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Zou J, Hao S. Exercise-induced neuroplasticity: a new perspective on rehabilitation for chronic low back pain. Front Mol Neurosci 2024; 17:1407445. [PMID: 38912176 PMCID: PMC11191426 DOI: 10.3389/fnmol.2024.1407445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Chronic low back pain patients often experience recurrent episodes due to various peripheral and central factors, leading to physical and mental impairments, affecting their daily life and work, and increasing the healthcare burden. With the continuous advancement of neuropathological research, changes in brain structure and function in chronic low back pain patients have been revealed. Neuroplasticity is an important mechanism of self-regulation in the brain and plays a key role in neural injury repair. Targeting neuroplasticity and regulating the central nervous system to improve functional impairments has become a research focus in rehabilitation medicine. Recent studies have shown that exercise can have beneficial effects on the body, such as improving cognition, combating depression, and enhancing athletic performance. Exercise-induced neuroplasticity may be a potential mechanism through which exercise affects the brain. This article systematically introduces the theory of exercise-induced neuroplasticity, explores the central effects mechanism of exercise on patients with chronic low back pain, and further looks forward to new directions in targeted neuroplasticity-based rehabilitation treatment for chronic low back pain.
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Affiliation(s)
- Jianpeng Zou
- Department of Rehabilitation and Physiotherapy, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shijie Hao
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Goikoetxea-Sotelo G, van Hedel HJA. Defining, quantifying, and reporting intensity, dose, and dosage of neurorehabilitative interventions focusing on motor outcomes. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1139251. [PMID: 37637933 PMCID: PMC10457006 DOI: 10.3389/fresc.2023.1139251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023]
Abstract
Introduction Determining the minimal amount of therapy needed for positive neurorehabilitative outcomes is important for optimizing active treatment interventions to improve motor outcomes. However, there are various challenges when quantifying these relationships: first, several consensuses on the definition and usage of the terms intensity, dose, and dosage of motor interventions have been proposed, but there seems to be no agreement, and the terms are still used inconsistently. Second, randomized controlled trials frequently underreport items relevant to determining the intensity, dose, and dosage of the interventions. Third, there is no universal measure to quantify therapy intensity accurately. This "perspectives" paper aims to increase awareness of these topics among neurorehabilitation specialists. Defining quantifying and reporting We searched the literature for definitions of intensity, dose, and dosage and adapted the ones we considered the most appropriate to fit the needs of neurorehabilitative interventions. Furthermore, we suggest refining the template for intervention description and replication (TIDieR) to enhance the reporting of randomized controlled trials. Finally, we performed a systematic literature search to provide a list of intensity measures and complemented these with some novel candidate measures. Discussion The proposed definitions of intensity, dose, and dosage could improve the communication between neurorehabilitation specialists and the reporting of dose and dosage in interventional studies. Quantifying intensity is necessary to improve our understanding of the minimal intensity, dose, and dosage of therapy needed to improve motor outcomes in neurorehabilitation. We consider the lack of appropriate intensity measures a significant gap in knowledge requiring future research.
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Affiliation(s)
- Gaizka Goikoetxea-Sotelo
- Swiss Children’s Rehab, University Children’s Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Hubertus J. A. van Hedel
- Swiss Children’s Rehab, University Children’s Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
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Johnson BP, Cohen LG. Applied strategies of neuroplasticity. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:599-609. [PMID: 37620093 DOI: 10.1016/b978-0-323-98817-9.00011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Various levels of somatotopic organization are present throughout the human nervous system. However, this organization can change when needed based on environmental demands, a phenomenon known as neuroplasticity. Neuroplasticity can occur when learning a new motor skill, adjusting to life after blindness, or following a stroke. Following an injury, these neuroplastic changes can be adaptive or maladaptive, and often occur regardless of whether rehabilitation occurs or not. But not all movements produce neuroplasticity, nor do all rehabilitation interventions. Here, we focus on research regarding how to maximize adaptive neuroplasticity while also minimizing maladaptive plasticity, known as applied neuroplasticity. Emphasis is placed on research exploring how best to apply neuroplastic principles to training environments and rehabilitation protocols. By studying and applying these principles in research and clinical practice, it is hoped that learning of skills and regaining of function and independence can be optimized.
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Affiliation(s)
- Brian P Johnson
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
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Update on an Observational, Clinically Useful Gait Coordination Measure: The Gait Assessment and Intervention Tool (G.A.I.T.). Brain Sci 2022; 12:brainsci12081104. [PMID: 36009168 PMCID: PMC9405699 DOI: 10.3390/brainsci12081104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
With discoveries of brain and spinal cord mechanisms that control gait, and disrupt gait coordination after disease or injury, and that respond to motor training for those with neurological disease or injury, there is greater ability to construct more efficacious gait coordination training paradigms. Therefore, it is critical in these contemporary times, to use the most precise, sensitive, homogeneous (i.e., domain-specific), and comprehensive measures available to assess gait coordination, dyscoordination, and changes in response to treatment. Gait coordination is defined as the simultaneous performance of the spatial and temporal components of gait. While kinematic gait measures are considered the gold standard, the equipment and analysis cost and time preclude their use in most clinics. At the same time, observational gait coordination scales can be considered. Two independent groups identified the Gait Assessment and Intervention Tool (G.A.I.T.) as the most suitable scale for both research and clinical practice, compared to other observational gait scales, since it has been proven to be valid, reliable, sensitive to change, homogeneous, and comprehensive. The G.A.I.T. has shown strong reliability, validity, and sensitive precision for those with stroke or multiple sclerosis (MS). The G.A.I.T. has been translated into four languages (English, Spanish, Taiwanese, and Portuguese (translation is complete, but not yet published)), and is in use in at least 10 countries. As a contribution to the field, and in view of the evidence for continued usefulness and international use for the G.A.I.T. measure, we have provided this update, as well as an open access copy of the measure for use in clinical practice and research, as well as directions for administering the G.A.I.T.
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Clos P, Mater A, Legrand H, Poirier G, Ballay Y, Martin A, Lepers R. Corticospinal Excitability Is Lower During Eccentric Than Concentric Cycling in Men. Front Physiol 2022; 13:854824. [PMID: 35370788 PMCID: PMC8966379 DOI: 10.3389/fphys.2022.854824] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
How corticospinal excitability changes during eccentric locomotor exercise is unknown. In the present study, 13 volunteers performed 30-min strenuous concentric and eccentric cycling bouts at the same power output (60% concentric peak power output). Transcranial magnetic and electrical femoral nerve stimulations were applied at exercise onset (3rd min) and end (25th min). Motor-evoked potentials (MEPs) amplitude was measured for the rectus femoris (RF) and vastus lateralis (VL) muscles with surface electromyography (EMG) and expressed as a percentage of maximal M-wave amplitude (MMAX). EMG amplitude 100 ms prior to MEPs and the silent period duration were calculated. There was no change in any neural parameter during the exercises (all P > 0.24). VL and RF MMAX were unaffected by exercise modality (all P > 0.38). VL MEP amplitude was greater (26 ± 11.4 vs. 15.2 ± 7.7% MMAX; P = 0.008) during concentric than eccentric cycling whereas RF MEP amplitude was not different (24.4 ± 10.8 vs. 17.2 ± 9.8% MMAX; P = 0.051). While VL EMG was higher during concentric than eccentric cycling (P = 0.03), RF EMG showed no significant difference (P = 0.07). Similar silent period durations were found (RF: 120 ± 30 ms; VL: 114 ± 27 ms; all P > 0.61), but the silent period/MEP ratio was higher during eccentric than concentric cycling for both muscles (all P < 0.02). In conclusion, corticospinal excitability to the knee extensors is lower and relative silent period longer during eccentric than concentric cycling, yet both remained unaltered with time.
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Proessl F, Canino MC, Beckner ME, Conkright WR, LaGoy AD, Sinnott AM, Eagle SR, Martin BJ, Sterczala AJ, Roma PG, Dretsch MN, Mi Q, Ferrarelli F, Germain A, Connaboy C, Nindl BC, Flanagan SD. Use-dependent corticospinal excitability is associated with resilience and physical performance during simulated military operational stress. J Appl Physiol (1985) 2022; 132:187-198. [PMID: 34855522 PMCID: PMC8791840 DOI: 10.1152/japplphysiol.00628.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Simulated military operational stress (SMOS) provides a useful model to better understand resilience in humans as the stress associated with caloric restriction, sleep deficits, and fatiguing exertion degrades physical and cognitive performance. Habitual physical activity may confer resilience against these stressors by promoting favorable use-dependent neuroplasticity, but it is unclear how physical activity, resilience, and corticospinal excitability (CSE) relate during SMOS. To examine associations between corticospinal excitability, physical activity, and physical performance during SMOS. Fifty-three service members (age: 26 ± 5 yr, 13 women) completed a 5-day and -night intervention composed of familiarization, baseline, SMOS (2 nights/days), and recovery days. During SMOS, participants performed rigorous physical and cognitive activities while receiving half of normal sleep (two 2-h blocks) and caloric requirements. Lower and upper limb CSE were determined with transcranial magnetic stimulation (TMS) stimulus-response curves. Self-reported resilience, physical activity, military-specific physical performance (TMT), and endocrine factors were compared in individuals with high (HIGH) and low CSE based on a median split of lower limb CSE at baseline. HIGH had greater physical activity and better TMT performance throughout SMOS. Both groups maintained physical performance despite substantial psychophysiological stress. Physical activity, resilience, and TMT performance were directly associated with lower limb CSE. Individual differences in physical activity coincide with lower (but not upper) limb CSE. Such use-dependent corticospinal excitability directly relates to resilience and physical performance during SMOS. Future studies may use noninvasive neuromodulation to clarify the interplay among CSE, physical activity, and resilience and improve physical and cognitive performance.NEW & NOTEWORTHY We demonstrate that individual differences in physical activity levels coincide with lower limb corticospinal excitability. Such use-dependent corticospinal excitability directly relates to resilience and physical performance during a 5-day simulation of military operational stress with caloric restriction, sleep restriction and disruption, and heavy physical and cognitive exertion.
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Affiliation(s)
- F. Proessl
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M. C. Canino
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M. E. Beckner
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - W. R. Conkright
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - A. D. LaGoy
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania,4Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - A. M. Sinnott
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - S. R. Eagle
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - B. J. Martin
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - A. J. Sterczala
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - P. G. Roma
- 2Behavioral Health & Performance Laboratory, Biomedical Research and Environmental Sciences Division, Human Health and Performance Directorate, NASA Johnson Space Center/KBR, Houston, Texas
| | - M. N. Dretsch
- 3U.S. Army Medical Research Directorate-West, Walter Reed
Army Institute of Research, Joint Base Lewis-McChord, Washington
| | - Qi Mi
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - F. Ferrarelli
- 4Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - A. Germain
- 4Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - C. Connaboy
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - B. C. Nindl
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - S. D. Flanagan
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
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Clos P, Mater A, Laroche D, Lepers R. Concentric versus eccentric cycling at equal power output or effort perception: Neuromuscular alterations and muscle pain. Scand J Med Sci Sports 2021; 32:45-59. [PMID: 34533875 DOI: 10.1111/sms.14053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/16/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to compare neuromuscular alterations and perceptions of effort and muscle pain induced by concentric and eccentric cycling performed at the same power output or effort perception. Fifteen participants completed three 30-min sessions: one in concentric at 60% peak power output (CON) and two in eccentric, at the same power output (ECCPOWER ) or same perceived effort (ECCEFFORT ). Muscle pain, perception of effort, oxygen uptake as well as rectus femoris and vastus lateralis electromyographic activities were collected when pedaling. The knee extensors maximal voluntary contraction (MVC) torque, the torque evoked by double stimulations at 100 Hz and 10 Hz (Dt100; Dt10), and the voluntary activation level (VAL) were evaluated before and after exercise. Power output was higher in ECCEFFORT than CON (89.1 ± 23.3% peak power). Muscle pain and effort perception were greater in CON than ECCPOWER (p < 0.03) while muscle pain was similar in CON and ECCEFFORT (p > 0.43). MVC torque, Dt100, and VAL dropped in all conditions (p < 0.04). MVC torque (p < 0.001) and the Dt10/ Dt100 ratio declined further in ECCEFFORT (p < 0.001). Eccentric cycling perceived as difficult as concentric cycling caused similar muscle pain but more MVC torque decrease. A given power output induced lower perceptions of pain and effort in eccentric than in concentric yet similar MVC torque decline. While neural impairments were similar in all conditions, eccentric cycling seemed to alter excitation-contraction coupling. Clinicians should thus be cautious when setting eccentric cycling intensity based on effort perception.
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Affiliation(s)
- Pierre Clos
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Adrien Mater
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Davy Laroche
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Romuald Lepers
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
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