1
|
Baroni A, Antonioni A, Fregna G, Lamberti N, Manfredini F, Koch G, D’Ausilio A, Straudi S. The Effectiveness of Paired Associative Stimulation on Motor Recovery after Stroke: A Scoping Review. Neurol Int 2024; 16:567-589. [PMID: 38804482 PMCID: PMC11130975 DOI: 10.3390/neurolint16030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Paired associative stimulation (PAS) is a non-invasive brain stimulation technique combining transcranial magnetic stimulation and peripheral nerve stimulation. PAS allows connections between cortical areas and peripheral nerves (C/P PAS) or between cortical regions (C/C PAS) to be strengthened or weakened by spike-timing-dependent neural plasticity mechanisms. Since PAS modulates both neurophysiological features and motor performance, there is growing interest in its application in neurorehabilitation. We aimed to synthesize evidence on the motor rehabilitation role of PAS in stroke patients. We performed a literature search following the PRISMA Extension for Scoping Reviews Framework. Eight studies were included: one investigated C/C PAS between the cerebellum and the affected primary motor area (M1), seven applied C/P PAS over the lesional, contralesional, or both M1. Seven studies evaluated the outcome on upper limb and one on lower limb motor recovery. Although several studies omit crucial methodological details, PAS highlighted effects mainly on corticospinal excitability, and, more rarely, an improvement in motor performance. However, most studies failed to prove a correlation between neurophysiological changes and motor improvement. Although current studies seem to suggest a role of PAS in post-stroke rehabilitation, their heterogeneity and limited number do not yet allow definitive conclusions to be drawn.
Collapse
Affiliation(s)
- Andrea Baroni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Annibale Antonioni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Giulia Fregna
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), 44121 Ferrara, Italy
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
| | - Alessandro D’Ausilio
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), 44121 Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
| |
Collapse
|
2
|
Piasecki J, Škarabot J, Spillane P, Piasecki M, Ansdell P. Sex Differences in Neuromuscular Aging: The Role of Sex Hormones. Exerc Sport Sci Rev 2024; 52:54-62. [PMID: 38329342 DOI: 10.1249/jes.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Males and females experience different trajectories of neuromuscular function across the lifespan, with females demonstrating accelerated deconditioning in later life. We hypothesize that the menopause is a critical period in the female lifespan, during which the dramatic reduction in sex hormone concentrations negatively impacts synaptic input to the motoneuron pool, as well as motor unit discharge properties.
Collapse
Affiliation(s)
- Jessica Piasecki
- Sport, Health and Performance Enhancement Research Centre, Nottingham Trent University, Nottingham, UK
| | - Jakob Škarabot
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Padraig Spillane
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Mathew Piasecki
- Centre of Metabolism, Ageing and Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Paul Ansdell
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| |
Collapse
|
3
|
Suzuki M, Saito K, Maeda Y, Cho K, Iso N, Okabe T, Suzuki T, Yamamoto J. Effects of Paired Associative Stimulation on Cortical Plasticity in Agonist–Antagonist Muscle Representations. Brain Sci 2023; 13:brainsci13030475. [PMID: 36979285 PMCID: PMC10046224 DOI: 10.3390/brainsci13030475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Paired associative stimulation (PAS) increases and decreases cortical excitability in primary motor cortex (M1) neurons, depending on the spike timing-dependent plasticity, i.e., long-term potentiation (LTP)- and long-term depression (LTD)-like plasticity, respectively. However, how PAS affects the cortical circuits for the agonist and antagonist muscles of M1 is unclear. Here, we investigated the changes in the LTP- and LTD-like plasticity for agonist and antagonist muscles during PAS: 200 pairs of 0.25-Hz peripheral electric stimulation of the right median nerve at the wrist, followed by a transcranial magnetic stimulation of the left M1 with an interstimulus interval of 25 ms (PAS-25 ms) and 10 ms (PAS-10 ms). The unconditioned motor evoked potential amplitudes of the agonist muscles were larger after PAS-25 ms than after PAS-10 ms, while those of the antagonist muscles were smaller after PAS-25 ms than after PAS-10 ms. The γ-aminobutyric acid A (GABAA)- and GABAB-mediated cortical inhibition for the agonist and antagonist muscles were higher after PAS-25 ms than after PAS-10 ms. The cortical excitability for the agonist and antagonist muscles reciprocally and topographically increased and decreased after PAS, respectively; however, GABAA and GABAB-mediated cortical inhibitory functions for the agonist and antagonist muscles were less topographically decreased after PAS-10 ms. Thus, PAS-25 ms and PAS-10 ms differentially affect the LTP- and LTD-like plasticity in agonist and antagonist muscles.
Collapse
Affiliation(s)
- Makoto Suzuki
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
- Faculty of Systems Design, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji City 192-0397, Tokyo, Japan
- Correspondence: ; Tel.: +81-42-955-6074
| | - Kazuo Saito
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Yusuke Maeda
- School of Health Sciences at Odawara, International University of Health and Welfare, 1-2-25 Shiroyama, Odawara City 250-8588, Kanagawa, Japan
| | - Kilchoon Cho
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Naoki Iso
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Takuhiro Okabe
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Takako Suzuki
- School of Health Sciences, Saitama Prefectural University, 820 Sannomiya, Koshigaya City 343-8540, Saitama, Japan
| | - Junichi Yamamoto
- Faculty of Systems Design, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji City 192-0397, Tokyo, Japan
| |
Collapse
|
4
|
Hermann JK, Borseth A, Pucci FG, Toth C, Hogue O, Chan HH, Machado AG, Baker KB. Changes in somatosensory evoked potentials elicited by lateral cerebellar nucleus deep brain stimulation in the naïve rodent. Neurosci Lett 2022; 786:136800. [PMID: 35842210 DOI: 10.1016/j.neulet.2022.136800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation (DBS) of the deep cerebellar nuclei has been shown to enhance perilesional cortical excitability and promote motor rehabilitation in preclinical models of cortical ischemia and is currently being evaluated in patients with chronic, post-stroke deficits. Understanding the effects of cerebellar DBS on contralateral sensorimotor cortex may be key to developing approaches to optimize stimulation delivery and treatment outcomes. Using the naïve rat model, we characterized the effects of DBS of the lateral cerebellar nucleus (LCN) on somatosensory evoked potentials (SSEPs) and evaluated their potential use as a surrogate index of cortical excitability. SSEPs were recorded concurrently with continuous 30 Hz or 100 Hz LCN DBS and compared to the DBS OFF condition. Ratios of SSEP peak to peak amplitude during 100 Hz LCN DBS to DBS OFF at longer latency peaks were significantly>1, suggesting that cortical excitability was enhanced as a result of LCN DBS. Although changes in SSEP peak to peak amplitudes were observed, they were modest in relation to previously reported effects on motor cortical excitability. Overall, our findings suggest that LCN output influences thalamocortical somatosensory pathways, however further work is need to better understand the potential role of SSEPs in optimizing therapy.
Collapse
Affiliation(s)
- John K Hermann
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Ashley Borseth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Francesco G Pucci
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Carmen Toth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Hugh H Chan
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Andre G Machado
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States.
| |
Collapse
|
5
|
Xu R, Zhu GY, Zhu J, Wang Y, Xing XX, Chen LY, Li J, Shen FQ, Chen JB, Hua XY, Xu DS. Using Hebbian-Type Stimulation to Rescue Arm Function After Stroke: Study Protocol for a Randomized Clinical Trial. Front Neural Circuits 2022; 15:789095. [PMID: 35221930 PMCID: PMC8867068 DOI: 10.3389/fncir.2021.789095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Upper-extremity hemiplegia after stroke remains a significant clinical problem. The supplementary motor area (SMA) is vital to the motor recovery outcomes of chronic stroke patients. Therefore, rebuilding the descending motor tract from the SMA to the paralyzed limb is a potential approach to restoring arm motor function after stroke. Paired associative stimulation (PAS), which is based on Hebbian theory, is a potential method for reconstructing the connections in the impaired motor neural circuits. The study described in this protocol aims to assess the effects of cortico–peripheral Hebbian-type stimulation (HTS), involving PAS, for neural circuit reconstruction to rescue the paralyzed arm after stroke. Methods The study is a 4-month double-blind randomized sham-controlled clinical trial. We will recruit 90 post-stroke individuals with mild to moderate upper limb paralysis. Based on a 1:1 ratio, the participants will be randomly assigned to the HTS and sham groups. Each participant will undergo 5-week HTS or sham stimulation. Assessments will be conducted at baseline, immediately after the 5-week treatment, and at a 3-month follow-up. The primary outcome will be the Wolf Motor Function Test (WMFT). The secondary outcomes will be Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Functional Independence Measure (FIM), and functional near-infrared spectroscopy (fNIRS) parameters. The adverse events will be recorded throughout the study. Discussion Upper-limb paralysis in stroke patients is due to neural circuit disruption, so the reconstruction of effective motor circuits is a promising treatment approach. Based on its anatomical structure and function, the SMA is thought to compensate for motor dysfunction after focal brain injury at the cortical level. Our well-designed randomized controlled trial will allow us to analyze the clinical efficacy of this novel Hebbian theory-based neuromodulation strategy regarding promoting the connection between the cortex and peripheral limb. The results may have significance for the development and implementation of effective neurorehabilitation treatments. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [ChiCTR2000039949].
Collapse
Affiliation(s)
- Rong Xu
- Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital, Shanghai, China
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Guang-Yue Zhu
- Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Jun Zhu
- Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Yong Wang
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Xiang-Xin Xing
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin-Yu Chen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Jie Li
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Fu-Qiang Shen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Jian-Bing Chen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Xu-Yun Hua
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xu-Yun Hua,
| | - Dong-Sheng Xu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xu-Yun Hua,
| |
Collapse
|
6
|
Sui YF, Tong LQ, Zhang XY, Song ZH, Guo TC. Effects of paired associated stimulation with different stimulation position on motor cortex excitability and upper limb motor function in patients with cerebral infarction. J Clin Neurosci 2021; 90:363-369. [PMID: 34275577 DOI: 10.1016/j.jocn.2021.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the effects of paired associated stimulation (PAS) with different stimulation position on motor cortex excitability and upper limb motor function in patients with cerebral infarction. METHOD A total of 120 volunteers with cerebral infarction were randomly divided into four groups. Based on conventional rehabilitation treatment, the PAS stimulation group was given the corresponding position of PAS treatment once a day for 28 consecutive days. The MEP amplitude and RMT of both hemispheres were assessed before and after treatment, and a simple upper limb Function Examination Scale (STEF) score, simplified upper limb Fugl-Meyer score (FMA), and improved Barthel Index (MBI) were used to assess upper limb motor function in the four groups. RESULTS Following PAS, the MEP amplitude decreased, and the RMT of abductor pollicis brevis (APB) increased on the contralesional side, while the MEP amplitude increased and the RMT of APB decreased on the ipsilesional side. After 28 consecutive days the scores of STEF, FMA, and MBI in the bilateral stimulation group were significantly better than those in the ipsilesional stimulation group and the contralesional stimulation group, but there was no significant difference in the scores of STEF, FMA, and MBI between the ipsilesional stimulation group and the contralesional stimulation group. CONCLUSION The excitability of the motor cortex can be changed when the contralesional side or the ipsilesional side was given the corresponding PAS stimulation, while the bilateral PAS stimulation can more easily cause a change of excitability of the motor cortex, resulting in better recovery of the upper limb function.
Collapse
Affiliation(s)
- Yan-Fang Sui
- Department of Rehabilitation Medicine, The Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou 570208, China
| | - Liang-Qian Tong
- Department of Rehabilitation Medicine, The Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou 570208, China
| | - Xiang-Yu Zhang
- Department of Rehabilitation Medicine, The 5th Hospital of Zhengzhou University, Zhengzhou 470000, China
| | - Zhen-Hua Song
- Department of Rehabilitation Medicine, The Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou 570208, China.
| | - Tie-Cheng Guo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| |
Collapse
|
7
|
Guidali G, Roncoroni C, Bolognini N. Paired associative stimulations: Novel tools for interacting with sensory and motor cortical plasticity. Behav Brain Res 2021; 414:113484. [PMID: 34302877 DOI: 10.1016/j.bbr.2021.113484] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 12/26/2022]
Abstract
In the early 2000s, a novel non-invasive brain stimulation protocol, the paired associative stimulation (PAS), was introduced, allowing to induce and investigate Hebbian associative plasticity within the humans' motor system, with patterns resembling spike-timing-dependent plasticity properties found in cellular models. Since this evidence, PAS efficacy has been proved in healthy, and to a lesser extent, in clinical populations. Recently, novel 'modified' protocols targeting sensorimotor and crossmodal networks appeared in the literature. In the present work, we have reviewed recent advances using these 'modified' PAS protocols targeting sensory and motor cortical networks. To better categorize them, we propose a novel classification according to the nature of the peripheral and cortical stimulations (i.e., within-system, cross-systems, and cortico-cortical PAS). For each protocol of the categories mentioned above, we describe and discuss their main features, how they have been used to study and promote brain plasticity, and their advantages and disadvantages. Overall, current evidence suggests that these novel non-invasive brain stimulation protocols represent very promising tools to study the plastic properties of humans' sensorimotor and crossmodal networks, both in the healthy and in the damaged central nervous system.
Collapse
Affiliation(s)
- Giacomo Guidali
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy.
| | - Camilla Roncoroni
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy; Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| |
Collapse
|
8
|
Ting WKC, Fadul FAR, Fecteau S, Ethier C. Neurostimulation for Stroke Rehabilitation. Front Neurosci 2021; 15:649459. [PMID: 34054410 PMCID: PMC8160247 DOI: 10.3389/fnins.2021.649459] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Neurological injuries such as strokes can lead to important loss in motor function. Thanks to neuronal plasticity, some of the lost functionality may be recovered over time. However, the recovery process is often slow and incomplete, despite the most effective conventional rehabilitation therapies. As we improve our understanding of the rules governing activity-dependent plasticity, neuromodulation interventions are being developed to harness neural plasticity to achieve faster and more complete recovery. Here, we review the principles underlying stimulation-driven plasticity as well as the most commonly used stimulation techniques and approaches. We argue that increased spatiotemporal precision is an important factor to improve the efficacy of neurostimulation and drive a more useful neuronal reorganization. Consequently, closed-loop systems and optogenetic stimulation hold theoretical promise as interventions to promote brain repair after stroke.
Collapse
Affiliation(s)
- Windsor Kwan-Chun Ting
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Faïza Abdou-Rahaman Fadul
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Shirley Fecteau
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Christian Ethier
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| |
Collapse
|
9
|
Paired Associative Stimulation Fails to Induce Plasticity in Freely Behaving Intact Rats. eNeuro 2020; 7:ENEURO.0396-19.2020. [PMID: 32139377 PMCID: PMC7113557 DOI: 10.1523/eneuro.0396-19.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 12/21/2022] Open
Abstract
Paired associative stimulation (PAS) has been explored in humans as a noninvasive tool to drive plasticity and promote recovery after neurologic insult. A more thorough understanding of PAS-induced plasticity is needed to fully harness it as a clinical tool. Here, we tested the efficacy of PAS with multiple interstimulus intervals in an awake rat model to study the principles of associative plasticity. Using chronically implanted electrodes in motor cortex and forelimb, we explored PAS parameters to effectively drive plasticity. We assessed changes in corticomotor excitability using a closed-loop, EMG-controlled cortical stimulation paradigm. We tested 11 PAS intervals, chosen to force the coincidence of neuronal activity in the motor cortex and spinal cord of rats with timings relevant to the principles of Hebbian spike timing-dependent plasticity. However, despite a relatively large number of stimulus pairings (300), none of the tested intervals reliably changed corticospinal excitability relative to control conditions. Our results question PAS effectiveness under these conditions.
Collapse
|
10
|
Hebbian associative plasticity in the visuo-tactile domain: A cross-modal paired associative stimulation protocol. Neuroimage 2019; 201:116025. [DOI: 10.1016/j.neuroimage.2019.116025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/05/2019] [Accepted: 07/15/2019] [Indexed: 12/27/2022] Open
|
11
|
Foysal KMR, Baker SN. A hierarchy of corticospinal plasticity in human hand and forearm muscles. J Physiol 2019; 597:2729-2739. [PMID: 30839110 PMCID: PMC6567854 DOI: 10.1113/jp277462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/27/2019] [Indexed: 02/05/2023] Open
Abstract
Key points Pairing stimulation of a finger flexor or extensor muscle at the motor point with transcranial magnetic stimulation (TMS) of the motor cortex generated plastic changes in motor output. Increases in output were greater in intrinsic hand muscles than in the finger flexor. No changes occurred in the finger extensor. This gradient was seen irrespective of which muscle was stimulated paired with transcranial magnetic stimulation. Intermittent theta‐burst stimulation also produced increases in output, although these were similar across muscles. We suggest that intrinsic hand and flexor muscles have a higher potential to show plasticity than extensors, although only when plasticity is induced by sensory input. This may relate to differences seen in recovery of function in these muscles after injury, such as post‐stroke.
Abstract The ability of the motor system to show plastic change underlies skill learning and also permits recovery after injury. One puzzling observation is that, after stroke, upper limb flexor muscles show good recovery but extensors remain weak, with this being a major contributor to residual disability. We hypothesized that there might be differences in potential for plasticity across hand and forearm muscles. In the present study, we investigated this using two protocols based on transcranial magnetic brain stimulation (TMS) in healthy human subjects. Baseline TMS responses were recorded from two intrinsic hand muscles: flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC). In the first study, paired associative stimulation (PAS) was delivered by pairing motor point stimulation of FDS or EDC with TMS. Responses were then remeasured. Increases were greatest in the hand muscles, smaller in FDS and non‐significant in EDC, irrespective of whether stimulation of FDS or EDC was used. In the second study, intermittent theta‐burst rapid rate TMS was applied instead of PAS. In this case, all muscles showed similar increases in TMS responses. We conclude that the potential to show plastic changes in motor cortical output has the gradient: hand muscles > flexors > extensors. However, this was only seen in a protocol that requires integration of sensory input (PAS) and not when plasticity was induced purely by cortical stimulation (rapid rate TMS). This observation may relate to why functional recovery tends to favour flexor and hand muscles over extensors. Pairing stimulation of a finger flexor or extensor muscle at the motor point with transcranial magnetic stimulation (TMS) of the motor cortex generated plastic changes in motor output. Increases in output were greater in intrinsic hand muscles than in the finger flexor. No changes occurred in the finger extensor. This gradient was seen irrespective of which muscle was stimulated paired with transcranial magnetic stimulation. Intermittent theta‐burst stimulation also produced increases in output, although these were similar across muscles. We suggest that intrinsic hand and flexor muscles have a higher potential to show plasticity than extensors, although only when plasticity is induced by sensory input. This may relate to differences seen in recovery of function in these muscles after injury, such as post‐stroke.
Collapse
Affiliation(s)
- K M Riashad Foysal
- Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart N Baker
- Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
12
|
Carson RG, Rankin ML. Shaping the Effects of Associative Brain Stimulation by Contractions of the Opposite Limb. Front Psychol 2018; 9:2249. [PMID: 30510533 PMCID: PMC6252341 DOI: 10.3389/fpsyg.2018.02249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/29/2018] [Indexed: 12/22/2022] Open
Abstract
There has been an explosion of interest in methods that may promote neural plasticity by indirectly stimulating tissue in damaged brains using transient magnetic fields or weak electrical currents. A major limitation of these approaches is that the induced variations in brain activity tend to be diffuse. Thus far it has proved extremely difficult to target pathways from the brain to specific muscles. This is a particular challenge for applications in rehabilitation. Stroke survivors often exhibit abnormal patterns of muscle activation, including diminished specificity and high levels of co-contraction. For the clinical relevance of brain stimulation to be enhanced, it is desirable that the effects can be restricted to pathways controlling muscles that are the specific targets of movement therapy. We have demonstrated previously that increases in the excitability of corticospinal projections to forearm muscles generated by paired associative stimulation (PAS), are modulated by contractions ipsilateral to the site of the cortical stimulus. The current aim was to determine whether in chronic stroke survivors, simultaneous contractions performed by the non-paretic limb increase the muscle specificity of changes in the excitability of projections to the impaired limb induced by PAS. Ten chronic stroke survivors, 13 age-equivalent and 27 younger healthy controls, completed two separate sessions/conditions. In one (PAS+CONT), isometric wrist flexion contractions of the non-impaired limb were made simultaneously with PAS. In the other (PAS), associative stimulation only was applied. In all groups, PAS alone gave rise to large increases in the excitability of projections to a wrist extensor muscle (extensor carpi radialis – ECR) that was not the target of stimulation. In marked contrast, for the stroke survivors, following combined PAS and flexion contractions of the non-impaired limb, there was no corresponding elevation in the excitability of corticospinal projections to the ECR of the paretic limb. A similar effect was present for the healthy young adults, but not expressed clearly for the age-equivalent controls. The implications of these findings with respect to the clinical deployment of non-invasive brain stimulation in movement rehabilitation are discussed.
Collapse
Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland.,School of Psychology, Queen's University Belfast, Belfast, United Kingdom
| | - Michelle L Rankin
- School of Psychology, Queen's University Belfast, Belfast, United Kingdom
| |
Collapse
|
13
|
Palmer JA, Wolf SL, Borich MR. Paired associative stimulation modulates corticomotor excitability in chronic stroke: A preliminary investigation. Restor Neurol Neurosci 2018. [PMID: 29526858 PMCID: PMC5870032 DOI: 10.3233/rnn-170785] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Paired associative stimulation (PAS) combining repeated pairing of electrical stimulation of a peripheral nerve with transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) can induce neuroplastic adaptations in the human brain and enhance motor learning in neurologically-intact individuals. However, the extent to which PAS is an effective technique for inducing associative plasticity and improving motor function in individuals post-stroke is unclear. OBJECTIVE The objective of this pilot study was to investigate the effects of a single session of PAS to modulate corticomotor excitability and motor skill performance in individuals post-stroke. METHODS Seven individuals with chronic stroke completed two separate visits separated by at least one week. We assessed general corticomotor excitability, intracortical network activity and behavioral outcomes prior to and at three time points following PAS and compared these outcomes to those following a sham PAS condition (PASSHAM). RESULTS Following PAS, we found increased general corticomotor excitability but no significant difference in behavioral measures between PAS conditions. There was a relationship between PAS-induced corticomotor excitability increase and enhanced motor skill performance across post-PAS testing time points. CONCLUSION These results provide preliminary evidence for the potential of PAS to increase corticomotor excitability that could favorably impact motor skill performance in chronic individuals post-stroke and are an important first step for future studies investigating the clinical application and behavioral relevance of PAS interventions in post stroke patient populations.
Collapse
Affiliation(s)
- Jacqueline A Palmer
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA.,Atlanta VA Visual and Neurocognitive Center of Excellence, Decatur, GA, USA
| | - Michael R Borich
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| |
Collapse
|
14
|
Ferris JK, Neva JL, Francisco BA, Boyd LA. Bilateral Motor Cortex Plasticity in Individuals With Chronic Stroke, Induced by Paired Associative Stimulation. Neurorehabil Neural Repair 2018; 32:671-681. [DOI: 10.1177/1545968318785043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In the chronic phase after stroke, cortical excitability differs between the cerebral hemispheres; the magnitude of this asymmetry depends on degree of motor impairment. It is unclear whether these asymmetries also affect capacity for plasticity in corticospinal tract excitability or whether hemispheric differences in plasticity are related to chronic sensorimotor impairment. Methods: Response to paired associative stimulation (PAS) was assessed bilaterally in 22 individuals with chronic hemiparesis. Corticospinal excitability was measured as the area under the motor-evoked potential (MEP) recruitment curve (AUC) at baseline, 5 minutes, and 30 minutes post-PAS. Percentage change in contralesional AUC was calculated and correlated with paretic motor and somatosensory impairment scores. Results: PAS induced a significant increase in AUC in the contralesional hemisphere ( P = .041); in the ipsilesional hemisphere, there was no significant effect of PAS ( P = .073). Contralesional AUC showed significantly greater change in individuals without an ipsilesional MEP ( P = .029). Percentage change in contralesional AUC between baseline and 5 m post-PAS correlated significantly with FM score ( r = −0.443; P = .039) and monofilament thresholds ( r = 0.444, P = .044). Discussion: There are differential responses to PAS within each cerebral hemisphere. Contralesional plasticity was increased in individuals with more severe hemiparesis, indicated by both the absence of an ipsilesional MEP and a greater degree of motor and somatosensory impairment. These data support a body of research showing compensatory changes in the contralesional hemisphere after stroke; new therapies for individuals with chronic stroke could exploit contralesional plasticity to help restore function.
Collapse
Affiliation(s)
| | - Jason L. Neva
- University of British Columbia, Vancouver, BC, Canada
| | | | - Lara A. Boyd
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
15
|
Tarri M, Brihmat N, Gasq D, Lepage B, Loubinoux I, De Boissezon X, Marque P, Castel-Lacanal E. Five-day course of paired associative stimulation fails to improve motor function in stroke patients. Ann Phys Rehabil Med 2018; 61:78-84. [DOI: 10.1016/j.rehab.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
|
16
|
Mrachacz-Kersting N, Voigt M, Stevenson A, Aliakbaryhosseinabadi S, Jiang N, Dremstrup K, Farina D. The effect of type of afferent feedback timed with motor imagery on the induction of cortical plasticity. Brain Res 2017; 1674:91-100. [DOI: 10.1016/j.brainres.2017.08.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/29/2017] [Accepted: 08/23/2017] [Indexed: 12/29/2022]
|
17
|
Suppa A, Quartarone A, Siebner H, Chen R, Di Lazzaro V, Del Giudice P, Paulus W, Rothwell J, Ziemann U, Classen J. The associative brain at work: Evidence from paired associative stimulation studies in humans. Clin Neurophysiol 2017; 128:2140-2164. [DOI: 10.1016/j.clinph.2017.08.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 12/25/2022]
|
18
|
Olsen S, Signal N, Niazi IK, Christensen T, Jochumsen M, Taylor D. Paired Associative Stimulation Delivered by Pairing Movement-Related Cortical Potentials With Peripheral Electrical Stimulation: An Investigation of the Duration of Neuromodulatory Effects. Neuromodulation 2017; 21:362-367. [DOI: 10.1111/ner.12616] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/20/2017] [Accepted: 04/20/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Sharon Olsen
- Health and Rehabilitation Research Institute; Auckland University of Technology; Auckland New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute; Auckland University of Technology; Auckland New Zealand
| | - Imran Khan Niazi
- Health and Rehabilitation Research Institute; Auckland University of Technology; Auckland New Zealand
- New Zealand College of Chiropractic; Auckland New Zealand
| | - Thomas Christensen
- Health and Rehabilitation Research Institute; Auckland University of Technology; Auckland New Zealand
| | - Mads Jochumsen
- Centre for Sensory-Motor Interaction, Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - Denise Taylor
- Health and Rehabilitation Research Institute; Auckland University of Technology; Auckland New Zealand
| |
Collapse
|
19
|
Mrachacz-Kersting N, Stevenson AJT. Paired Associative Stimulation Targeting the Tibialis Anterior Muscle using either Mono or Biphasic Transcranial Magnetic Stimulation. Front Hum Neurosci 2017; 11:197. [PMID: 28473764 PMCID: PMC5397406 DOI: 10.3389/fnhum.2017.00197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/04/2017] [Indexed: 12/02/2022] Open
Abstract
Paired associative stimulation (PAS) protocols induce plastic changes within the motor cortex. The objectives of this study were to investigate PAS effects targeting the tibialis anterior (TA) muscle using a biphasic transcranial magnetic stimulation (TMS) pulse form and, to determine whether a reduced intensity of this pulse would lead to significant changes as has been reported for hand muscles using a monophasic TMS pulse. Three interventions were investigated: (1) suprathreshold PAbi-PAS (n = 11); (2) suprathreshold PAmono-PAS (n = 11) where PAS was applied using a biphasic or monophasic pulse form at 120% resting motor threshold (RMT); (3) subthreshold PAbi-PAS (n = 10) where PAS was applied as for (1) at 95% active motor threshold (AMT). The peak-to-peak motor evoked potentials (MEPs) were quantified prior to, immediately following, and 30 min after the cessation of the intervention. TA MEP size increased significantly for all interventions immediately post (61% for suprathreshold PAbi-PAS, 83% for suprathreshold PAmono-PAS, 55% for subthreshold PAbi-PAS) and 30 min after the cessation of the intervention (123% for suprathreshold PAbi-PAS, 105% for suprathreshold PAmono-PAS, 80% for subthreshold PAbi-PAS. PAS using a biphasic pulse form at subthreshold intensities induces similar effects to conventional PAS.
Collapse
Affiliation(s)
- Natalie Mrachacz-Kersting
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg UniversityAalborg, Denmark
| | - Andrew J T Stevenson
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg UniversityAalborg, Denmark
| |
Collapse
|
20
|
Castel-Lacanal E. Sites of electrical stimulation used in neurology. Ann Phys Rehabil Med 2015; 58:201-207. [PMID: 26183200 DOI: 10.1016/j.rehab.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
Rehabilitation aims to decrease neurological impairments, in guiding plasticity. Electrical stimulation has been used for many years in rehabilitation treatment of neurological disabilities as a tool for neuromodulation inducing plasticity, although the mechanisms of its action are not well known. The applications vary, encompassing therapeutic and rehabilitative aims. The type and site of stimulation vary depending on the objectives. Some techniques are widely used in clinical practice; others are still in the research stage. They may be invasive, epidural or in direct contact with neurons; they may be noninvasive, applied transcutaneously or indirectly by current vectors. The indications vary: mobility, functionality, pain as well as pharyngeal, respiratory, and perineal function. This paper aims to summarize current data on electrical neuromodulation techniques used in neurorehabilitation, their effects and their mechanisms of action.
Collapse
Affiliation(s)
- E Castel-Lacanal
- Inserm U 825, CHU Purpan, Pavillon Baudot, place du Dr-Baylac, 31024 Toulouse cedex 3, France; Service de Médecine Physique et Réadaptation, CHU Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
| |
Collapse
|
21
|
Wessel MJ, Zimerman M, Hummel FC. Non-invasive brain stimulation: an interventional tool for enhancing behavioral training after stroke. Front Hum Neurosci 2015; 9:265. [PMID: 26029083 PMCID: PMC4432668 DOI: 10.3389/fnhum.2015.00265] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/23/2015] [Indexed: 01/20/2023] Open
Abstract
Stroke is the leading cause of disability among adults. Motor deficit is the most common impairment after stroke. Especially, deficits in fine motor skills impair numerous activities of daily life. Re-acquisition of motor skills resulting in improved or more accurate motor performance is paramount to regain function, and is the basis of behavioral motor therapy after stroke. Within the past years, there has been a rapid technological and methodological development in neuroimaging leading to a significant progress in the understanding of the neural substrates that underlie motor skill acquisition and functional recovery in stroke patients. Based on this and the development of novel non-invasive brain stimulation (NIBS) techniques, new adjuvant interventional approaches that augment the response to behavioral training have been proposed. Transcranial direct current, transcranial magnetic, and paired associative (PAS) stimulation are NIBS techniques that can modulate cortical excitability, neuronal plasticity and interact with learning and memory in both healthy individuals and stroke patients. These techniques can enhance the effect of practice and facilitate the retention of tasks that mimic daily life activities. The purpose of the present review is to provide a comprehensive overview of neuroplastic phenomena in the motor system during learning of a motor skill, recovery after brain injury, and of interventional strategies to enhance the beneficial effects of customarily used neurorehabilitation after stroke.
Collapse
Affiliation(s)
- Maximilian J Wessel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Máximo Zimerman
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany ; Institute of Cognitive Neurology (INECO) , Buenos Aires , Argentina
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany ; Favaloro University , Buenos Aires , Argentina
| |
Collapse
|
22
|
Shulga A, Lioumis P, Kirveskari E, Savolainen S, Mäkelä JP, Ylinen A. The use of F-response in defining interstimulus intervals appropriate for LTP-like plasticity induction in lower limb spinal paired associative stimulation. J Neurosci Methods 2015; 242:112-7. [DOI: 10.1016/j.jneumeth.2015.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 11/29/2022]
|
23
|
McNickle E, Carson RG. Paired associative transcranial alternating current stimulation increases the excitability of corticospinal projections in humans. J Physiol 2015; 593:1649-66. [PMID: 25504575 DOI: 10.1113/jphysiol.2014.280453] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/01/2014] [Indexed: 11/08/2022] Open
Abstract
Many types of non-invasive brain stimulation alter corticospinal excitability (CSE). Paired associative stimulation (PAS) has attracted particular attention as its effects ostensibly adhere to Hebbian principles of neural plasticity. In prototypical form, a single electrical stimulus is directed to a peripheral nerve in close temporal contiguity with transcranial magnetic stimulation delivered to the contralateral primary motor cortex (M1). Repeated pairing of the two discrete stimulus events (i.e. association) over an extended period either increases or decreases the excitability of corticospinal projections from M1, contingent on the interstimulus interval. We studied a novel form of associative stimulation, consisting of brief trains of peripheral afferent stimulation paired with short bursts of high frequency (≥80 Hz) transcranial alternating current stimulation (tACS) over contralateral M1. Elevations in the excitability of corticospinal projections to the forearm were observed for a range of tACS frequency (80, 140 and 250 Hz), current (1, 2 and 3 mA) and duration (500 and 1000 ms) parameters. The effects were at least as reliable as those brought about by PAS or transcranial direct current stimulation. When paired with tACS, muscle tendon vibration also induced elevations of CSE. No such changes were brought about by the tACS or peripheral afferent stimulation alone. In demonstrating that associative effects are expressed when the timing of the peripheral and cortical events is not precisely circumscribed, these findings suggest that multiple cellular pathways may contribute to a long term potentiation-type response. Their relative contributions will differ depending on the nature of the induction protocol that is used.
Collapse
Affiliation(s)
- Emmet McNickle
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Ireland; School of Psychology, Queen's University Belfast, Northern Ireland, UK
| | | |
Collapse
|
24
|
Direct and crossed effects of somatosensory stimulation on neuronal excitability and motor performance in humans. Neurosci Biobehav Rev 2014; 47:22-35. [DOI: 10.1016/j.neubiorev.2014.07.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/11/2022]
|
25
|
Post-stroke hemiplegia rehabilitation: Evolution of the concepts. Ann Phys Rehabil Med 2014; 57:520-529. [DOI: 10.1016/j.rehab.2014.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 11/17/2022]
|
26
|
Flamand VH, Schneider C. Noninvasive and painless magnetic stimulation of nerves improved brain motor function and mobility in a cerebral palsy case. Arch Phys Med Rehabil 2014; 95:1984-90. [PMID: 24907638 DOI: 10.1016/j.apmr.2014.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/06/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022]
Abstract
Motor deficits in cerebral palsy disturb functional independence. This study tested whether noninvasive and painless repetitive peripheral magnetic stimulation could improve motor function in a 7-year-old boy with spastic hemiparetic cerebral palsy. Stimulation was applied over different nerves of the lower limbs for 5 sessions. We measured the concurrent aftereffects of this intervention on ankle motor control, gait (walking velocity, stride length, cadence, cycle duration), and function of brain motor pathways. We observed a decrease of ankle plantar flexors resistance to stretch, an increase of active dorsiflexion range of movement, and improvements of corticospinal control of ankle dorsiflexors. Joint mobility changes were still present 15 days after the end of stimulation, when all gait parameters were also improved. Resistance to stretch was still lower than prestimulation values 45 days after the end of stimulation. This case illustrates the sustained effects of repetitive peripheral magnetic stimulation on brain plasticity, motor function, and gait. It suggests a potential impact for physical rehabilitation in cerebral palsy.
Collapse
Affiliation(s)
- Véronique H Flamand
- Neuroscience Division, CHU de Québec Research Center, Québec, QC, Canada; Faculty of Medicine, Université Laval, Québec, QC, Canada.
| | - Cyril Schneider
- Neuroscience Division, CHU de Québec Research Center, Québec, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| |
Collapse
|
27
|
Fang JH, Huang YZ, Hwang IS, Chen JJJ. Selective modulation of motor cortical plasticity during voluntary contraction of the antagonist muscle. Eur J Neurosci 2014; 39:2083-8. [DOI: 10.1111/ejn.12565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 01/30/2014] [Accepted: 02/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jhih-Hong Fang
- Department of Biomedical Engineering; National Cheng Kung University; Tainan City 701 Taiwan
| | - Ying-Zu Huang
- School of Medicine; Chang Gung University; Taoyuan 333 Taiwan
- Department of Neurology; Chang Gung Memorial Hospital; Taipei 105 Taiwan
| | - Ing-Shiou Hwang
- Department of Physical Therapy; National Cheng Kung University; Tainan City Taiwan
- Institute of Allied Health Sciences; National Cheng Kung University; Tainan City Taiwan
| | - Jia-Jin J. Chen
- Department of Biomedical Engineering; National Cheng Kung University; Tainan City 701 Taiwan
- National Applied Research Laboratories; Taipei Taiwan
| |
Collapse
|
28
|
Ayache SS, Farhat WH, Zouari HG, Hosseini H, Mylius V, Lefaucheur JP. Stroke rehabilitation using noninvasive cortical stimulation: motor deficit. Expert Rev Neurother 2014; 12:949-72. [DOI: 10.1586/ern.12.83] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
29
|
Suzuki M, Kirimoto H, Sugawara K, Watanabe M, Shimizu S, Ishizaka I, Yamada S, Matsunaga A, Fukuda M, Onishi H. Induction of cortical plasticity for reciprocal muscles by paired associative stimulation. Brain Behav 2014; 4:822-32. [PMID: 25365805 PMCID: PMC4212109 DOI: 10.1002/brb3.280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/27/2014] [Accepted: 08/18/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Paired associative stimulation (PAS) is widely used to induce plasticity in the human motor cortex. Although reciprocal inhibition of antagonist muscles plays a fundamental role in human movements, change in cortical circuits for reciprocal muscles by PAS is unknown. METHODS We investigated change in cortical plasticity for reciprocal muscles during PAS. PAS consisted of 200 pairs of peripheral electric stimulation of the right median nerve at the wrist at a frequency of 0.25 Hz followed by transcranial magnetic stimulation of the left M1 at the midpoint between the center of gravities of the flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles. Measures of motor cortical excitability included resting motor threshold (RMT), GABAA-mediated short-interval intracortical inhibition (SICI), and GABAB-mediated long-interval intracortical inhibition (LICI). RESULTS Motor evoked potential amplitude-conditioned LICI for the FCR muscle was significantly decreased after PAS (P = 0.020), whereas that for the ECR muscle was significantly increased (P = 0.033). Changes in RMT and SICI for the FCR and ECR muscles were not significantly different before and after PAS. Corticospinal excitability for both reciprocal muscles was increased during PAS, but GABAB-mediated cortical inhibitory functions for the agonist and antagonist muscles were reciprocally altered after PAS. CONCLUSION These results implied that the cortical excitability for reciprocal muscles including GABAB-ergic inhibitory systems within human M1 could be differently altered by PAS.
Collapse
Affiliation(s)
- Makoto Suzuki
- Graduate School of Medical Sciences, Kitasato University Kanagawa, Japan ; School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Hikari Kirimoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare Niigata, Japan
| | - Kazuhiro Sugawara
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare Niigata, Japan
| | - Makoto Watanabe
- School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Shinobu Shimizu
- School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Ikuyo Ishizaka
- School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Sumio Yamada
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine Nagoya, Japan
| | - Atsuhiko Matsunaga
- Graduate School of Medical Sciences, Kitasato University Kanagawa, Japan ; School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Michinari Fukuda
- Graduate School of Medical Sciences, Kitasato University Kanagawa, Japan ; School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare Niigata, Japan
| |
Collapse
|
30
|
Carson RG, Kennedy NC. Modulation of human corticospinal excitability by paired associative stimulation. Front Hum Neurosci 2013; 7:823. [PMID: 24348369 PMCID: PMC3847812 DOI: 10.3389/fnhum.2013.00823] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/14/2013] [Indexed: 12/04/2022] Open
Abstract
Paired Associative Stimulation (PAS) has come to prominence as a potential therapeutic intervention for the treatment of brain injury/disease, and as an experimental method with which to investigate Hebbian principles of neural plasticity in humans. Prototypically, a single electrical stimulus is directed to a peripheral nerve in advance of transcranial magnetic stimulation (TMS) delivered to the contralateral primary motor cortex (M1). Repeated pairing of the stimuli (i.e., association) over an extended period may increase or decrease the excitability of corticospinal projections from M1, in manner that depends on the interstimulus interval (ISI). It has been suggested that these effects represent a form of associative long-term potentiation (LTP) and depression (LTD) that bears resemblance to spike-timing dependent plasticity (STDP) as it has been elaborated in animal models. With a large body of empirical evidence having emerged since the cardinal features of PAS were first described, and in light of the variations from the original protocols that have been implemented, it is opportune to consider whether the phenomenology of PAS remains consistent with the characteristic features that were initially disclosed. This assessment necessarily has bearing upon interpretation of the effects of PAS in relation to the specific cellular pathways that are putatively engaged, including those that adhere to the rules of STDP. The balance of evidence suggests that the mechanisms that contribute to the LTP- and LTD-type responses to PAS differ depending on the precise nature of the induction protocol that is used. In addition to emphasizing the requirement for additional explanatory models, in the present analysis we highlight the key features of the PAS phenomenology that require interpretation.
Collapse
Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin Dublin, Ireland ; School of Psychology, Queen's University Belfast Belfast, UK
| | - Niamh C Kennedy
- School of Psychology, Queen's University Belfast Belfast, UK ; School of Rehabilitation Sciences University of East Anglia Norwich, UK
| |
Collapse
|
31
|
Mohamed T, Marion SMM, Isabelle L, Xavier D, David G, Phillipe M, Evelyne CL. P 123. CIPASS: Trial of a daily program of cerebral stimulation by TMS using a PAS paradigm in the recovery phase of stroke patients. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Sale MV, Mattingley JB. Selective enhancement of motor cortical plasticity by observed mirror-matched actions. Neuroimage 2013; 74:30-6. [DOI: 10.1016/j.neuroimage.2013.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 11/25/2022] Open
|
33
|
Silbert BI, Pevcic DD, Patterson HI, Windnagel KA, Thickbroom GW. Inverse correlation between resting motor threshold and corticomotor excitability after static magnetic stimulation of human motor cortex. Brain Stimul 2013; 6:817-20. [PMID: 23598254 DOI: 10.1016/j.brs.2013.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND High-strength static magnetic field stimulation (SMS) results in a period of reduced corticomotor excitability that may be mediated through a decrease in membrane excitability. OBJECTIVE As resting motor threshold (RMT) is thought to reflect membrane excitability, we hypothesized that SMS may increase RMT and that there would be an inverse relationship between RMT and motor-evoked potential (MEP) amplitude. METHODS Ten healthy subjects (aged 20-29; 4 females) participated in a double-blinded crossover design comparing MEP amplitude and RMT before and after a 15-min period of SMS or sham stimulation over primary motor cortex (M1). RESULTS MEP amplitude was initially significantly reduced post-SMS (∼20%), and returned to baseline by 6 min post-intervention. MEP amplitude and RMT were inversely correlated (r(2) = 0.924; P = 0.001). Sham stimulation had no effect on MEP amplitude (P = 0.969) or RMT (P = 0.549). CONCLUSION After SMS, corticomotor excitability is transiently reduced in association with a correlated modulation of RMT. SMS after effects may be mediated in part by a reduction in membrane excitability, suggesting a possible role for non-synaptic (intrinsic) plasticity mechanisms.
Collapse
Affiliation(s)
- Benjamin I Silbert
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Australian Neuro-Muscular Research Institute, M518, Nedlands, WA 6009, Australia
| | | | | | | | | |
Collapse
|
34
|
Carson RG, Nelson BD, Buick AR, Carroll TJ, Kennedy NC, Cann RM. Characterizing changes in the excitability of corticospinal projections to proximal muscles of the upper limb. Brain Stimul 2013; 6:760-8. [PMID: 23474090 DOI: 10.1016/j.brs.2013.01.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There has been an explosion of interest in methods of exogenous brain stimulation that induce changes in the excitability of human cerebral cortex. The expectation is that these methods may promote recovery of function following brain injury. To assess their effects on motor output, it is typical to assess the state of corticospinal projections from primary motor cortex to muscles of the hand, via electromyographic responses to transcranial magnetic stimulation. If a range of stimulation intensities is employed, the recruitment curves (RCs) obtained can, at least for intrinsic hand muscles, be fitted by a sigmoid function. OBJECTIVE/HYPOTHESIS To establish whether sigmoid fits provide a reliable basis upon which to characterize the input-output properties of the corticospinal pathway for muscles proximal to the hand, and to assess as an alternative the area under the (recruitment) curve (AURC). METHODS A comparison of the reliability of these measures, using RCs obtained for muscles that are frequently the targets of rehabilitation. RESULTS The AURC is an extremely reliable measure of the state of corticospinal projections to hand and forearm muscles, which has both face and concurrent validity. Construct validity is demonstrated by detection of widely distributed (across muscles) changes in corticospinal excitability induced by paired associative stimulation (PAS). CONCLUSION(S) The parameters derived from sigmoid fits are unlikely to provide an adequate means to assess the effectiveness of therapeutic regimes. The AURC can be employed to characterize corticospinal projections to a range of muscles, and gauge the efficacy of longitudinal interventions in clinical rehabilitation.
Collapse
Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland; School of Psychology, Queen's University Belfast, Northern Ireland, UK.
| | | | | | | | | | | |
Collapse
|
35
|
“Functional rTMS”: Putting the brain to work to enhance brain stimulation post-stroke? Clin Neurophysiol 2013; 124:215-6. [DOI: 10.1016/j.clinph.2012.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 11/16/2022]
|
36
|
Delvendahl I, Jung NH, Kuhnke NG, Ziemann U, Mall V. Plasticity of motor threshold and motor-evoked potential amplitude--a model of intrinsic and synaptic plasticity in human motor cortex? Brain Stimul 2012; 5:586-93. [PMID: 22445536 DOI: 10.1016/j.brs.2011.11.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neuronal plasticity is the physiological correlate of learning and memory. In animal experiments, synaptic (i.e. long-term potentiation (LTP) and depression (LTD)) and intrinsic plasticity are distinguished. In human motor cortex, cortical plasticity can be demonstrated using transcranial magnetic stimulation (TMS). Changes in motor-evoked potential (MEP) amplitudes most likely represent synaptic plasticity and are thus termed LTP-like and LTD-like plasticity. OBJECTIVE/HYPOTHESIS We investigated the role of changes of motor threshold and their relation to changes of MEP amplitudes. METHODS We induced plasticity by paired associative stimulation (PAS) with 25 ms or 10 ms inter-stimulus interval or by motor practice (MP) in 64 healthy subjects aged 18-31 years (median 24.0). RESULTS We observed changes of MEP amplitudes and motor threshold after PAS[25], PAS[10] and MP. In all three protocols, long-term individual changes in MEP amplitude were inversely correlated to changes in motor threshold (PAS[25]: P = .003, n = 36; PAS[10]: P = .038, n = 19; MP: P = .041, n = 19). CONCLUSION We conclude that changes of MEP amplitudes and MT represent two indices of motor cortex plasticity. Whereas increases and decreases in MEP amplitude are assumed to represent LTP-like or LTD-like synaptic plasticity of motor cortex output neurons, changes of MT may be considered as a correlate of intrinsic plasticity.
Collapse
Affiliation(s)
- Igor Delvendahl
- Division of Neuropaediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Freiburg, Germany
| | | | | | | | | |
Collapse
|
37
|
List J, Duning T, Kürten J, Deppe M, Wilbers E, Flöel A. Cortical plasticity is preserved in nondemented older individuals with severe ischemic small vessel disease. Hum Brain Mapp 2012; 34:1464-76. [PMID: 22331645 DOI: 10.1002/hbm.22003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/31/2011] [Accepted: 11/03/2011] [Indexed: 11/06/2022] Open
Abstract
Ischemic small vessel disease (SVD) is a common finding on routine scans in older people, but cognitive sequelae vary considerably. To improve understanding of mechanisms underlying decline or preservation of cognitive function in this condition, we assessed cognition and cortical plasticity in 20 elderly subjects with severe SVD and 20 age-matched controls without SVD, as rated on conventional MRI. Cognitive status was determined with a neuropsychological test battery, cortical plasticity induced with a paired associative stimulation protocol. Microstructural white matter changes were further analyzed for fractional anisotrophy using diffusion tensor imaging. We found that cortical plasticity as well as memory functions were preserved in severe SVD, while executive functions showed trendwise or significant decreases. Within the SVD group, lower white matter integrity in parahippocampal regions and posterior parts of the corpus callosum was associated with larger cortical plasticity, an association not seen for prefrontal white matter tracts. Enhanced cortical plasticity in subjects with lower white matter integrity in memory-relevant areas might thus indicate a compensatory mechanism to counteract memory decline in severe SVD.
Collapse
Affiliation(s)
- Jonathan List
- Department of Neurology, University Hospital of Münster, Charitéplatz 1, Münster, Germany
| | | | | | | | | | | |
Collapse
|
38
|
Delvendahl I, Kuhnke NG, Jung NH, Mainberger F, Cronjaeger M, Unterrainer J, Hauschke D, Mall V. The time course of motor cortex plasticity after spaced motor practice. Brain Stimul 2011; 4:156-64. [DOI: 10.1016/j.brs.2010.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/25/2022] Open
|
39
|
List J, Duning T, Meinzer M, Kurten J, Schirmacher A, Deppe M, Evers S, Young P, Floel A. Enhanced Rapid-Onset Cortical Plasticity in CADASIL as a Possible Mechanism of Preserved Cognition. Cereb Cortex 2011; 21:2774-87. [DOI: 10.1093/cercor/bhr071] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
40
|
Schmidt MW, Hinder MR, Summers JJ, Garry MI. Long-lasting contralateral motor cortex excitability is increased by unilateral hand movement that triggers electrical stimulation of opposite homologous muscles. Neurorehabil Neural Repair 2011; 25:521-30. [PMID: 21436392 DOI: 10.1177/1545968310397202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVE Long-term changes in the motor cortex can be induced by practicing motor tasks with simultaneous application of peripheral nerve stimulation. This combination may augment motor rehabilitation after stroke but has been used primarily during contraction of the affected hand. The authors tested the effect of a right hand movement that electrically stimulated left hand contraction on right motor cortex excitability. METHODS Three tasks were used in 15 healthy subjects--a motor and stimulation task (MS(task)), stimulation only task (S(task)), and motor only task (M(task)). The MS(task) consisted of isometric thumb abduction of the right hand that triggered paired electrical stimulation of the left abductor pollicis brevis (APB) and first dorsal interosseus (FDI) motor points. The S(task) was performed 1 week later and matched the stimulation received in the MS(task). The M(task) was performed as a control. Transcranial magnetic stimulation applied to the right motor cortex assessed corticospinal excitability, short latency intracortical inhibition, and intracortical facilitation of the FDI and APB before, immediately after, and 30 minutes after task performance. RESULTS Corticospinal excitability increased in the FDI and APB following the MS(task) but not following the S(task) or M(task). The increased excitability present 30 minutes after the MS(task) also correlated with excitability measures recorded 1 week later. CONCLUSION A bilateral motor and electrical stimulation task can drive persistent adaptation within the corticospinal system. Hemiplegic subjects who have poor voluntary movement of the affected hand may be able to contract the unaffected hand to activate and train homologous movements.
Collapse
Affiliation(s)
- Matthew W Schmidt
- Motor Control Laboratory, School of Psychology, University of Tasmania, Hobart, Tasmania, Australia.
| | | | | | | |
Collapse
|
41
|
Abstract
Approximately one-third of patients with stroke exhibit persistent disability after the initial cerebrovascular episode, with motor impairments accounting for most poststroke disability. Exercise and training have long been used to restore motor function after stroke. Better training strategies and therapies to enhance the effects of these rehabilitative protocols are currently being developed for poststroke disability. The advancement of our understanding of the neuroplastic changes associated with poststroke motor impairment and the innate mechanisms of repair is crucial to this endeavor. Pharmaceutical, biological and electrophysiological treatments that augment neuroplasticity are being explored to further extend the boundaries of poststroke rehabilitation. Potential motor rehabilitation therapies, such as stem cell therapy, exogenous tissue engineering and brain-computer interface technologies, could be integral in helping patients with stroke regain motor control. As the methods for providing motor rehabilitation change, the primary goals of poststroke rehabilitation will be driven by the activity and quality of life needs of individual patients. This Review aims to provide a focused overview of neuroplasticity associated with poststroke motor impairment, and the latest experimental interventions being developed to manipulate neuroplasticity to enhance motor rehabilitation.
Collapse
Affiliation(s)
- Michael A Dimyan
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1428, USA
| | | |
Collapse
|
42
|
Delvendahl I, Jung NH, Mainberger F, Kuhnke NG, Cronjaeger M, Mall V. Occlusion of bidirectional plasticity by preceding low-frequency stimulation in the human motor cortex. Clin Neurophysiol 2010; 121:594-602. [DOI: 10.1016/j.clinph.2009.09.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 08/27/2009] [Accepted: 09/25/2009] [Indexed: 11/28/2022]
|
43
|
Roy FD, Yang JF, Gorassini MA. Afferent Regulation of Leg Motor Cortex Excitability After Incomplete Spinal Cord Injury. J Neurophysiol 2010; 103:2222-33. [DOI: 10.1152/jn.00903.2009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An incomplete spinal cord injury (SCI) impairs neural conduction along spared ascending sensory pathways to disrupt the control of residual motor movements. To characterize how SCI affects the activation of the motor cortex by spared ascending sensory pathways, we examined how stimulation of leg afferents facilitates the excitability of the motor cortex in subjects with incomplete SCI. Homo- and heteronymous afferents to the tibialis anterior (TA) representation in the motor cortex were electrically stimulated, and the responses were compared with uninjured controls. In addition, we examined if cortical excitability could be transiently increased by repetitively pairing stimulation of spared ascending sensory pathways with transcranial magnetic stimulation (TMS), an intervention termed paired associative stimulation (PAS). In uninjured subjects, activating the tibial nerve at the ankle 45–50 ms before a TMS pulse in a conditioning-test paradigm facilitated the motor-evoked potential (MEP) in the heteronymous TA muscle by twofold on average. In contrast, prior tibial nerve stimulation did not facilitate the TA MEP in individuals with incomplete SCI ( n = 8 SCI subjects), even in subjects with less severe injuries. However, we provide evidence that ascending sensory inputs from the homonymous common peroneal nerve (CPN) can, unlike the heteronymous pathways, facilitate the motor cortex to modulate the TA MEP ( n = 16 SCI subjects) but only in subjects with less severe injuries. Finally, by repetitively coupling CPN stimulation with coincident TA motor cortex activation during PAS, we show that 7 of 13 SCI subjects produced appreciable (>20%) facilitation of the MEP following the intervention. The increase in corticospinal tract excitability by PAS was transient (<20 min) and tended to be more prevalent in SCI subjects with stronger functional ascending sensory pathways.
Collapse
Affiliation(s)
| | - Jaynie F. Yang
- Physical Therapy, Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | | |
Collapse
|
44
|
Conchou F, Loubinoux I, Castel-Lacanal E, Le Tinnier A, Gerdelat-Mas A, Faure-Marie N, Gros H, Thalamas C, Calvas F, Berry I, Chollet F, Simonetta Moreau M. Neural substrates of low-frequency repetitive transcranial magnetic stimulation during movement in healthy subjects and acute stroke patients. A PET study. Hum Brain Mapp 2009; 30:2542-57. [PMID: 19072894 DOI: 10.1002/hbm.20690] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of the study was to investigate, with an rTMS/PET protocol, the after-effects induced by 1-Hz repetitive transcranial magnetic stimulation (rTMS) in the regional cerebral blood flow (rCBF) of the primary motor cortex (M1) contralateral to that stimulated during a movement. Eighteen healthy subjects underwent a baseline PET scan followed, in randomized order, by a session of Real/Sham low-frequency (1 Hz) subthreshold rTMS over the right M1 for 23 min. The site of stimulation was fMRI-guided. After each rTMS session (real or sham), subjects underwent behavioral hand motor tests and four PET scans. During the first two scans, ten subjects (RH group) moved the right hand ipsilateral to the stimulated site and eight subjects (LH group) moved the left contralateral hand. All remained still during the last two scans (rest). Two stroke patients underwent the same protocol with rTMS applied on contralesional M1. Compared with Sham-rTMS, Real-rTMS over the right M1 was followed by a significant increase of rCBF during right hand movement in left S1M1, without any significant change in motor performance. The effect lasted less than 1 h. The same rTMS-induced S1M1 overactivation was observed in the two stroke patients. Commissural connectivity between right dorsal premotor cortex and left M1 after real-rTMS was observed with a psychophysiological interaction analysis in healthy subjects. No major changes were found for the left hand. These results give further arguments in favor of a plastic commissural connectivity between M1 both in healthy subjects and in stroke patients, and reinforce the potential for therapeutic benefit of low-frequency rTMS in stroke rehabilitation.
Collapse
|
45
|
Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med 2009; 52:269-93. [DOI: 10.1016/j.rehab.2008.10.003] [Citation(s) in RCA: 231] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 10/06/2008] [Indexed: 11/27/2022]
|
46
|
Celnik P, Paik NJ, Vandermeeren Y, Dimyan M, Cohen LG. Effects of combined peripheral nerve stimulation and brain polarization on performance of a motor sequence task after chronic stroke. Stroke 2009; 40:1764-71. [PMID: 19286579 DOI: 10.1161/strokeaha.108.540500] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Recent work demonstrated that application of peripheral nerve and cortical stimulation independently can induce modest improvements in motor performance in patients with stroke. The purpose of this study was to test the hypothesis that combining peripheral nerve stimulation (PNS) to the paretic hand with anodal direct current stimulation (tDCS) to the ipsilesional primary motor cortex (M1) would facilitate beneficial effects of motor training more than each intervention alone or sham (tDCS(Sham) and PNS(Sham)). METHODS Nine chronic stroke patients completed a blinded crossover designed study. In separate sessions, we investigated the effects of single applications of PNS+tDCS, PNS+tDCS(Sham), tDCS+PNS(Sham), and PNS(Sham)+tDCS(Sham) before motor training on the ability to perform finger motor sequences with the paretic hand. RESULTS PNS+tDCS resulted in a 41.3% improvement in the number of correct key presses relative to PNS(Sham)+tDCS(Sham), 15.4% relative to PNS+tDCS(Sham), and 22.7% relative to tDCS+PNS(Sham). These performance differences were maintained 1 and 6 days after the end of the training. CONCLUSIONS These results indicate that combining PNS with tDCS can facilitate the beneficial effects of training on motor performance beyond levels reached with each intervention alone, a finding of relevance for the neurorehabilitation of motor impairments after stroke.
Collapse
Affiliation(s)
- Pablo Celnik
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | | | | | | | | |
Collapse
|
47
|
Castel-Lacanal E, Marque P, Tardy J, de Boissezon X, Guiraud V, Chollet F, Loubinoux I, Simonetta-Moreau M. Induction of Cortical Plastic Changes in Wrist Muscles by Paired Associative Stimulation in the Recovery Phase of Stroke Patients. Neurorehabil Neural Repair 2008; 23:366-72. [DOI: 10.1177/1545968308322841] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Paired associative stimulation (PAS) combining peripheral nerve and transcranial magnetic stimulation (TMS) have been proposed to induce long-term changes in excitability of the cerebral cortex and potentially optimize motor recovery in stroke patients. Objective. This pilot study examined whether short-lasting changes in cortical excitability could be induced by a single session of PAS within the first months after stroke. Methods. Six hemiparetic patients with a subcortical stroke were included. The single session PAS protocol was applied at 1, 5, and 12 months after stroke. During the follow-up, the clinical recovery of wrist function was assessed in parallel to the PAS study by the Fugl-Meyer motor scale and dynamometry of wrist extension. Results. The PAS protocol induced a significant extensor carpi radialis motor evoked potential facilitation (mean +78.5%) on the paretic side 5 months after stroke. The facilitation was still present 12 months after stroke but on average smaller (+30 %). Conclusions. These electrophysiological findings suggest that patients with subcortical infarcts may respond to PAS in an earlier than later period after stroke. If the clinical efficacy of interventions such as PAS is confirmed, it could be proposed early as add-on therapy to optimize training-induced plasticity processes.
Collapse
Affiliation(s)
- Evelyne Castel-Lacanal
- Universités de Toulouse, IFR 96, Pôle Santé, Société, Réadaptation, Hôpitaux de Toulouse, INSERM U 825
| | - Philippe Marque
- Universités de Toulouse, IFR 96, Pôle Santé, Société, Réadaptation, Hôpitaux de Toulouse, INSERM U 825
| | - Jean Tardy
- Pôle Neurosciences, Hôpitaux de Toulouse Toulouse, France, Universités de Toulouse, IFR 96, Pôle Santé, Société, Réadaptation, Hôpitaux de Toulouse, INSERM U 825
| | - Xavier de Boissezon
- Universités de Toulouse, IFR 96, Pôle Santé, Société, Réadaptation, Hôpitaux de Toulouse, INSERM U 825
| | | | - François Chollet
- Pôle Neurosciences, Hôpitaux de Toulouse Toulouse, France, Universités de Toulouse, IFR 96, INSERM U 825
| | | | - Marion Simonetta-Moreau
- Pôle Neurosciences, Hôpitaux de Toulouse Toulouse, France, , Universités de Toulouse, IFR 96, INSERM U 825
| |
Collapse
|
48
|
Sullivan JE, Hedman LD. Sensory dysfunction following stroke: incidence, significance, examination, and intervention. Top Stroke Rehabil 2008; 15:200-17. [PMID: 18647725 DOI: 10.1310/tsr1503-200] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent studies have provided evidence of the widespread incidence of sensory dysfunction following stroke. The importance of these findings lies in the association between sensory loss poststroke and poorer outcomes in motor capacity, functional abilities, length of inpatient stay, and quality of life. Since literature suggests that clinicians can use information about clients' sensory status to predict rehabilitation outcomes and select appropriate interventions, the accuracy of somatosensory assessment is extremely clinically relevant. However, many of the clinical tests that are commonly used to examine sensation have not been found to be valid or reliable. Emerging evidence supports the efficacy of several interventions that target the sensory systems. This article reviews the incidence, significance, examination, and interventions for sensory dysfunction following stroke and summarizes the important characteristics of interventions directed at somatosensation.
Collapse
Affiliation(s)
- Jane E Sullivan
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine Northwestern University, Chicago, IL, USA
| | | |
Collapse
|
49
|
The effect of simultaneous contractions of ipsilateral muscles on changes in corticospinal excitability induced by paired associative stimulation (PAS). Neurosci Lett 2008; 445:7-11. [PMID: 18771706 DOI: 10.1016/j.neulet.2008.08.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 08/20/2008] [Accepted: 08/24/2008] [Indexed: 11/21/2022]
Abstract
Consideration was given to means of increasing the reliability and muscle specificity of paired associative stimulation (PAS) by utilising the phenomenon of crossed-facilitation. Eight participants completed three separate sessions: isometric flexor contractions of the left wrist at 20% of maximum voluntary contraction (MVC) simultaneously with PAS (20s intervals; 14 min duration) delivered at the right median nerve and left primary motor cortex (M1); isometric contractions at 20% of MVC; and PAS only (14 min). Eight further participants completed two sessions of longer duration PAS (28 min): either alone or in conjunction with flexion contractions of the left wrist. Thirty motor potentials (MEPs) were evoked in the right flexor (rFCR) and extensor (rECR) carpi radialis muscles by magnetic stimulation of left M1 prior to the interventions, immediately post-intervention, and 10 min post-intervention. Both 14 and 28 min of combined PAS and (left wrist flexion) contractions resulted in reliable increases in rFCR MEP amplitude, which were not present in rECR. In the PAS only conditions, 14 min of stimulation gave rise to unreliable increases in MEP amplitudes in rFCR and rECR, whereas 28 min of PAS induced small (unreliable) changes only for rFCR. These results support the conclusion that changes in the excitability of the corticospinal pathway induced by PAS interact with those associated with contraction of the muscles ipsilateral to the site of cortical stimulation. Furthermore, focal contractions applied by the opposite limb increase the extent and muscle specificity of the induced changes in excitability associated with PAS.
Collapse
|