Postexercise facilitation of motor evoked potentials following transcranial magnetic stimulation: a study in normal subjects

Effects of Motor Learning on Corticospinal Tract Excitability During Motor Imagery

We aimed to examine the effects of motor performance improvements produced by practice on corticospinal tract excitability during motor imagery (MI) of identical movements. Participants performed a motor task with no guidelines displayed on the monitor (performance test); the participants only imagined performing the task without performing the movement (MI test), and the participants performed the power output and then adjusted it (exercise). The output force conditions were 20, 40, and 60% of the maximum voluntary contraction, and the objective was for 21 participants to learn each output force condition. The outcome of the performance test was calculated as the difference between the actual motor output and the target. During the MI test, we applied a single transcranial magnetic stimulation during imagery, assessed the corticospinal tract excitability of the right first dorsal interosseous by motor-evoked potential (MEP) amplitude, and recorded the vividness of the MI in each trial. We evaluated performance and MI before practice (Pre-test), after 150 practice sessions (Post-test 1), and after another 150 practice sessions (Post-test 2). The MEP amplitude was significantly reduced at Post-test 2 compared to Pre-test. The vividness of the MI improved with practice. Corticospinal tract excitability during MI decreased as motor performance improved. Thus, actual motor practice was also reflected in the MI of the exercise. Performance improvement was accompanied by a decrease in redundant activity, enhancing the efficiency and appropriateness of the exercise.

Transcranial magnetic stimulation in the assessment of acupuncture effect on exercise-induced fatigue

BACKGROUND

Acupuncture as a traditional Chinese medicine therapy relies on unique theories to alleviate fatigue. The aim of this study is to evaluate the effect of acupuncture on exercise-induced fatigue utilizing transcranial magnetic stimulation (TMS).

METHODS

A total of 20 participants with regular exercise habits were recruited for this study. All participants were randomly assigned to receive either acupuncture or sham acupuncture intervention for exercise-induced fatigue. TMS and a heart rate monitor were used to measure the amplitude and latency of motor evoked potential (MEP) as well as heart rate every 5 min over a 30-min period. The blood lactic acid (BLA) levels were measured using Lactate Scout+ at baseline, 0 min, and 30 min after fatigue. Two-way repeated measures analysis of variance was utilized to compare the differences between the effects of acupuncture method and time. Bonferroni post hoc tests were conducted to compare specific differences. Statistical significance was set at p < .05.

RESULTS

Interaction effect was observed between acupuncture method and time effect in terms of amplitude (F(1, 38) = 5.40, p < .001, η2 = 0.12) and latency (F(1, 38) = 3.78, p = .008, η2 = .09) of MEP. The application of acupuncture can promote the recovery of heart rate especially at 30 min (p < .05), but which seem insufficient to generate significant difference in BLA (F(1, 38) = 0.067, p = .797, η2 = 0.002).

CONCLUSIONS

Acupuncture can promote the increase of MEP amplitude, shorten MEP latency, and restore heart rate. Preliminary findings provide novel insights for individuals with exercise habits to alleviate fatigue and enhance sports performance.

Effects of Remote Ischemic Conditioning on Hand Engagement in individuals with Spinal cord Injury (RICHES): protocol for a pilot crossover study

​​​​​​Background: Most spinal cord injuries (SCI) are not full transections, indicating that residual nerve circuits are retained. Rehabilitation interventions have been shown to beneficially reorganize motor pathways in the brain, corticospinal tract, and at the spinal level. However, rehabilitation training require a large number of repetitions, and intervention effects may be absent or show transient retention. Therefore, the need remains for an effective approach to synergistically improve the amount and duration of neuroplasticity in combination with other interventions. Remote ischemic conditioning (RIC) demonstrates several potential advantages as a candidate for such an approach. Therefore, we propose a protocol to investigate RIC coupled with physical training to promote neuroplasticity in hand muscles. Methods: This will be a prospective randomized-order crossover trial to be performed in eight able-bodied participants and eight participants with chronic cervical SCI. Patients will participate in two experimental sessions consisting of either active or sham RIC preceding a bout of pinch movement exercise. Serial evaluations will be conducted at baseline, after RIC, immediately after pinch exercise, and follow up 15-minutes later. The primary outcome is the change in corticospinal excitability (primarily measured by the motor evoked potential of abductor pollicis brevis muscle). Secondary outcomes will include maximal volitional pinch force, and inflammatory biomarkers. To ensure safety, we will monitor tolerability and hemodynamic responses during RIC. Discussion: This protocol will be the first to test RIC in people with cervical SCI and to investigate whether RIC alters corticospinal excitability. By sharing the details of our protocol, we hope other interested researchers will seek to investigate similar approaches – depending on overlap with the current study and mutual sharing of participant-level data, this could increase the sample size, power, and generalizability of the analysis and results. Trial registration: ClinicalTrial.gov, ID: NCT03851302; Date of registration: February 22, 2019

State-of-the-art review: spinal and supraspinal responses to muscle potentiation in humans

Post-activation potentiation (PAP), described as a muscular phenomenon, refers to the enhancement of contractile properties following a voluntary or electrically stimulated short duration (< 10 s) high-intensity contraction. Mechanistic factors and subsequent effects on voluntary performance have been well documented. Associations between neural activation and PAP, however, are less understood and systematically have not been explored. Thus, the aim is to critically summarize the current understanding of PAP regarding the motor pathway from the corticospinal tract to spinal level factors including the H-reflex and motor unit activation. This review highlights aspects for further investigation by providing an integrative summary of the relationship between PAP and neural control. Contractile history affects neural control in subsequent contractions, (e.g. fatiguing tasks), however, by contrast acute contractile enhancement due to PAP in relation to neural responses are not well-studied. From the limited number of investigations, motor unit discharge rates are reduced subsequent to PAP and, although less consistently reported, generally H-reflexes are depressed. Additionally, corticomedullary evoked potentials are depressed and the cortical silent period is elongated. Thus, overall there is a depression of spinal and supraspinal responses following PAP. Although specific factors responsible and their pathways are unclear, this down-regulation may occur to conserve neural activation when muscle contraction is more responsive, and concurrently a strategy used to delay neuromuscular fatigue. Indeed, the co-existence of PAP and fatigue is not a novel concept, but the interactions between PAP and neural responses are not understood and likely are more than coincidental.

Motor cortex excitability and inhibitory imbalance in autism spectrum disorder assessed with transcranial magnetic stimulation: a systematic review

Cortical excitation/inhibition (E/I) imbalances contribute to various clinical symptoms observed in autism spectrum disorder (ASD). However, the detailed pathophysiologic underpinning of E/I imbalance remains uncertain. Transcranial magnetic stimulation (TMS) motor-evoked potentials (MEP) are a non-invasive tool for examining cortical inhibition in ASD. Here, we conducted a systematic review on TMS neurophysiology in motor cortex (M1) such as MEPs and short-interval intracortical inhibition (SICI) between individuals with ASD and controls. Out of 538 initial records, we identified six articles. Five studies measured MEP, where four studies measured SICI. There were no differences in MEP amplitudes between the two groups, whereas SICI was likely to be reduced in individuals with ASD compared with controls. Notably, SICI largely reflects GABA(A) receptor-mediated function. Conversely, other magnetic resonance spectroscopy and postmortem methodologies assess GABA levels. The present review demonstrated that there may be neurophysiological deficits in GABA receptor-mediated function in ASD. In conclusion, reduced GABAergic function in the neural circuits could underlie the E/I imbalance in ASD, which may be related to the pathophysiology of clinical symptoms of ASD. Therefore, a novel treatment that targets the neural circuits related to GABA(A) receptor-mediated function in regions involved in the pathophysiology of ASD may be promising.

Reduced corticospinal responses in older compared with younger adults during submaximal isometric, shortening, and lengthening contractions

The aim of this study was to assess differences in motor performance, as well as corticospinal and spinal responses to transcranial magnetic and percutaneous nerve stimulation, respectively, during submaximal isometric, shortening, and lengthening contractions between younger and older adults. Fifteen younger [26 yr (SD 4); 7 women, 8 men] and 14 older [64 yr (SD 3); 5 women, 9 men] adults performed isometric and shortening and lengthening dorsiflexion on an isokinetic dynamometer (5°/s) at 25% and 50% of contraction type-specific maximums. Motor evoked potentials (MEPs) and H reflexes were recorded at anatomical zero. Maximal dorsiflexor torque was greater during lengthening compared with shortening and isometric contractions ( P < 0.001) but was not age dependent ( P = 0.158). However, torque variability was greater in older compared with young adults ( P < 0.001). Background electromyographic (EMG) activity was greater in older compared with younger adults ( P < 0.005) and was contraction type dependent ( P < 0.001). As evoked responses are influenced by both the maximal level of excitation and background EMG activity, the responses were additionally normalized {[MEP/maximum M wave (M_max)]/root-mean-square EMG activity (RMS) and [H reflex (H)/M_max]/RMS}. (MEP/M_max)/RMS and (H/M_max)/RMS were similar across contraction types but were greater in young compared with older adults ( P < 0.001). Peripheral motor conduction times were prolonged in older adults ( P = 0.003), whereas peripheral sensory conduction times and central motor conduction times were not age dependent ( P ≥ 0.356). These data suggest that age-related changes throughout the central nervous system serve to accommodate contraction type-specific motor control. Moreover, a reduction in corticospinal responses and increased torque variability seem to occur without a significant reduction in maximal torque-producing capacity during older age. NEW & NOTEWORTHY This is the first study to have explored corticospinal and spinal responses with aging during submaximal contractions of different types (isometric, shortening, and lengthening) in lower limb musculature. It is demonstrated that despite preserved maximal torque production capacity corticospinal responses are reduced in older compared with younger adults across contraction types along with increased torque variability during dynamic contractions. This suggests that the age-related corticospinal changes serve to accommodate contraction type-specific motor control.

Corticospinal excitability to the biceps brachii and its relationship to postactivation potentiation of the elbow flexors

We examined the effects of a submaximal voluntary elbow flexor contraction protocol on measures of corticospinal excitability and postactivation potentiation of evoked muscle forces and if these measures were state‐dependent (rest vs. voluntary muscle contraction). Participants completed four experimental sessions where they rested or performed a 5% maximum voluntary contraction (MVC) of the elbow flexors prior to, immediately, and 5 min following a submaximal contraction protocol. During rest or 5% MVC, transcranial magnetic stimulation, transmastoid electrical stimulation, electrical stimulation of biceps brachii motor point and Erb's point were elicited to induce motor‐evoked potentials (MEPs), cervicomedullary MEPs (CMEPs), potentiated twitch (PT) force, and maximal muscle compound action potential (M_max), respectively prior to, immediately, and 5 min postcontraction protocol. MEP amplitudes increased (215 and 165%M_max, P ≤ 0.03) only at 1 and 6s postcontraction protocol, respectively during rest but not 5% MVC. CMEP amplitudes decreased during rest and 5% MVC (range:21–58%M_max, P ≤ 0.04) for up to 81 sec postcontraction protocol. Peak twitch force increased immediately postcontraction protocol and remained elevated for 90 sec (range:122–147% increase, P < 0.05). There was a significant positive correlation between MEP and PT force during rest (r = 0.88, P = 0.01) and a negative correlation between CMEP and PT force during rest (r = −0.85, P < 0.02 and 5% MVC (r = −0.96, P < 0.01) immediately postcontraction protocol. In conclusion, the change in corticospinal and spinal excitability was state‐ and time‐dependent whereas spinal excitability and postactivation potentiation were time‐dependent following the contraction protocol. Changes in corticospinal excitability and postactivation potentiation correlated and were also state‐dependent.

Influence of dual-task on postexercise facilitation: a transcranial magnetic stimulation study

In this study we investigated the effect of a dual task (DT) comprised of a nonfatiguing leg and foot extension coupled with a calculation task on postexercise facilitation (PEF) of motor evoked potentials (MEPs) tested by using transcranial magnetic stimulation (TMS). Twelve right-handed healthy subjects participated in the study. They were required to perform a motor task, a cognitive task and a DT. The motor task consisted of extending the right leg and foot for 30 sec at 20% of the maximal voluntary contraction. The cognitive task consisted of a 30-sec backward calculation. In the DT condition, motor and cognitive tasks were performed concurrently. Resting motor threshold and 10 MEPs were collected before and immediately after each task. TMS was delivered to the motor hot spot of the right vastus lateralis and tibialis anterior (TA) muscles. Results showed that exercise induced a significant PEF in both VL and TA muscles while calculation was not associated with significant PEF. Furthermore, DT was associated with lack of significant PEF in both muscles (VL, 116.1%±9.6%; TA, 115.7%±9%). Our data indicates DT interference on corticospinal excitability after a nonfatiguing exercise. Our experimental paradigm may be used to address postexercise motor cortex plastic adaptations induced by motor and cognitive tasks of different complexity in sport, aging and neuropsychiatric diseases.

Motor imagery muscle contraction strength influences spinal motor neuron excitability and cardiac sympathetic nerve activity

[Purpose] The aim of this study was to investigate the changes in spinal motor neuron excitability and autonomic nervous system activity during motor imagery of isometric thenar muscle activity at 10% and 50% maximal voluntary contraction (MVC). [Methods] The F-waves and low frequency/high frequency (LF/HF) ratio were recorded at rest, during motor imagery, and post-trial. For motor imagery trials, subjects were instructed to imagine thenar muscle activity at 10% and 50% MVC while holding the sensor of a pinch meter for 5 min. [Results] The F-waves and LF/HF ratio during motor imagery at 50% MVC were significantly increased compared with those at rest, whereas those during motor imagery at 10% MVC were not significantly different from those at rest. The relative values of the F/M amplitude ratio during motor imagery at 50% MVC were significantly higher than those at 10% MVC. The relative values of persistence and the LF/HF ratio during motor imagery were similar during motor imagery at the two muscle contraction strengths. [Conclusion] Motor imagery can increase the spinal motor neuron excitability and cardiac sympathetic nerve activity. Motor imagery at 50% MVC may be more effective than motor imagery at 10% MVC.

Fatigue in patients with multiple sclerosis: from movement preparation to motor execution

BACKGROUND

The neural mechanisms underlying fatigue in multiple sclerosis (MS) are still poorly understood. Cortico-cortical and cortico-subcortical circuitry abnormalities may play a central role in its pathogenesis. Our previous studies suggest that central fatigue may be related to an impairment of volition drive during movement preparation.

OBJECTIVE

We further explored the central mechanisms of fatigue at the premovement level in MS patients during a sustained motor task.

METHODS

In MS patients with (MS-F) and without (MS-NF) fatigue and age-matched healthy controls, we evaluated the motor cortex excitability and the premovement facilitation (PMF) through transcranial magnetic stimulation before and after 5min of sequenced finger-tapping movements at a fixed frequency of 2Hz.

RESULTS

In MS-F patients, the number of correct sequences performed and the ability to keep a fixed movement rate during the 5-min motor task were significantly decreased in comparison to the normal controls and MS-NF patients. Also, in MS-F patients, post-exercise PMF was significantly decreased. The PMF abnormalities were highly correlated with the performance decay.

CONCLUSIONS

PMF may be considered as a kind of servo-mechanism which could play a crucial role during sustained motor task in order to prevent motor performance disruption and to avoid motor exhaustion.

Modulation of corticospinal excitability dependent upon imagined force level

Motor imagery is defined as the mental execution of a movement without any muscle activity. In the present study, corticospinal excitability was assessed by motor evoked potentials (MEPs) when the subjects imagined isometric elbow flexion at various force levels. Electromyography was recorded from the right brachioradialis, the biceps brachii and the triceps brachii muscles. First, the maximum voluntary contraction (MVC) of elbow flexion was recorded in each subject. Subjects practiced performing 10, 30 and 60 % MVC using visual feedback. After the practice, MEPs were recorded during the imagery of elbow flexion with the forces of 10, 30 and 60 % MVC without any feedback. After the MEPs recording, we assigned subjects to reproduce the actual elbow flexion force at 10, 30 and 60 % MVC. The MEPs amplitudes in the brachioradialis and biceps brachii in the 60 % MVC condition were significantly greater than those in the 10 % MVC condition (p < 0.05). These findings suggest that the enhancement of corticospinal excitability during motor imagery is associated with an increase in imagined force level.

Method for assessing brain changes associated with gluteus maximus activation

STUDY DESIGN

Reliability study.

OBJECTIVES

To determine the feasibility and reliability of using transcranial magnetic stimulation (TMS) to assess corticomotor excitability (CE) of the gluteus maximus.

BACKGROUND

Sport-specific skill training targeting greater utilization of the gluteus maximus has been proposed as a method to reduce the incidence of noncontact knee injuries. The use of TMS to assess changes in CE may help to determine training-induced central mechanisms associated with gluteus maximus activation.

METHODS

Within- and between-day reliability was measured in 10 healthy adults. The CE was measured by stimulating the gluteus maximus ìhotspotî at 120% and 150% of motor threshold, while subjects performed a double-leg bridge. An intraclass correlation coefficient (model 2,1), standard error of measurement, and minimal detectable change were calculated to determine the within- and between-day reliability for the following TMS variables: peak-to-peak motor-evoked potential (MEP) amplitudes, cortical silent period, and MEP latency.

RESULTS

It is feasible to measure the CE of the gluteus maximus with TMS. The intraclass correlation coefficients for all TMS outcome measures ranged from 0.73 to 0.97. The ranges of minimal detectable change, with respect to mean values for each TMS variable, were larger for MEP amplitude (304.7-585.4 µV) compared to those for cortical silent period duration (25.3-40.8 milliseconds) and MEP latency (1.1-2.1 milliseconds).

CONCLUSION

The present study demonstrated a feasible method for using TMS to measure CE of the gluteus maximus. Small minimal detectable change values for the cortical silent period and MEP latency provide a reference for future studies.

Protracted exercise without overt neuromuscular fatigue influences cortical excitability

The authors' aim was to determine the cortical mechanisms that underlie the transition from effective performance to its disruption. They thus used transcranial magnetic stimulation (TMS) to study changes of corticospinal excitability after a motor exercise that did not produce overt or perceived neuromuscular fatigue. Forty-four subjects performed either 5 or 10 min of repetitive finger movements paced by tones at 2 Hz, a frequency below the spontaneous movement rate. Changes of corticospinal excitability were assessed with TMS at rest and during motor response preparation (premovement facilitation paradigm). Over time, variability of movement rate increased, while the average movement rate shifted toward self-paced rhythms, without significant changes in other kinematic parameters. Amplitudes of motor evoked potentials at rest decreased depending on task duration and TMS intensity. Moreover, 5-min exercise induced fully compensatory increases in premovement facilitation, while 10-min exercise produced partially compensatory increases with loss of temporal modulation. Our findings suggest that protracted exercise induces significant decrements in corticospinal excitability with initial impairment of the phasic motor neurons that are recruited at higher stimulus intensities. Changes in premovement facilitation likely represent compensation of premotor areas for decreased efficiency of the primary motor cortex induced by exercise.

Understanding inhibitory mechanisms of lumbar spinal manipulation using H-reflex and F-wave responses: a methodological approach

The purpose of this research was to characterize unique neurophysiologic events following a high velocity, low amplitude (HVLA) spinal manipulation (SM) procedure. Descriptive time series analysis techniques of time plots, outlier detection and autocorrelation functions were applied to time series of tibial nerve H-reflexes that were evoked at 10-s intervals from 100 s before the event until 100 s after three distinct events L5-S1 HVLA SM, or a L5-S1 joint pre-loading procedure, or the control condition. Sixty-six subjects were randomly assigned to three procedures, i.e., 22 time series per group. If the detection of outliers and correlograms revealed a pattern of non-randomness that was only time-locked to a single, specific event in the normalized time series, then an experimental effect would be inferred beyond the inherent variability of H-reflex responses. Tibial nerve F-wave responses were included to determine if any new information about central nervous function following a HVLA SM procedure could be ascertained. Time series analyses of H(max)/M(max) ratios, pre-post L5-S1 HVLA SM, substantiated the hypothesis that the specific aspects of the manipulative thrust lead to a greater attenuation of the H(max)/M(max) ratio as compared to the non-specific aspects related to the postural perturbation and joint pre-loading. The attenuation of the H(max)/M(max) ratio following the HVLA SM procedure was reliable and may hold promise as a translational tool to measure the consistency and accuracy of protocol implementation involving SM in clinical trials research. F-wave responses were not sensitive to mechanical perturbations of the lumbar spine.

Recovery time of motor evoked potentials following lengthening and shortening muscle action in the tibialis anterior

Motor evoked potentials (MEP) at rest remain facilitated following an isometric muscle contraction. Because the pre-synaptic and post-synaptic control of shortening (SHO) and lengthening (LEN) contractions differs, the possibility exists that the recovery of the MEP is also task specific. The time course of MEP recovery was assessed in the tibialis anterior following SHO and LEN (0.26 rad/s) at 25% and 80% of maximal voluntary contraction. Following LEN and SHO contractions, the MEP recovered to baseline levels within 10s. Despite task-specific differences between SHO and LEN contractions, the MEP facilitation from the augmented neurotransmitter release appears to be short lasting and not influenced by contraction type.

Volume, intensity, and timing of muscle power potentiation are variable

Whereas muscle potentiation is consistently demonstrated with evoked contractile properties, the potentiation of functional and physiological measures is inconsistent. The objective was to compare a variety of conditioning stimuli volumes and intensities over a 15-min recovery period. Twelve volleyball players were subjected to conditioning stimuli that included 10 repetitions of half squats with 70% of 1-repetition maximum (RM) (10 × 70), 5 × 70, 5 × 85, 3 × 85, 3 × 90, 1 × 90, and control. Jump height, power, velocity, and force were measured at baseline, 1, 3, 5, 10, and 15 min. Data were analysed with a 2-way repeated measure ANOVA and magnitude-based inferences. The ANOVA indicated significant decreases in jump height, power, and velocity during recovery. This should not be interpreted that no potentiation occurred. Each dependent variable reached a peak at a slightly different time: peak jump height (2.8 ± 2.3 min), mean power (3.6 ± 3.01 min), peak power (2.5 ± 1.8 min), and peak velocity (2.5 ± 1.8 min). Magnitude-based inference revealed that both the 5 × 70 and 3 × 85 protocol elicited changes that exceeded 75% likelihood of exceeding the smallest worthwhile change (SWC) for peak power and velocity. The 10 × 70 and the 5 × 70 had a substantial likelihood of potentiating peak velocity and mean power above the SWC, respectively. Magnitude-based inferences revealed that while no protocol had a substantial likelihood of potentiating the peak vertical jump, the 5 × 70 had the most consistent substantial likelihood of increasing the peak of most dependent variables. We were unable to consistently predict if these peaks occurred at 1, 3, or 5 min poststimulation, though declines after 5 min seems probable.

Neuromuscular fatigue in healthy muscle: underlying factors and adaptation mechanisms

OBJECTIVES

This review aims to define the concept of neuromuscular fatigue and to present the current knowledge of the central and peripheral factors at the origin of this phenomenon. This review also addresses the literature that focuses on the mechanisms responsible for the adaption to neuromuscular fatigue.

METHOD

One hundred and eighty-two articles indexed in PubMed (1954-2010) have been considered.

RESULTS

Neuromuscular fatigue has central and peripheral origins. Central fatigue, preponderant during long-duration, low-intensity exercises, may involve a drop in the central command (motor, cortex, motoneurons) elicited by the activity of cerebral neurotransmitters and muscular afferent fibers. Peripheral fatigue, associated with an impairment of the mechanisms from excitation to muscle contraction, may be induced by a perturbation of the calcium ion movements, an accumulation of phosphate, and/or a decrease of the adenosine triphosphate stores. To compensate for the consequent drop in force production, the organism develops several adaptation mechanisms notably implicating motor units.

CONCLUSION

Fatigue onset is associated with an alteration of the mechanisms involved in force production. Then, the interaction between central and peripheral mechanisms leads to a series of events that ultimately contribute to the observed decrease in force production.

Intracortical excitability after repetitive hand movements is differentially affected in cortical versus subcortical strokes

Repetitive training of isolated movements induces reorganization of motor cortical representations. To elucidate the mechanisms of practice-dependent cortical plasticity within the lesioned central motor system at the time of the application of a therapeutic intervention, we examined the effect of repetitive movements on intracortical facilitation (ICF) and inhibition of agonist (extensor carpi radialis [ECR]) and antagonist (flexor carpi ulnaris) muscles of the hand shortly after the movements, by the paired-pulse technique in patients with cortical (n = 9) and subcortical strokes (n = 11). Short intracortical inhibition and ICF were studied by using interstimulus intervals of 2 and 8 milliseconds, respectively, and their interaction with active or passive movement. The active movement produced significantly larger motor-evoked potentials in the ECR muscle in both patient groups. Short intracortical inhibition was particularly decreased after cortical stroke, whereas it was still significant after subcortical stroke. ICF increased significantly after movements compared with rest in the ECR for subcortical stroke patients only. We conclude that repetitive active movements increase the excitability of the motor cortex representing the agonist muscle and interact with intracortical facilitatory circuits in the subcortical stroke group but not in the cortical stroke group. This interaction of circuitry has been reported previously in control subjects and seems to still operate after subcortical stroke during active movement. Alternative networks may be recruited for active movement after cortical stroke. This finding proposes lesion-specific mechanisms of reorganization during the same rehabilitative intervention. Distinct rehabilitative strategies may be required to optimize the activation of the physiologic motor network for different lesions.

Motor-evoked potentials recorded from lumbar erector spinae muscles: a study of corticospinal excitability changes associated with spinal manipulation

OBJECTIVE

The purpose of this study was to determine if high-velocity, low-amplitude spinal manipulation (SM) altered the effects of corticospinal excitability on motoneuron activity innervating the paraspinal muscles. In a previous study using transcranial magnetic stimulation (TMS), augmentation of motor-evoked potentials (MEPs) from the gastrocnemius muscle after lumbar SM was reported. To date, there is no known report of the effect of SM on paraspinal muscle excitability.

METHODS

The experimental design was a prospective physiologic evaluation of the effects of SM on corticospinal excitability in asymptomatic subjects. The TMS-induced MEPs were recorded from relaxed lumbar erector spinae muscles of 72 asymptomatic subjects. The MEP amplitudes were evaluated pre-SM and post-SM or conditions involving prethrust positioning and joint loading or control.

RESULTS

There was a transient increase in MEP amplitudes from the paraspinal muscles as a consequence of lumbar SM (F([6,414]) = 8.49; P < .05) without concomitant changes after prethrust positioning and joint loading or in control subjects (P > .05). These data findings were substantiated by a significant condition x time interaction term (F([12,414]) = 2.28; P < .05).

CONCLUSIONS

These data suggest that there is a postsynaptic facilitation of alpha motoneurons and/or corticomotoneurons innervating paraspinal muscles as a consequence of SM. It appears that SM may offer unique sensory input to the excitability of the motor system as compared to prethrust positioning and joint loading and control conditions.

Exercise-induced depression of the diaphragm motor evoked potential is not affected by non-invasive ventilation

Whole body exercise is followed by a depression of the diaphragm motor evoked potential (MEP). It is unknown whether the change is due to diaphragm activity or whole body exercise. To test the hypothesis that exercise-induced MEP depression was related to diaphragm activity, we performed two experiments. The first examined the effect of whole body exercise, performed with and without the use of non-invasive ventilation (NIV). NIV resulted in significant unloading of the diaphragm (pressure time product 101+/-68 cm H(2)O/s/min versus 278+/-95 cm H(2)O/s/min, p<0.001). Both conditions produced significant MEP depression compared to the control condition (% drop at 5 min, after exercise and exercise with NIV: 29 and 34%, p=0.77). Study 2 compared exercise with isocapnic hyperventilation. At 20 min the MEP had fallen by 29% in the exercise session versus 5% with hyperventilation (p=0.098). We conclude that the work of breathing during whole body exercise is not the primary driver of exercise-induced diaphragm MEP depression.

Putative protective effect of inspiratory threshold loading against exercise-induced supraspinal diaphragm fatigue

The present investigation was intended to assess the consequences of an inspiratory load on the diaphragm central component of fatigue during exercise. We recorded the motor potential evoked (MEP) by transcranial magnetic stimulation of the motor cortex in 10 subjects. The diaphragm and rectus femoris were studied before and 10, 20, and 40 min after two 16-min cycling exercise (E) trials requiring 55% of maximal oxygen uptake: 1) one with an inspiratory threshold load (E + ITL), corresponding to 10% of maximal inspiratory pressure; and 2) the other without the load (E). Dyspnea, heart rate, electromyographic activity of the sternocleidomastoid, and diaphragm work were significantly higher in E + ITL than in E. Neither trial affected the response to phrenic magnetic stimulation, which was performed 15 and 25 min postexercise, or the maximal inspiratory pressure (116 and 120 cm H(2)O before E and E + ITL, respectively, and 110 and 114 cm H(2)O at 30 min postexercise). Whereas the amplitude of the diaphragm MEP was unaffected by E + ITL (+2.1 +/- 29.4%), a significant decrease was observed 10 min after E compared with baseline (-37.1 +/- 22.3%) and compared with E + ITL. The MEP amplitude of rectus femoris remained unchanged with E and E + ITL. The recruitment of synergistic agonists during E + ITL may have normalized the major ventilatory stress and reset up the excitability of the diaphragm pathway.

Post-exercise facilitation and depression of motor evoked potentials to transcranial magnetic stimulation: a study in multiple sclerosis

OBJECTIVE

To evaluate motor cortex excitability changes by transcranial magnetic stimulation (TMS) following repetitive muscle contractions in patients with multiple sclerosis (MS); to state whether a typical pattern of post-exercise motor evoked potentials (MEPs) is related to clinical fatigue in MS.

METHODS

In 41 patients with definite MS (32 with fatigue and 9 without fatigue according to Fatigue Severity Scale) and 13 controls, MEPs were recorded at rest: at baseline condition, following repetitive contractions until fatigue, and after fatigue, to evaluate post-exercise MEP facilitation (PEF) and depression (PED).

RESULTS

After exercise, MEP amplitude significantly increased both in patients and controls (PEF). When fatigue set in, MEP amplitude was significantly reduced in normal subjects (PED), but not in patients. Post-exercise MEP findings were similar both in patients with and without fatigue.

CONCLUSIONS

Our findings suggest an intracortical motor dysfunction following a voluntary contraction in MS patients, possibly due to failure of depression of facilitatory cortical circuits, or alternatively of inhibitory mechanisms.

Central fatigue and transcranial magnetic stimulation: effect of caffeine and the confound of peripheral transmission failure

In this experiment, we attempt to replicate the fatigue-induced decline in voluntary surface electromyography (EMG) and motor evoked potentials (MEPs) observed in previous studies and determine: (1) if this decline can be attributed to central failure, and (2) whether this failure is offset by caffeine. Seven subjects each attended two sessions (caffeine and placebo). Central excitability was estimated using transcranial magnetic stimulation (TMS), and surface EMG and twitch interpolation were used to estimate voluntary activation before, during and after fatigue of the first dorsal interosseous (FDI). Mass action potentials (M waves) were evoked to assess peripheral transmission throughout the experiment. We observed an increase in post-activation potentiation of the motor evoked potential in the caffeine trial and a fatigue-induced decline in the MEP and maximal EMG in both the placebo and caffeine trials. However, there was also a fatigue-induced decline in peripheral transmission, and estimates of central failure were considerably reduced when normalized to the M wave. A review of central fatigue literature revealed many studies that attribute the decline in voluntary EMG or MEPs wholly to central failure and fail to consider peripheral transmission. Thus, we conclude by stressing the importance of reporting peripheral transmission when surface recordings are used to estimate central mechanisms.

Effect of Acute Static Stretching on Force, Balance, Reaction Time, and Movement Time

PURPOSE

The purpose of the study was to investigate the effect of an acute bout of lower limb static stretching on balance, proprioception, reaction, and movement time.

METHODS

Sixteen subjects were tested before and after both a static stretching of the quadriceps, hamstrings, and plantar flexors or a similar duration control condition. The stretching protocol involved a 5-min cycle warm-up followed by three stretches to the point of discomfort of 45 s each with 15-s rest periods for each muscle group. Measurements included maximal voluntary isometric contraction (MVC) force of the leg extensors, static balance using a computerized wobble board, reaction and movement time of the dominant lower limb, and the ability to match 30% and 50% MVC forces with and without visual feedback.

RESULTS

There were no significant differences in the decrease in MVC between the stretch and control conditions or in the ability to match submaximal forces. However, there was a significant (P < 0.009) decrease in balance scores with the stretch (decreasing 9.2%) compared with the control (increasing 17.3%) condition. Similarly, decreases in reaction (5.8%) and movement (5.7%) time with the control condition differed significantly (P < 0.01) from the stretch-induced increases of 4.0% and 1.9%, respectively.

CONCLUSION

In conclusion, it appears that an acute bout of stretching impaired the warm-up effect achieved under control conditions with balance and reaction/movement time.

Force Maintenance With Submaximal Fatiguing Contractions

Whereas many definitions of fatigue include externally measurable decrements in force or performance, fatigue can be present with no change in the external output of the muscle. The maintenance of submaximal forces can be considered a compromise between neuromuscular force enhancement and competing inhibitory influences. An example of a muscle facilitatory process includes postactivation potentiation that results in an increased sensitivity to Ca++. The neuromuscular system copes with metabolic disruption and subsequent loss of force by recruiting additional motor units and increasing the firing frequency. If the contraction persists, firing frequency may decrease so as to optimize the stimulus rate with the prolonged duration of the muscle fibre action potential (muscle wisdom). The insertion of additional neural impulses into the train of stimuli can result in force potentiation (catch-like properties). Furthermore, there is evidence of neural potentiation and a dissociation of muscle activity with submaximal fatigue. Conversely, inhibition may be derived supraspinally or at the spinal level. While there may be some evidence of intrinsic motoneuronal fatigue, inhibitory afferent influences from chemical, tensile, pressure, and other factors play an important role in the competing influences on force output. Key words: postactivation potentiation, recruitment, rate coding, inhibition, catch-like properties

Effects of exhaustive incremental treadmill exercise on diaphragm and quadriceps motor potentials evoked by transcranial magnetic stimulation

It is unknown whether changes in corticomotor excitability follow exercise in healthy humans. We hypothesized that a fall in the diaphragm and quadriceps motor-evoked potential (MEP) amplitude elicited by transcranial magnetic stimulation of the motor cortex would occur after an incremental exercise task. In 11 healthy subjects, we measured transdiaphragmatic pressure and isometric quadriceps tension in response to supramaximal peripheral magnetic nerve stimulation. MEPs were recorded from these muscles in response to transcranial magnetic stimulation. After baseline measurements, subjects performed a period of submaximal exercise (gentle walking). Measurements were repeated 5 and 20 min after this. The subjects then exercised on a treadmill with an incremental protocol to exhaustion. Transcranial magnetic stimulation was performed at baseline and at 5, 20, 40, and 60 min after exhaustive exercise, and force measurements were obtained at baseline, 20 min, and 60 min. Mean exercise duration was 18 +/- 4 min, and mean maximum heart rate was 172 +/- 10 beats/min. Twitch transdiaphragmatic pressure and twitch isometric quadriceps tension were not different from baseline after exercise, but a significant decrease was observed in diaphragm MEP amplitude 5 and 20 min after exercise (60 +/- 38 and 45 +/- 24%, respectively, of baseline, P = 0.0001). At the same times, the mean quadriceps MEPs were 59 +/- 39 and 74 +/- 32% of baseline (P < 0.0001 and P < 0.01, respectively). Studies using paired stimuli confirmed a likely intracortical mechanism for this depression. Our data confirm significant depression of both diaphragm and quadriceps MEPs after incremental treadmill exercise.