Distribution of corticospinal motor fibres within the cervical spinal cord with special reference to the phrenic nucleus: a WGA-HRP anterograde transport study in the cat

The phrenic neuromuscular system

The phrenic neuromuscular system consists of the phrenic motor nucleus in the mid-cervical spinal cord, the phrenic nerve, and the diaphragm muscle. This motor system helps sustain breathing throughout life, while also contributing to posture, coughing, swallowing, and speaking. The phrenic nerve contains primarily efferent phrenic axons and afferent axons from diaphragm sensory receptors but is also a conduit for autonomic fibers. On a breath-by-breath basis, rhythmic (inspiratory) depolarization of phrenic motoneurons occurs due to excitatory bulbospinal synaptic pathways. Further, a complex propriospinal network innervates phrenic motoneurons and may serve to coordinate postural, locomotor, and respiratory movements. The phrenic neuromuscular system is impacted in a wide range of neuromuscular diseases and injuries. Contemporary research is focused on understanding how neuromuscular plasticity occurs in the phrenic neuromuscular system and using this information to optimize treatments and rehabilitation strategies to improve breathing and related behaviors.

Role of the diaphragm in trunk rotation in humans

The objectives of the present study were to test the hypothesis that the costal diaphragm contracts during ipsilateral rotation of the trunk and that such trunk rotation increases the motor output of the muscle during inspiration. Monopolar electrodes were inserted in the right costal hemidiaphragm in six subjects, and electromyographic (EMG) recordings were made during isometric rotation efforts of the trunk to the right ("ipsilateral rotation") and to the left ("contralateral rotation"). EMG activity was simultaneously recorded from the parasternal intercostal muscles on the right side. The parasternal intercostals were consistently active during ipsilateral rotation but silent during contralateral rotation. In contrast, the diaphragm was silent in the majority of rotations in either direction, and whenever diaphragm activity was recorded, it involved very few motor units. In addition, whereas parasternal inspiratory activity substantially increased during ipsilateral rotation and decreased during contralateral rotation, inspiratory activity in the diaphragm was essentially unaltered and the discharge frequency of single motor units in the muscle remained at 13-14 Hz in the different postures. It is concluded that 1) the diaphragm makes no significant contribution to trunk rotation and 2) even though the diaphragm and parasternal intercostals contract in a coordinated manner during resting breathing, the inspiratory output of the two muscles is affected differently by voluntary drive during trunk rotation.

Neural control of phrenic motoneuron discharge

Phrenic motoneurons (PMNs) provide a synaptic relay between bulbospinal respiratory pathways and the diaphragm muscle. PMNs also receive propriospinal inputs, although the functional role of these interneuronal projections has not been established. Here we review the literature regarding PMN discharge patterns during breathing and the potential mechanisms that underlie PMN recruitment. Anatomical and neurophysiological studies indicate that PMNs form a heterogeneous pool, with respiratory-related PMN discharge and recruitment patterns likely determined by a balance between intrinsic MN properties and extrinsic synaptic inputs. We also review the limited literature regarding PMN bursting during respiratory plasticity. Differential recruitment or rate modulation of PMN subtypes may underlie phrenic motor plasticity following neural injury and/or respiratory stimulation; however, this possibility remains relatively unexplored.

EMG recurrence quantifications in dynamic exercise

This study was designed to evaluate the suitability of nonlinear recurrence quantification analysis (RQA) in assessing electromyograph (EMG) signals during dynamic exercise. RQA has been proven to be effective in analyzing nonstationary signals. The subject group consisted of 19 male patients diagnosed with low back pain. EMG signals were recorded from left and right paraspinal muscles during isoinertial exercise both before and after 12 weeks of regimented physical therapy. Autorecurrence analysis was performed between the left and right EMG signals individually, and cross-recurrence analysis was performed on the left-right EMG pairs. Spectral analysis of the EMG signals was employed as an independent, objective measure of fatigue. Increase in the RQA variable % determinism during the 90-s dynamic tests was found to be a good marker for fatigue. Before physical therapy, this nonlinear marker revealed simultaneous increases in motor unit recruitment within each pool and between left and right pools. After physical therapy, the motor unit recruitment was less within and between pools, indicative of increased fatigue resistance. Finally, fatigue resistance (less increase in % determinism) correlated well with subjective scores of pain relief. Taken together, these latter results indicate that recurrence analysis may be useful in charting the efficacy of a specific exercise therapy program in reducing low back pain by elevating the fatigue threshold.

Control of the respiratory cycle in conscious humans

We studied in conscious humans the relative strength of mechanisms controlling timing and drive components of the respiratory cycle around their resting set points. A system of auditory feedback with end-tidal PCO2 held constant in mild hyperoxia via an open circuit was used to induce subjects independently to change inspiratory time (TI) and tidal volume (VTI) over a wide range above and below the resting values for every breath for up to 1 h. Four protocols were studied in various levels of hypercapnia (1-5% inspired CO2). We found that TI (and expiratory time) could be changed over a wide range (1.17 - 2.86 s, P < 0.01 for TI) and VTI increased by > or = 500 ml (P < 0.01) without difficulty. However, in no protocol was it possible to decrease VTI below the free-breathing resting value in response to reduction of auditory feedback thresholds by up to 600 ml. This applied at all levels of chemical drive studied, with resting VTI values varying from 1.06 to 1.74 liters. When reduction in VTI was forced by the more "programmed" procedure of isocapnic panting, end-expiratory of volume was sacrificed to ensure that peak tidal volume reached a fixed absolute lung volume. These results suggest that the imperative for control of resting breathing is to prevent reduction of VTI below the level dictated by the prevailing chemical drive, presumably to sustain metabolic requirements of the body, whereas respiratory timing is weakly controlled consistent with the needs for speech and other nonmetabolic functions of breathing.

Thalamocortical projections activated by phrenic nerve afferents in the cat

This study identified thalamocortical projections activated by respiratory afferents. Cortical evoked potentials were recorded in the right primary somatosensory cortex of the cat following electrical stimulation of the left C5 root of the phrenic nerve. The majority of primary sites were located in the vicinity of the postcruciate dimple, in area 3a near the 3a/3b border, corresponding to the trunk region of the cortical body map. Retrograde fluorescent tracers injected at the sites of primary activation produced labeled cells in the oralis nucleus of the ventroposterior complex [4]. Control injections made in adjacent cortical areas not activated by phrenic stimulation resulted in labeling in the ventroposterior complex which did not overlap that seen with injections of primary activation sites. We conclude that respiratory muscle afferents in the phrenic nerve elicit activity in the trunk region of primary somatosensory cortex via specific thalamocortical projections originating in the oralis portion of the thalamic ventroposterior complex.

Evidence for bilateral innervation of certain homologous motoneurone pools in man

1. Surface EMG recordings were made from left and right homologous muscle pairs in healthy adults. During each recording session subjects were requested to maintain a weak isometric contraction of both the left and right muscle. 2. Cross-correlation analysis of the two multiunit EMG recordings from each pair of muscles was performed. Central peaks of short duration (mean durations, 11.3-13.0 ms) were seen in correlograms constructed from multiunit EMG recordings obtained from left and right diaphragm, rectus abdominis and masseter muscles. No central peaks were seen in correlograms constructed from the multiunit EMG recordings from left and right upper limb muscles. 3. To investigate descending pathways to the homologous muscle pairs, the dominant motor cortex was stimulated using a focal magnetic brain stimulator whilst recording from homologous muscle pairs. 4. Following magnetic stimulation of the dominant motor cortex, a response was recorded from both right and left diaphragm, rectus abdominis and masseter muscles. In contrast, when recording from homologous upper limb muscles, a response was only seen contralateral to the side of stimulation. 5. The finding of short duration central peaks in the cross-correlograms constructed from multiunit recordings from left and right diaphragm, rectus abdominis and masseter, suggests that muscles such as these, that are normally co-activated, share a common drive. The mechanism is discussed and it is argued that the time course of the central correlogram peaks is consistent with the hypothesis that they could be produced by a common drive that arises from activity in last-order branched presynaptic fibres although presynaptic synchronization of last-order inputs is also likely to be involved. 6. The results of the magnetic stimulation experiments suggest that this common drive may involve the corticospinal tract. 7. We saw no evidence for a common drive to left and right homologous muscle pairs that may be voluntarily co-activated but often act independently.

The cortical drive to human respiratory muscles in the awake state assessed by premotor cerebral potentials

1. We investigated the possibility of a cortical contribution to human respiration by recording from the scalp of awake subjects the premotor cerebral potentials that are known to precede voluntary limb movements. 2. Electroencephalographic activity (EEG) was recorded from scalp electrodes and averaged for 1.8-2.0 s before the time at which airway pressure exceeded an inspiratory or expiratory threshold. Clear premotor cerebral potentials were recorded during brisk, self-paced nasal inhalations or exhalations. In ten subjects, a slow cortical negativity (Bereitschaftspotential) was apparent in the averaged EEG, commencing 1.2 +/- 0.3 s before the onset of inspiratory (scalene) or expiratory (abdominal) muscle activity (EMG). It was maximal at the vertex, with a mean slope of 12.3 +/- 5.8 microV/s, and was followed by a post-movement positivity. 3. In four subjects the inspiratory premotor potential culminated in a large negativity, the motor potential, which began 24 +/- 15 ms before the onset of scalene EMG. It is argued that such a short latency is consistent with a volitionally generated respiratory command which travels relatively directly to the respiratory muscles, having a total central delay which is no longer than that for voluntary finger movements. 4. That the respiratory premotor and motor potentials did not originate in subcortical structures was supported by their absence in a patient suffering from chronic reflexogenic hiccups, in whom cerebral activity was back-averaged from each brisk hiccup. 5. During quiet breathing, in which subjects were relaxed and distracted from thinking about their respiration, no premotor cerebral potentials preceding inspiration could be detected. This failure was not due to the slow rate of rise of inspiratory activity during quiet breathing as compared with a brisk sniff, because premotor potentials were detected when subjects intermittently generated slow active expiratory efforts. 6. These observations suggest that during quiet breathing the cerebral cortex does not contribute to respiratory drive on a breath-by-breath basis. Conversely, the presence of clear premotor cerebral potentials when subjects performed self-paced inspiratory or expiratory manoeuvres illustrates the powerful cortical projection to human respiratory muscles.

Synchronization of motor unit firing during different respiratory and postural tasks in human sternocleidomastoid muscle

1. Motor unit firing has been studied in human sternocleidomastoid muscle. 2. Two needle electrodes were inserted into the muscle and the activity of pairs of motor units recorded during (a) reflex hypercapnic obstructed breathing, (b) eucapnic voluntary copying of (a) against the same inspiratory resistance and (c) voluntary copying of (a) without any resistance, accompanied by isometric neck rotation. 3. Cross-correlation histograms of the firing of unit pairs showed a clear central peak, indicative of synchronization. The mean duration of the peak during voluntary breathing was 25 ms (range 9-40 ms). There was no difference in duration of synchronization during the different tasks. 4. For the duration of the synchronization peak, the mean strength of synchronization expressed as the number of concomitant discharges of the two units as a proportion of the total number of discharges was 0.026 (range 0.011-0.058) for reflex hypercapnic obstructed breathing. For the same unit pairs the strength of synchronization for isometric neck rotation was the same as that during reflex hypercapnic breathing but for voluntary obstructed breathing it was, on average, threefold greater. 5. In three out of twenty-two motor units studied, 'discharge' occurred with an interval of less than 10 ms ('doublet' firing) at the onset of each inspiration during both types of obstructed breathing; this was rarely observed during neck rotation. 6. The results are interpreted in terms of different synaptic drives to the motor units during the three different tasks.

Monoaminergic and GABAergic terminations in phrenic nucleus of rat identified by immunohistochemical labeling

The termination patterns of axons in the phrenic nucleus immunoreactive to synthetic enzymes for catecholamines and for serotonin and GABA were studied in rats. Spinal cord tissue in which phrenic motoneurons were retrogradely labeled with horseradish peroxidase was incubated with antisera against dopamine beta-hydroxylase, phenylethanolamine-N-methyltransferase, 5-hydroxytryptamine, and GABA to identify presumptive terminations of monoaminergic and GABAergic neurons onto identified phrenic motoneurons. In the C3 to C5 spinal cord, 5-hydroxytryptamine-, dopamine beta-hydroxylase- and GABA-like positive terminals with varicosities formed a dense network, with presumptive synaptic contacts on dendrites and somas of phrenic motoneurons. A similar pattern of terminations was also observed in adjacent (non-respiratory muscle) motoneuron pools. There were fewer phenylethanolamine-N-methyltransferase-positive terminal arborizations in the cervical spinal cord compared to thoracic spinal cord; phenylethanolamine-N-methyltransferase terminals were not seen in the vicinity of phrenic motoneurons. These results suggest that phrenic motoneuronal activity is influenced by multiple supraspinal inputs utilizing different neurotransmitters. These transmitters also mediate inputs to other (nearby) spinal motoneurons and thus are not unique for signal transmission to phrenic motoneurons.

Responses in human intercostal and truncal muscles to motor cortical and spinal stimulation

Percutaneous electrical stimulation of the human motor cortex (up to 750 V) has been used to study the cortical projections to intercostal and truncal muscles. The latencies of electromyographic (EMG) responses were measured to motor cortical stimuli and also to spinal stimulation of the appropriate nerve roots. Following single anodal stimuli at (or near) the vertex, short-latency responses were recorded in pectoralis major (mean 9.6 msec), latissimus dorsi (9.7 msec), paravertebral muscles (11.1 msec), 3rd/4th parasternal intercostals (11.1 msec), and 6th/7th intercostal muscles (12.3 msec). Responses in each muscle group were potentiated by background voluntary respiratory and truncal manoeuvres which activated the muscles. The mean estimated central conduction times from motor cortex to spinal segmental level were 4.8 msec for pectoralis major, 5.8 msec for parasternal intercostals and 6.2 msec for 6th/7th intercostal muscles. The central conduction times and properties of the cortically evoked responses are consistent with a rapidly conducting, oligosynaptic pathway from the human motor cortex to accessory respiratory muscles and to truncal muscles.