persistent inward currents and common synaptic inputs are lower in the vastus lateralis of older males when compared to young. These data highlight altered neural input to the clinically and functionally important quadriceps, further underpinning age-related loss of function which may occur independently of the loss of muscle mass.

Motor unit discharge rate modulation during isometric contractions to failure is intensity- and modality-dependent

The physiological mechanisms determining the progressive decline in the maximal muscle torque production capacity during isometric contractions to task failure are known to depend on task demands. Task-specificity of the associated adjustments in motor unit discharge rate (MUDR), however, remains unclear. This study examined MUDR adjustments during different submaximal isometric knee extension tasks to failure. Participants performed a sustained and an intermittent task at 20% and 50% of maximal voluntary torque (MVT), respectively (Experiment 1). High-density surface EMG signals were recorded from vastus lateralis (VL) and medialis (VM) and decomposed into individual MU discharge timings, with the identified MUs tracked from recruitment to task failure. MUDR was quantified and normalised to intervals of 10% of contraction time (CT). MUDR of both muscles exhibited distinct modulation patterns in each task. During the 20% MVT sustained task, MUDR decreased until ∼50% CT, after which it gradually returned to baseline. Conversely, during the 50% MVT intermittent task, MUDR remained stable until ∼40-50% CT, after which it started to continually increase until task failure. To explore the effect of contraction intensity on the observed patterns, VL and VM MUDR was quantified during sustained contractions at 30% and 50% MVT (Experiment 2). During the 30% MVT sustained task, MUDR remained stable until ∼80-90% CT in both muscles, after which it continually increased until task failure. During the 50% MVT sustained task the increase in MUDR occurred earlier, after ∼70-80% CT. Our results suggest that adjustments in MUDR during submaximal isometric contractions to failure are contraction modality- and intensity-dependent. KEY POINTS: During prolonged muscle contractions a constant motor output can be maintained by recruitment of additional motor units and adjustments in their discharge rate. Whilst contraction-induced decrements in neuromuscular function are known to depend on task demands, task-specificity of motor unit discharge behaviour adjustments is still unclear. In this study, we tracked and compared discharge activity of several concurrently active motor units in the vastii muscles during different submaximal isometric knee extension tasks to failure, including intermittent vs. sustained contraction modalities performed in the same intensity domain (Experiment 1), and two sustained contractions performed at different intensities (Experiment 2). During each task, motor units modulated their discharge rate in a distinct, biphasic manner, with the modulation pattern depending on contraction intensity and modality. These results provide insight into motoneuronal adjustments during contraction tasks posing different demands on the neuromuscular system.

Effect of Warm-Up Exercise on Functional Regulation of Motor Unit Activation during Isometric Torque Production

In this study, we tested several hypotheses related to changes in motor unit activation patterns after warm-up exercise. Fifteen healthy young men participated in the experiment and the main task was to produce voluntary torque through the elbow joint under the isometric condition. The experimental conditions consisted of two directions of torque, including flexion and extension, at two joint angles, 10° and 90°. Participants were asked to increase the joint torque to the maximal level at a rate of 10% of the maximum voluntary torque. The warm-up protocol followed the ACSM guidelines, which increased body temperature by approximately 1.5°C. Decomposition electromyography electrodes, capable of extracting multiple motor unit action potentials from surface signals, were placed on the biceps and triceps brachii muscles, and joint torque was measured on the dynamometer. The mean firing rate and the recruitment threshold of the decomposed motor units were quantified. In addition, a single motor unit activity from the spike train was quantified for each of five selected motor units. The magnitude of joint torque increased with the warm-up exercise for all the experimental conditions. The results of the motor unit analyses showed a positive and beneficial effect of the warm-up exercise, with an increase in both the mean firing rate and the recruitment threshold by about 56% and 33%, respectively, particularly in the agonist muscle. Power spectral density in the gamma band, which is thought to be the dominant voluntary activity, was also increased by the warm-up exercise only in the high threshold motor units.

Tutorial: Analysis of central and peripheral motor unit properties from decomposed High-Density surface EMG signals with openhdemg

High-Density surface Electromyography (HD-sEMG) is the most established technique for the non-invasive analysis of single motor unit (MU) activity in humans. It provides the possibility to study the central properties (e.g., discharge rate) of large populations of MUs by analysis of their firing pattern. Additionally, by spike-triggered averaging, peripheral properties such as MUs conduction velocity can be estimated over adjacent regions of the muscles and single MUs can be tracked across different recording sessions. In this tutorial, we guide the reader through the investigation of MUs properties from decomposed HD-sEMG recordings by providing both the theoretical knowledge and practical tools necessary to perform the analyses. The practical application of this tutorial is based on openhdemg, a free and open-source community-based framework for the automated analysis of MUs properties built on Python 3 and composed of different modules for HD-sEMG data handling, visualisation, editing, and analysis. openhdemg is interfaceable with most of the available recording software, equipment or decomposition techniques, and all the built-in functions are easily adaptable to different experimental needs. The framework also includes a graphical user interface which enables users with limited coding skills to perform a robust and reliable analysis of MUs properties without coding.

Visual Information Processing in Older Adults: Force Control and Motor Unit Pool Modulation

Increased visual information about a task impairs force control in older adults. To date, however, it remains unclear how increased visual information changes the activation of the motor unit pool differently for young and older adults. Therefore, this study aimed to determine how increased visual information alters the activation of the motor neuron pool and influences force control in older adults. Fifteen older adults (66-86 years, seven women) and fifteen young adults (18-30 years, eight women) conducted a submaximal constant force task (15% of maximum) with ankle dorsiflexion for 20 s. The visual information processing was manipulated by changing the amount of force visual feedback into a low-gain (0.05°) or high-gain (1.2°) condition. Older adults exhibited greater force variability, especially at high-gain visual feedback. This exacerbated force variability from low- to high-gain visual feedback was associated with modulations of multiple motor units, not single motor units. Specifically, increased modulation of multiple motor units from 10 to 35 Hz may contribute to the amplification in force variability. Therefore, our findings suggest evidence that high-gain visual feedback amplifies force variability of older adults which is related to increases in the activation of motor neuron pool from 10 to 35 Hz.

The role of clinical neurophysiology in the definition and assessment of fatigue and fatigability

Though a common symptom, fatigue is difficult to define and investigate, occurs in a wide variety of neurological and systemic disorders, with differing pathological causes. It is also often accompanied by a psychological component. As a symptom of long-term COVID-19 it has gained more attention. In this review, we begin by differentiating fatigue, a perception, from fatigability, quantifiable through biomarkers. Central and peripheral nervous system and muscle disorders associated with these are summarised. We provide a comprehensive and objective framework to help identify potential causes of fatigue and fatigability in a given disease condition. It also considers the effectiveness of neurophysiological tests as objective biomarkers for its assessment. Among these, twitch interpolation, motor cortex stimulation, electroencephalography and magnetencephalography, and readiness potentials will be described for the assessment of central fatigability, and surface and needle electromyography (EMG), single fibre EMG and nerve conduction studies for the assessment of peripheral fatigability. The purpose of this review is to guide clinicians in how to approach fatigue, and fatigability, and to suggest that neurophysiological tests may allow an understanding of their origin and interactions. In this way, their differing types and origins, and hence their possible differing treatments, may also be defined more clearly.

Adding the latency period to a muscle contraction model coupled to a membrane action potential model

Introduction: Skeletal muscle is responsible for multiple functions for maintaining energy homeostasis and daily activities. Muscle contraction is activated by nerve signals, causing calcium release and interaction with myofibrils. It is important to understand muscle behavior and its impact on medical conditions, like in the presence of some diseases and their treatment, such as cancer, which can affect muscle architecture, leading to deficits in its function. For instance, it is known that radiotherapy and chemotherapy also have effects on healthy tissues, leading to a reduction in the rate of force development and the atrophy of muscle fibers. The main aim is to reproduce the behavior of muscle contraction using a coupled model of force generation and the action potential of the cell membrane, inserting the latency period observed between action potential and force generation in the motor unit.

Methods: Mathematical models for calcium dynamics and muscle contraction are described, incorporating the role of calcium ions and rates of reaction. An action potential initiates muscle contraction, as described by the Hodgkin–Huxley model. The numerical method used to solve the equations is the forward Euler method.

Results and Discussion: The results show dynamic calcium release and force generation, aligning with previous research results, and the time interval between membrane excitation and force generation was accomplished. Future work should suggest simulating more motor units at the actual scale for the possibility of a comparison with real data collected from both healthy individuals and those who have undergone cancer treatment.

Spatial decomposition of ultrafast ultrasound images to identify motor unit activity - A comparative study with intramuscular and surface EMG

The smallest voluntarily controlled structure of the human body is the motor unit (MU), comprised of a motoneuron and its innervated fibres. MUs have been investigated in neurophysiology research and clinical applications, primarily using electromyographic (EMG) techniques. Nonetheless, EMG (both surface and intramuscular) has a limited detection volume. A recent alternative approach to detect MUs is ultrafast ultrasound (UUS) imaging. The possibility of identifying MU activity from UUS has been shown by blind source separation (BSS) of UUS images, using optimal separation spatial filters. However, this approach has yet to be fully compared with EMG techniques for a large population of unique MU spike trains. Here we identify individual MU activity in UUS images using the BSS method for 401 MU spike trains from eleven participants based on concurrent recordings of either surface or intramuscular EMG from forces up to 30% of the maximum voluntary contraction (MVC) force. We assessed the BSS method's ability to identify MU spike trains from direct comparison with the EMG-derived spike trains as well as twitch areas and temporal profiles from comparison with the spike-triggered-averaged UUS images when using the EMG-derived spikes as triggers. We found a moderate rate of correctly identified spikes (53.0 ± 16.0%) with respect to the EMG-identified firings. However, the MU twitch areas and temporal profiles could still be identified accurately, including at 30% MVC force. These results suggest that the current BSS methods for UUS can accurately identify the location and average twitch of a large pool of MUs in UUS images, providing potential avenues for studying neuromechanics from a large cross-section of the muscle. On the other hand, more advanced methods are needed to address the convolutive and partly non-linear summation of velocities for recovering the full spike trains.

Physical strength levels and short-term memory efficiency in primary school children: a possible match?

BACKGROUND

Physical strength stimulation and, in general, physical activity induces brain plasticity (functional and structural adaptations) in different cerebral areas, benefiting executive function, cognition, attention and academic performance, which is usually estimated by measuring the Intelligent Quotient (IQ), and IQ is related to short-term memory, generally during school age. However, very little is known about the role of physical strength on short-term memory efficiency. Therefore, the primary aim of this study is to examine whether the level of physical strength can positively impact short-term memory efficiency in primary school children. Additionally, if this effect is observed, the secondary goal of this study is to determine whether the age of the participants plays a role in mediating and moderating this influence.

METHODS

Seventy-five children from a primary school in the metropolitan area of Turin were recruited for this study. Each subject performed the overhead medicine ball toss (backwards) test to assess physical strength and the Digit Span test from the Wechsler Intelligence Scale for Children (WISC) to evaluate short-term memory efficiency. Firstly, a simple mediation model was used to identify the possible impact of physical strength levels on short-term memory efficiency and the potential role of participants' chronological age. Secondly, a moderation model was carried out to observe if age could moderate the impact of physical training on short-term memory efficiency and the different significance levels of the moderator. Significance was assumed at P<0.05.

RESULTS

The results showed a statistically significant direct effect of physical strength on short-term memory (Β=0.429, t(72)=3.247, P<0.01). On the contrary, age was not statistically significant (Β=0.167, t(72)=3.247, P=0.211). Furthermore, a significant interaction between strength and age was identified by the moderation model (β=-0.270, P<0.01). Specifically, the impact of physical strength levels on short-term memory increased for individuals who were above the mean age (β=0.755, P<0.001). but not for those under the mean age (β=0.215, P=0.153). This model explains 37.2% of the variance in memory (R2=0.372, F(3, 71)=14.031, P<0.001).

CONCLUSIONS

These findings suggest that physical strength can positively influence short-term memory. In addition, this impact is enhanced in older-age children. Thus, primary school programs should stimulate physical strength to help children develop cognitive abilities.