Task-relevancy effects on movement-related gating are modulated by continuous theta-burst stimulation of the dorsolateral prefrontal cortex and primary somatosensory cortex

The Neurophysiological Effects of Theta Burst Stimulation as Measured by Electroencephalography: A Systematic Review

Theta burst stimulation (TBS) is a non-invasive brain stimulation technique that can modulate neural activity. The effect of TBS on regions beyond the motor cortex remains unclear. With increased interest in applying TBS to non-motor regions for research and clinical purposes, these effects must be understood and characterised. We synthesised the electrophysiological effects of a single session of TBS, as indexed by electroencephalography (EEG) and concurrent transcranial magnetic stimulation and EEG (TMS-EEG), in non-clinical participants. We reviewed 79 studies that administered either continuous TBS (cTBS) or intermittent TBS (iTBS) protocols. Broadly, cTBS suppressed and iTBS facilitated evoked response component amplitudes. Response to TBS as measured by spectral power and connectivity was much more variable. Variability increased in the presence of task stimuli. There was a large degree of heterogeneity in the research methodology across studies. Additionally, the effect of individual differences on TBS response is insufficiently investigated. Future research investigating the effects of TBS as measured by EEG must consider methodological and individual factors that may affect TBS outcomes.

Tactile facilitation during actual and mere expectation of object reception

During reaching and grasping movements tactile processing is typically suppressed. However, during a reception or catching task, the object can still be acquired but without suppressive processes related to movement execution. Rather, tactile information may be facilitated as the object approaches in anticipation of object contact and the utilization of tactile feedback. Therefore, the current study investigated tactile processing during a reception task. Participants sat with their upper limb still as an object travelled to and contacted their fingers. At different points along the object's trajectory and prior to contact, participants were asked to detect tactile stimuli delivered to their index finger. To understand if the expectation of object contact contributed to any modulation in tactile processing, the object stopped prematurely on 20% of trials. Compared to a pre-object movement baseline, relative perceptual thresholds were decreased throughout the object's trajectory, and even when the object stopped prematurely. Further, there was no evidence for modulation when the stimulus was presented shortly before object contact. The former results suggest that tactile processing is facilitated as an object approaches an individual's hand. As well, we purport that the expectation of tactile feedback drives this modulation. Finally, the latter results suggest that peripheral masking may have reduced/abolished any facilitation.

Facilitation of tactile processing during action observation of goal-directed reach and grasp movements

Our perception of sensory events can be altered by action, but less is known about how our perception can be altered by action observation. For example, our ability to detect tactile stimuli is reduced when our limb is moving, and task-relevance and movement speed can alter such tactile detectability. During action observation, however, the relationship between tactile processing and such modulating factors is not known. Thus, the current study sought to explore tactile processing at a task-relevant location during the observation of reaching and grasping movements performed at different speeds. Specifically, participants observed videos of an anonymous model performing movements at a slow (i.e., peak velocity [PV]: 155 mm/second), medium (i.e., PV: 547 mm/s), or fast speed (i.e., PV: 955 mm/s). To assess tactile processing, weak electrical stimuli of different amplitudes were presented to participants' right thumbs when the observed model was at their starting position and prior to any movement, or when the observed model's limb reached its PV. When observing slow movements, normalized perceptual thresholds were significantly lower/ better than for the pre-movement stimulation time. These data suggest that the movement speed can modulate tactile processing, even when observing a movement. Further, these findings provide seminal evidence for tactile facilitation at a task-relevant location during the observation of slow reaching and grasping movements (i.e., speeds associated with tactile exploration).

Therapeutic benefits of noninvasive somatosensory cortex stimulation on cortical plasticity and somatosensory function: a systematic review

Optimal limb coordination requires efficient transmission of somatosensory information to the sensorimotor cortex. The primary somatosensory cortex (S1) is frequently damaged by stroke, resulting in both somatosensory and motor impairments. Noninvasive brain stimulation (NIBS) to the primary motor cortex is thought to induce neural plasticity that facilitates neurorehabilitation. Several studies have also examined if NIBS to the S1 can enhance somatosensory processing as assessed by somatosensory-evoked potentials (SEPs) and improve behavioral task performance, but it remains uncertain if NIBS can reliably modulate S1 plasticity or even whether SEPs can reflect this plasticity. This systematic review revealed that NIBS has relatively minor effects on SEPs or somatosensory task performance, but larger early SEP changes after NIBS can still predict improved performance. Similarly, decreased paired-pulse inhibition in S1 post-NIBS is associated with improved somatosensory performance. However, several studies still debate the role of inhibitory function in somatosensory performance after NIBS in terms of the direction of the change (that, disinhibition or inhibition). Altogether, early SEP and paired-pulse inhibition (particularly inter-stimulus intervals of 30-100 ms) may become useful biomarkers for somatosensory deficits, but improved NIBS protocols are required for therapeutic applications.

Long-term effects of concussion on relevancy-based modulation of somatosensory-evoked potentials

OBJECTIVE

The purpose of this investigation was to better understand the effects of concussions on the ability to selectively up or down-regulate incoming somatosensory information based on relevance.

METHODS

Median nerve somatosensory-evoked potentials (SEPs) were elicited from electrical stimulation and recorded from scalp electrodes while participants completed tasks that altered the relevance of specific somatosensory information being conveyed along the stimulated nerve.

RESULTS

Within the control group, SEP amplitudes for task-relevant somatosensory information were significantly greater than for non-relevant somatosensory information at the earliest cortical processing potentials (N20-P27). Alternatively, the concussion history group showed similar SEP amplitudes for all conditions at early processing potentials, however a pattern similar to controls emerged later in the processing stream (P100) where both movement-related gating and facilitation of task-relevant information were present.

CONCLUSIONS

Previously concussed participants demonstrated impairments in the ability to up-regulate relevant somatosensory information at early processing stages. These effects appear to be chronic, as this pattern was observed on average several years after participants' most recent concussion.

SIGNIFICANCE

Given the role of the prefrontal cortex in relevancy-based facilitation during movement-related gating, these findings lend support to the notion that this brain area may be particularly vulnerable to concussive forces.

Evidence of altered interhemispheric communication after pediatric concussion

OBJECTIVES: To investigate neurophysiological alterations within the typical symptomatic period after concussion (1-month) and throughout recovery (6-months) in adolescents; and (2) to examine relationships between neurophysiological and upper limb kinematic outcomes.METHODS: 18 adolescents with concussion were compared to 17 healthy controls. Transcranial magnetic stimulation (TMS) was used to assess neurophysiological differences between groups including: short- and long-interval intracortical inhibition, intracortical facilitation, short- and long-latency afferent inhibition, afferent facilitation, and transcallosal inhibition (TCI). Behavioral measures of upper limb kinematics were assessed with a robotic device.RESULTS: Mixed model analysis of neurophysiological data identified two key findings. First, participants with concussion demonstrated delayed onset of interhemispheric inhibition, as indexed by TCI, compared to healthy controls. Second, our exploratory analysis indicated that the magnitude of TCI onset delay in adolescents with concussion was related to upper limb kinematics.CONCLUSIONS: Our findings indicate that concussion in adolescence alters interhemispheric communication. We note relationships between neurophysiological and kinematic data, suggesting an affinity for individuals with less concussion-related physiological change to improve their motor behavior over time. These data serve as an important step in future development of assessments (neurobiological and clinical) and interventions for concussion.

A History of Concussion Affects Relevancy-Based Modulation of Cortical Responses to Tactile Stimuli

Modulating cortical excitability based on a stimulus’ relevance to the task at hand is a component of sensory gating, and serves to protect higher cortical centers from being overwhelmed with irrelevant information (McIlroy et al., 2003; Kumar et al., 2005; Wasaka et al., 2005). This study examined relevancy-based modulation of cortical excitability, and corresponding behavioral responses, in the face of distracting stimuli in participants with and without a history of concussion (mean age 22 ± 3 SD years; most recent concussion 39.1 ± 30 SD months). Participants were required to make a scaled motor response to the amplitudes of visual and tactile stimuli presented individually or concurrently. Task relevance was manipulated, and stimuli were occasionally presented with irrelevant distractors. Electroencephalography (EEG) and task accuracy data were collected from participants with and without a history of concussion. The somatosensory-evoked N70 event-related potential (ERP) was significantly modulated by task relevance in the control group but not in those with a history of concussion, and there was a significantly greater cost to task accuracy in the concussion history group when relevant stimuli were presented with an irrelevant distractor. This study demonstrated that relevancy-based modulation of electrophysiological responses and behavioral correlates of sensory gating differ in people with and without a history of concussion, even after patients were symptom-free and considered recovered from their injuries.

Cortical processing of irrelevant somatosensory information from the leg is altered by attention during early movement preparation

The ability to actively suppress, or gate, irrelevant sensory information is needed for safe and efficient walking in sensory-rich environments. Both attention and the late phase of motor preparation alter somatosensory evoked potentials (SEPs) in healthy adults. The aim of this study was to examine the effect of attention on the processing of irrelevant somatosensory information during the early phase of preparation of plantarflexion movements. Young healthy individuals received tibial nerve stimulation while electroencephalography (EEG) recorded SEPs over the Cz electrode. Three conditions were tested in both legs: 1) Rest, 2) Attend To the stimulated limb, and 3) Attend Away from the stimulated limb. In conditions 2 and 3, vibration (80 Hz) was applied over the medial soleus muscle to cue voluntary plantarflexion movements of the stimulated (Attend To) or non-stimulated leg (Attend Away). Only SEPs delivered during early preparation were averaged for statistical analysis. Results demonstrated a main effect of condition for the N40 and N70 indicating that SEP amplitudes in the Attend To condition were smaller than rest (p ≤ 0.02). For the P50, no interaction effects or main effects were found (p ≥ 0.08). There was no main effect of leg for any component measured. The results indicate that gating of irrelevant sensory information during early preparation occurs in the leg when attention is directed within the same limb. If attention alters the somatosensory stimuli from a leg movement, then directing attention may affect safe community walking.

Sensorimotor integration in chronic stroke: Baseline differences and response to sensory training

BACKGROUND

The integration of somatosensory information from the environment into the motor cortex to inform movement is essential for motor function. As motor deficits commonly persist into the chronic phase of stroke recovery, it is important to understand potential contributing factors to these deficits, as well as their relationship with motor function. To date the impact of chronic stroke on sensorimotor integration has not been thoroughly investigated.

OBJECTIVES

The current study aimed to comprehensively examine the influence of chronic stroke on sensorimotor integration, and determine whether sensorimotor integration can be modified with an intervention. Further, it determined the relationship between neurophysiological measures of sensorimotor integration and motor deficits post-stroke.

METHODS

Fourteen individuals with chronic stroke and twelve older healthy controls participated. Motor impairment and function were quantified in individuals with chronic stroke. Baseline neurophysiology was assessed using nerve-based measures (short- and long-latency afferent inhibition, afferent facilitation) and vibration-based measures of sensorimotor integration, which paired vibration with single and paired-pulse TMS techniques. Neurophysiological assessment was performed before and after a vibration-based sensory training paradigm to assess changes within these circuits.

RESULTS

Vibration-based, but not nerve-based measures of sensorimotor integration were different in individuals with chronic stroke, as compared to older healthy controls, suggesting that stroke differentially impacts integration of specific types of somatosensory information. Sensorimotor integration was behaviourally relevant in that it related to both motor function and impairment post-stroke. Finally, sensory training modulated sensorimotor integration in individuals with chronic stroke and controls.

CONCLUSION

Sensorimotor integration is differentially impacted by chronic stroke based on the type of afferent feedback. However, both nerve-based and vibration-based measures relate to motor impairment and function in individuals with chronic stroke.

Suppression of somatosensory stimuli during motor planning may explain levels of balance and mobility after stroke

The ability to actively suppress, or gate, irrelevant sensory information is required for safe and efficient walking in sensory-rich environments. Both motor attention and motor planning alter somatosensory evoked potentials (SEPs) in healthy adults. This study's aim was to examine the effect of motor attention on processing of irrelevant somatosensory information during plantar flexion motor planning after stroke. Thirteen healthy older adults and 11 individuals with stroke participated. Irrelevant tibial nerve stimulation was delivered while SEPs were recorded over Cz, overlaying the leg portion of the sensorimotor cortex at the vertex of the head. Three conditions were tested in both legs: (1) Rest, (2) Attend To, and (3) Attend Away from the stimulated limb. In conditions 2 and 3, relevant vibration cued voluntary plantar flexion movements of the stimulated (Attend To) or non-stimulated (Attend Away) leg. SEP amplitudes were averaged during motor planning per condition. Individuals with stroke did not show attention-mediated gating of the N40 component associated with irrelevant somatosensory information during motor planning. It may be that dysfunction in pathways connecting to area 3b explains the lack of attention-mediated gating of the N40. Also, attention-mediated gating during motor planning explained significant and unique variance in a measure of community balance and mobility combined with response time. Thus, the ability to gate irrelevant somatosensory information appears important for stepping in both older adults and after stroke. Our data suggest that therapies that direct motor attention could positively impact walking after stroke.

Gating at early cortical processing stages is associated with changes in behavioural performance on a sensory conflict task

While there is evidence to show early enhancement of modality-specific somatosensory cortical event-related potentials (ERP) when two stimuli are task-relevant, less is understood about the cortical and behavioural correlates of early modality-specific sensory gating. This study sought to understand how attentional gating affects cortical processing of visual and tactile stimuli at early stages of modality-specific representation. Specifically, alterations in early somatosensory and visual processing based on attentional relevance were examined, along with the effect of an unattended sensory stimulus on cortical processing and behavioural performance. Electroencephalography (EEG) was collected from healthy participants as they performed a sensory selection task. This task required participants to make a scaled motor response to the amplitudes of visual and tactile stimuli presented individually or concurrently. Results showed that the somatosensory N70 ERP was significantly attenuated when tactile stimuli were unattended. When visual stimuli were unattended, modulation of visual potentials occurred later, at the visual P2 potential. Since unattended tactile stimuli were gated at early cortical processing stages, when they were used as distractors, no changes in cortical responses to target stimuli were observed. Additionally, there was no decrease in task accuracy when grading attended stimuli in the presence of a tactile distractor. However, since early gating was not observed in the visual modality, a visual stimulus used as an unattended distractor resulted in smaller-amplitude cortical responses to attended tactile stimuli and less accurate task performance when grading attended stimuli. In conclusion, this study suggests that early gating of unattended stimuli supports modality-specific cortical processing of target stimuli and maintains behavioural task performance.

Time Course of Tactile Gating in a Reach-to-Grasp and Lift Task

Humans' sensory systems are bombarded by myriad events every moment of our lives. Thus, it is crucial for sensory systems to choose and process critical sensory events deemed important for a given task and, indeed, those that affect survival. Tactile gating is well known, and defined as a reduced ability to detect and discriminate tactile events before and during movement. Also, different locations of the effector exhibit different magnitudes of sensitivity changes. The authors examined that time course of tactile gating in a reaching and grasping movement to characterize its behavior. Tactile stimulators were attached to the right and left mid-forearms and the right index finger and fifth digit. When participants performed reach-to-grasp and lift targets, tactile acuity decreased at the right forearm before movement onset (F. L. Colino, G. Buckingham, D. T. Cheng, P. van Donkelaar, & G. Binsted, 2014 ). However, tactile sensitivity at the right index finger decreased by nearly 20% contrary to expectations. This result reflecting that there may be an additional source acting to reduce inhibition related to tactile gating. Additionally, sensitivity improved as movement end approached. Collectively, the present results indicate that predictive and postdictive mechanisms strongly influence tactile gating.

Practice changes beta power at rest and its modulation during movement in healthy subjects but not in patients with Parkinson's disease

BACKGROUND

PD (Parkinson's disease) is characterized by impairments in cortical plasticity, in beta frequency at rest and in beta power modulation during movement (i.e., event-related ERS [synchronization] and ERD [desynchronization]). Recent results with experimental protocols inducing long-term potentiation in healthy subjects suggest that cortical plasticity phenomena might be reflected by changes of beta power recorded with EEG during rest. Here, we determined whether motor practice produces changes in beta power at rest and during movements in both healthy subjects and patients with PD. We hypothesized that such changes would be reduced in PD.

METHODS

We thus recorded EEG in patients with PD and age-matched controls before, during and after a 40-minute reaching task. We determined posttask changes of beta power at rest and assessed the progressive changes of beta ERD and ERS during the task over frontal and sensorimotor regions.

RESULTS

We found that beta ERS and ERD changed significantly with practice in controls but not in PD. In PD compared to controls, beta power at rest was greater over frontal sensors but posttask changes, like those during movements, were far less evident. In both groups, kinematic characteristics improved with practice; however, there was no correlation between such improvements and the changes in beta power.

CONCLUSIONS

We conclude that prolonged practice in a motor task produces use-dependent modifications that are reflected in changes of beta power at rest and during movement. In PD, such changes are significantly reduced; such a reduction might represent, at least partially, impairment of cortical plasticity.