The effect of muscle hyper- and hypoactivity upon fibre diameters of intact and regenerating nerves

The Role of Physical Exercise and Rehabilitative Implications in the Process of Nerve Repair in Peripheral Neuropathies: A Systematic Review

BACKGROUND

The various mechanisms involved in peripheral nerve regeneration, induced by exercise and electrical nerve stimulation, are still unclear.

OBJECTIVE

The aim of this review was to summarize the influence of physical exercise and/or electrical stimulation on peripheral nerve repair and regeneration and the variation of impact of intervention depending on timing, as well as kind and dosage of the intervention. A literature survey was conducted on PubMed, Scopus, and Web of Science, between February 2021 to July 2021, with an update in September 2022.

METHODOLOGY

The literature search identified 101,386 articles with the keywords: "peripheral nerve" OR "neuropathy" AND "sprouting" OR "neuroapraxia" OR "axonotmesis" OR "neurotmesis" OR "muscle denervation" OR "denervated muscle" AND "rehabilitation" OR "physical activity" OR "physical exercise" OR "activity" OR "electrical stimulation". A total of 60 publications were included. Eligible studies were focused on evaluating the process of nerve repair (biopsy, electromyographic parameters or biomarker outcomes) after electrical stimulation or physical exercise interventions on humans or animals with peripheral sensory or motor nerve injury.

SYNTHESIS

This study shows that the literature, especially regarding preclinical research, is mainly in agreement that an early physical program with active exercise and/or electrical stimulation promotes axonal regenerative responses and prevents maladaptive response. This was evaluated by means of changes in electrophysiological recordings of CMAPs for latency amplitude, and the sciatic functional index (SFI). Furthermore, this type of activity can cause an increase in weight and in muscle fiber diameter. Nevertheless, some detrimental effects of exercising and electrical stimulation too early after nerve repair were recorded.

CONCLUSION

In most preclinical studies, peripheral neuropathy function was associated with improvements after physical exercise and electrical stimulation. For humans, too little research has been conducted on this topic to reach a complete conclusion. This research supports the need for future studies to test the validity of a possible rehabilitation treatment in humans in cases of peripheral neuropathy to help nerve sprouting.

Increases in human motoneuron excitability after cervical spinal cord injury depend on the level of injury

After human spinal cord injury (SCI), motoneuron recruitment and firing rate during voluntary and involuntary contractions may be altered by changes in motoneuron excitability. Our aim was to compare F waves in single thenar motor units paralyzed by cervical SCI to those in uninjured controls because at the single-unit level F waves primarily reflect the intrinsic properties of the motoneuron and its initial segment. With intraneural motor axon stimulation, F waves were evident in all 4 participants with C₄-level SCI, absent in 8 with C₅ or C₆ injury, and present in 6 of 12 Uninjured participants (P < 0.001). The percentage of units that generated F waves differed across groups (C₄: 30%, C₅ or C₆: 0%, Uninjured: 16%; P < 0.001). Mean (±SD) proximal axon conduction velocity was slower after C₄ SCI [64 ± 4 m/s (n = 6 units), Uninjured: 73 ± 8 m/s (n = 7 units); P = 0.037]. Mean distal axon conduction velocity differed by group [C₄: 40 ± 8 m/s (n = 20 units), C₅ or C₆: 49 ± 9 m/s (n = 28), Uninjured: 60 ± 7 m/s (n = 45); P < 0.001]. Motor unit properties (EMG amplitude, twitch force) only differed after SCI (P ≤ 0.004), not by injury level. Motor units with F waves had distal conduction velocities, M-wave amplitudes, and twitch forces that spanned the respective group range, indicating that units with heterogeneous properties produced F waves. Recording unitary F waves has shown that thenar motoneurons closer to the SCI (C₅ or C₆) have reduced excitability whereas those further away (C₄) have increased excitability, which may exacerbate muscle spasms. This difference in motoneuron excitability may be related to the extent of membrane depolarization following SCI.

NEW & NOTEWORTHY

Unitary F waves were common in paralyzed thenar muscles of people who had a chronic spinal cord injury (SCI) at the C₄ level compared with uninjured people, but F waves did not occur in people that had SCI at the C₅ or C₆ level. These results highlight that intrinsic motoneuron excitability depends, in part, on how close the motoneurons are to the site of the spinal injury, which could alter the generation and strength of voluntary and involuntary muscle contractions.

Effects of endurance and resistance training on calcitonin gene-related Peptide and acetylcholine receptor at slow and fast twitch skeletal muscles and sciatic nerve in male wistar rats

The aim of this study was to investigate effects of endurance and resistance training (ET and RT) on CGRP and AChRs at slow and fast twitch muscles and sciatic nerve in rats. Twenty-five male rats were randomly assigned into three groups including sedentary (SED), endurance training (ET), and resistance training (RT). Animals of ET exercised for 12 weeks, five times/week, and 60 min/day at 30 m/min. Animals of RT were housed in metal cage with 2 m high wire-mesh tower, with water bottles set at the top. 48 h after the last session of training protocol, animals were anaesthetized. The right sciatic nerves were removed; then, Soleus (SOL) and Tibialis anterior (TA) muscles were excised and immediately snap frozen in liquid nitrogen. All frozen tissues were stored at -80°C. Results showed that, after both ET and RT, CGRP content as well as AChR content of SOL and TA muscles significantly increased. But there was no significant difference among groups at sciatic nerve' CGRP content. In conclusion, data demonstrate that ET and RT lead to changes of CGRP and AChR content of ST and FT muscles. The changes indicate to the importance of neuromuscular activity.

Balance and coordination training after sciatic nerve injury

INTRODUCTION

Numerous therapeutic interventions have been tested to enhance functional recovery after peripheral nerve injuries.

METHODS

After sciatic nerve crush in rats we tested balance and coordination and motor control training in sensorimotor tests and analyzed nerve and muscle histology.

RESULTS

The balance and coordination training group and the sham group had better results than the sedentary and motor control groups in sensorimotor tests. The sham and balance and coordination groups had a significantly larger muscle area than the other groups, and the balance and coordination group showed significantly better values than the sedentary and motor control groups for average myelin sheath thickness and g-ratio of the distal portion of the nerve.

CONCLUSIONS

The findings indicate that balance and coordination training improves sciatic nerve regeneration, suggesting that it is possible to revert and/or prevent soleus muscle atrophy and improve performance on sensorimotor tests.

Exercise and fitness are related to peripheral nervous system function in overweight adults

PURPOSE

This study examined the association between physical activity and fitness and peripheral nervous system (PNS) function in overweight and obese individuals.

METHODS

Forty nondiabetic overweight adults (mean +/- SD; age = 44 +/- 11 yr) were recruited for the study. Peroneal motor nerve and radial, sural, and medial plantar sensory nerve conductions were studied. Maximal oxygen uptake was measured in an incremental bicycle ergometer test. Physical activity was assessed by accelerometer and self-reporting. We analyzed the data using multiple stepwise linear regression models adjusted for age, height, and skin temperature.

RESULTS

VO2max predicted 17% of peroneal distal compound muscle action potential (CMAP) amplitude variation and 16% of peroneal proximal CMAP amplitude variation. Physical activity index at the age of 30 yr predicted 9% of peroneal motor nerve conduction velocity (NCV), 8% of peroneal F-wave maximum latency, 14% of medial plantar sensory latency, and 10% of medial plantar sensory NCV variation.

CONCLUSIONS

Physical activity and fitness are positively associated with PNS function and should be encouraged in overweight people.

Effect of treadmill exercise on serotonin immunoreactivity in medullary raphe nuclei and spinal cord following sciatic nerve transection in rats

The serotoninergic system modulates nociceptive and locomotor spinal cord circuits. Exercise improves motor function and changes dopaminergic, noradrenergic, and serotonergic central systems. However, the direct relationship between serotonin, peripheral nerve lesion and aerobic treadmill exercise has not been studied. Using immunohistochemistry and optic densitometry, this study showed that the sciatic nerve transection increased the serotoninergic immunoreactivity in neuronal cytoplasm of the magnus raphe nuclei of trained and sedentary rats. In the dorsal raphe nucleus the increase only occurred in sedentary-sham-operated rats. In the spinal cord of trained, transected rats, the ventral horn showed significant changes, while the change in dorsal horn was insignificant. Von Frey's test indicated analgesia in all exercise-trained rats. The sciatic nerve functional index indicated recovery in the trained group. Thus, both the aerobic treadmill exercise training and the nervous lesion appear to contribute to changes in serotonin immunoreactivity.

Endurance and resistance exercise training programs elicit specific effects on sciatic nerve regeneration after experimental traumatic lesion in rats

OBJECTIVE

To evaluate the effects of endurance, resistance, and a combination of both types of exercise training on hindlimb motor function recovery and nerve regeneration after experimental sciatic nerve lesion in rats.

METHODS

Sciatic nerve crush was performed on adult male rats, and after 2 weeks of the nerve lesion, the animals were submitted to endurance, resistance, and a combination of endurance-resistance training programs for 5 weeks. Over the training period, functional recovery was monitored weekly using the Sciatic Functional Index (SFI) and histological and morphometric nerve analyses were used to assess the nerve regeneration at the end of the trainings.

RESULTS

The SFI values of the endurance-trained group reached the control values from the first posttraining week and were significantly better than both the resistance-trained group at the first, second, and third posttraining weeks and the concurrent training group at the first posttraining week. At the distal portion of the regenerating sciatic nerve, the endurance-trained group showed a greater degree of the myelinated fiber maturation than the sedentary, resistance-trained, and concurrent training groups. Furthermore, the endurance-trained group showed a smaller percentage area of endoneurial connective tissue and a greater percentage area of myelinated fibers than the sedentary group.

CONCLUSION

These data provide evidence that endurance training improves sciatic nerve regeneration after an experimental traumatic injury and that resistance training or the combination of 2 strategies may delay functional recovery and do not alter sciatic nerve fiber regeneration.

Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice

The structural organization of peripheral nerves enables them to function while tolerating and adapting to stresses placed upon them by postures and movements of the trunk, head, and limbs. They are exposed to combinations of tensile, shear, and compressive stresses that result in nerve excursion, strain, and transverse contraction. The purpose of this appraisal is to review the structural and biomechanical modifications seen in peripheral nerves exposed to various levels of physical stress. We have followed the primary tenet of the Physical Stress Theory presented by Mueller and Maluf (2002), specifically, that the level of physical stress placed upon biological tissue determines the adaptive response of the tissue. A thorough understanding of the biomechanical properties of normal and injured nerves and the stresses placed upon them in daily activities will help guide physical therapists in making diagnoses and decisions regarding interventions.

Neural Adaptations to Resistive Exercise

It is generally accepted that neural factors play an important role in muscle strength gains. This article reviews the neural adaptations in strength, with the goal of laying the foundations for practical applications in sports medicine and rehabilitation. An increase in muscular strength without noticeable hypertrophy is the first line of evidence for neural involvement in acquisition of muscular strength. The use of surface electromyographic (SEMG) techniques reveal that strength gains in the early phase of a training regimen are associated with an increase in the amplitude of SEMG activity. This has been interpreted as an increase in neural drive, which denotes the magnitude of efferent neural output from the CNS to active muscle fibres. However, SEMG activity is a global measure of muscle activity. Underlying alterations in SEMG activity are changes in motor unit firing patterns as measured by indwelling (wire or needle) electrodes. Some studies have reported a transient increase in motor unit firing rate. Training-related increases in the rate of tension development have also been linked with an increased probability of doublet firing in individual motor units. A doublet is a very short interspike interval in a motor unit train, and usually occurs at the onset of a muscular contraction. Motor unit synchronisation is another possible mechanism for increases in muscle strength, but has yet to be definitely demonstrated. There are several lines of evidence for central control of training-related adaptation to resistive exercise. Mental practice using imagined contractions has been shown to increase the excitability of the cortical areas involved in movement and motion planning. However, training using imagined contractions is unlikely to be as effective as physical training, and it may be more applicable to rehabilitation. Retention of strength gains after dissipation of physiological effects demonstrates a strong practice effect. Bilateral contractions are associated with lower SEMG and strength compared with unilateral contractions of the same muscle group. SEMG magnitude is lower for eccentric contractions than for concentric contractions. However, resistive training can reverse these trends. The last line of evidence presented involves the notion that unilateral resistive exercise of a specific limb will also result in training effects in the unexercised contralateral limb (cross-transfer or cross-education). Peripheral involvement in training-related strength increases is much more uncertain. Changes in the sensory receptors (i.e. Golgi tendon organs) may lead to disinhibition and an increased expression of muscular force. Agonist muscle activity results in limb movement in the desired direction, while antagonist activity opposes that motion. Both decreases and increases in co-activation of the antagonist have been demonstrated. A reduction in antagonist co-activation would allow increased expression of agonist muscle force, while an increase in antagonist co-activation is important for maintaining the integrity of the joint. Thus far, it is not clear what the CNS will optimise: force production or joint integrity. The following recommendations are made by the authors based on the existing literature. Motor learning theory and imagined contractions should be incorporated into strength-training practice. Static contractions at greater muscle lengths will transfer across more joint angles. Submaximal eccentric contractions should be used when there are issues of muscle pain, detraining or limb immobilisation. The reversal of antagonists (antagonist-to-agonist) proprioceptive neuromuscular facilitation contraction pattern would be useful to increase the rate of tension development in older adults, thus serving as an important prophylactic in preventing falls. When evaluating the neural changes induced by strength training using EMG recording, antagonist EMG activity should always be measured and evaluated.

Ulnar nerve conduction velocity in injured baseball pitchers

OBJECTIVE

To compare the ulnar nerve conduction velocity (NCV) of baseball pitchers without elbow injury to baseball pitchers with elbow injury and to persons who do not play baseball.

DESIGN

Cross-sectional.

SETTING

Hospital rehabilitation department.

PARTICIPANTS

Eight college baseball pitchers without elbow injury, 8 age-matched controls who did not play baseball, and 8 college baseball pitchers with a history of elbow injury with tenderness over the cubital tunnel area.

INTERVENTION

Supramaximal electric stimulation was applied superficially to the ulnar nerve at the wrist, below the elbow, and above the elbow of both the dominant and nondominant arms of all subjects. M waves were recorded from the abductor digiti minimi muscles.

MAIN OUTCOME MEASURES

The ulnar NCV was calculated separately for the across-elbow and below-elbow segments. The ulnar NCVs of both arms of the 3 groups were compared by using a 2-way (arm by group) analysis of variance, with a statistical significance level of P less than .05.

RESULTS

The ulnar NCVs were 64.40+/-7.34m/s, 54.97+/-8.67m/s, and 59.18+/-4.10m/s for the pitchers without injury, pitchers with injury, and the subjects who were not pitchers, respectively. The pitchers without injury were significantly faster than the other 2 groups. For pitchers without injury, the ulnar NCVs of the dominant arm were significantly faster than those of the nondominant arm (56.26+/-2.63m/s). No significant difference was found between the dominant and nondominant arms for the group of injured pitchers and for the group of subjects who were not pitchers.

CONCLUSIONS

The ulnar NCVs of the injured pitchers did not appear to be abnormal, but were suboptimal in comparison with the noninjured pitchers. The above-normal NCVs observed in the noninjured pitchers may be the result of an adaptation to trauma associated with ball throwing.

Inactivation of baroafferents leads to loss of barosensitivity without changes in nerve morphology

Baroreceptors are stretch-sensitive mechanoreceptors, which are silenced by preventing distension of the receptor zone. Does chronic inactivation of these peripheral afferents alter their function or morphology? Compound action potentials and morphometry of carotid sinus nerves of 10 rabbits were investigated. The baroafferents were inactivated by embedding the pressure-released carotid sinus into silicon gel. The success of this procedure was validated by the absence of spike activity of the sinus nerve during normal and elevated systemic blood pressure. The contralateral vessels of the same animals were sham-operated and also embedded into silicon, but without prevention of wall movements. After 5, 7, 14 or 28 days the nerves were functionally reinvestigated before and after release of the sinus wall. Afterwards, the morphology of the nerve cross-sections was analysed by morphometry of electron micrographs. Baroafferents did not regain spike activity during immobilisation of the sinus wall. After release of the carotid sinus wall only nerves inactivated for five days regained their pulse synchronous baroreceptor discharge. Following seven days of inactivation, baroreceptor discharge could be elicited by maximal pressure elevation in only one of three nerves. At any time later, the baroreceptor response to arterial pressure changes was lost completely. The activity of the control nerves was preserved after 28 days. No obvious differences in fibre size and myelin thickness were observed between inactivated and control nerves. Inactivation of baroafferents for more than one week leads to a loss of pressure-dependent spike activity. Since morphology did not differ between inactivated and control nerves, it is suggested that changes of baroreceptor endings are responsible for this loss of function.

Exercise training improves functional recovery and motor nerve conduction velocity after sciatic nerve crush lesion in the rat

OBJECTIVE

To observe the effects of exercise training on recuperation of sensorimotor function in the early phase of regeneration, and to monitor the long-term effects of exercise on electrophysiological aspects of the regenerating nerve.

DESIGN

After sciatic nerve crush in 20 male Wistar rats, one random selected group was subjected to 24 days of exercise training, whereas the other group served as sedentary controls.

INTERVENTIONS

Exercise training was induced for 24 days, starting the first postoperation day, by placing bottles of water at such a height that the exercising rats had to maximally erect on both hindpaws to drink.

MAIN OUTCOME MEASURES

Recovery of motor and sensory function in the early phase was monitored by analysis of the free walking pattern and the foot reflex withdrawal test, respectively. Electrophysiological measurements on postoperation days 50, 75, 100, 125, and 150 were used to evaluate the late phase of recovery of nerve conduction velocity.

RESULTS

During the early phase of the recovery period, exercise training enhanced functional recovery. The motor nerve conduction velocity (MNCV), as measured in the late phase of recovery, was significantly better in the trained group than in the control group (p < .01).

CONCLUSIONS

We conclude that exercise training enhances the return of sensomotoric function in the early phase of recovery from peripheral nerve lesion. Furthermore, these results suggest that the beneficial effects of 24 days of exercise training after crush persist in the late phase of peripheral nerve recovery.

Effects of myotoxins on skeletal muscle fibers

This review highlights various aspects of a number of experimental myological alterations, induced by different chemical toxicants, including anticholinesterase, colchicine, vincristine, chloroquine, tetanus toxin, botulinum toxin, reserpine and emetine. Despite their chemical diversity and mechanism(s) of action, it is evident from the data discussed here that remarkably different toxic agents exert quite similar effects and induce toxic myopathies. The latter include preferential involvement of slow-twitch red muscle, mitochondrial derangement, denervation-like alterations, formation of membranous whorls, tubular aggregates, autophagic vacuoles and axonal sprouts. The non-invasive experimental models discussed here are valuable in studying various aspects of myopathology in the absence of any mechanical damage to the innervating elements from neurons to axonal terminals.

Effects on recovery of soleus and extensor digitorum longus muscles of prolonged wheel running during a period of repeated nerve damage

The right sciatic nerve in NMRI mice was frozen under anaesthesia 13 times at three-week intervals for a total period of 8.5 months. During this period, but not afterwards, one sub-group of these mice had access to running wheels in which the animals ran several kilometres per night, thereby actively or passively training reinnervated or denervated leg muscles, as well as the intact contralateral muscles. A number of distinct effects persisted for as long as 14-18 weeks after the termination of this "endurance training". In reinnervated soleus muscle, tetanic force was significantly higher (37%) in the trained muscles as was muscle weight (36%); in general, negative effects of the nerve damage persisted. In the reinnervated extensor digitorum longus, tetanic force and muscle weight were significantly smaller in the trained animals (by 11 and 16%, respectively) which are considered typical effects of endurance training. The resistance of the soleus neuromuscular junction to block by both curare and Mg2+ was depressed on the damaged side but this property was not influenced by the training; in extensor digitorum longus the pattern was similar. It is concluded that training during the period of repeated cycles of denervation-reinnervation produced significant effects which impressively outlasted the training period. The possible nature of these effects is discussed.

Tenotomy-induced motor endplate alterations in rat soleus muscle

The effects of tenotomy on the ultrastructure of rat soleus muscle motor endplates were examined both qualitatively and quantitatively. Rat soleus muscle was studied 2 weeks following tenotomy and compared with normal littermates. The motor endplates from the tenotomized muscles were found to exhibit both degenerative and regenerative changes. Degeneration consisted of postjunctional fold breakdown, exposed junctional folds, myelin-like bodies within the sub-junctional sarcoplasm, and dense bodies within the Schwann cell cytoplasm. The regenerative changes consisted of several small nerve terminals occurring within the same primary synaptic cleft and several axons wrapped by the same Schwann cell. The results demonstrate that tenotomy induces denervation-like changes at endplates that lead to terminal sprouting within the neuromuscular junctional area and remodelling.

Reinnervation and recovery of mouse soleus muscle after long-term denervation

Reinnervation and recovery of the mouse soleus muscle were studied 2-10 months after denervation periods of about 7 months. To maintain denervation the right sciatic nerve was frozen 14 times at 2-week intervals. Though initially intermittent muscle reinnervation occurred, contractile force of denervated muscles was reduced to less than 10% of the contralateral muscles by the fifth nerve freezing and further declined thereafter. Following reinnervation, recovery of soleus muscle force proceeded slowly to reach plateau values after 5-6 months. Tetanic muscle force reached on average 72% (range 58-86%, n = 12) of contralateral muscles after 5-10 months, (P less than 0.01, t-test for absolute values) and 87% of unoperated animals after 10 months (P less than 0.05, n = 5). Muscle fibre diameters were significantly reduced in reinnervated muscles, but frequency distributions were normal and similarly shaped in reinnervated and control muscles, suggesting complete muscle reinnervation and the absence of denervated fibres even at 2 months of reinnervation. Total numbers of muscle fibres were similar in reinnervated (842 +/- 73 S.D., n = 15), contralateral (854 +/- 104 S.D., n = 15) and control soleus muscles (853 +/- 77 S.D., n = 5). The number of myelinated axons in regenerating soleus nerves reached control values by 3 months after the last freezing, continued to increase till 6 months (150% of control), and declined thereafter (125% at 9-10 months). In the contralateral soleus nerves the number of myelinated axons remained constant during this period. Nerve fibre diameters remained abnormally small; even after 10 months of reinnervation fibre diameters were unimodally distributed with a mean diameter of 3.3 microns in contrast to the bimodal distribution in intact nerves (mean values 3.9 and 9.0 microns, respectively). Total fibre cross-section area per nerve increased with time but reached only 54% +/- 6 S.D., (n = 3) of contralateral nerves by 10 months. The relative thickness of the myelin sheath (g-ratio) returned to normal after 9-10 months. Anatomically, muscle reinnervation appeared to be complete by 7-8 weeks since unusually small muscle fibre profiles were absent.(ABSTRACT TRUNCATED AT 400 WORDS)

Motoneuron firing and isomyosin type of muscle fibres in prior polio

In patients with prior polio there was an excessive use of remaining motor units and an absence of type II muscle fibres in the tibialis anterior (TA). In the present study, eight subjects with prior polio with more than 90% type I fibres in the TA were examined. The aim was to elucidate whether the lack of type II muscle fibres was due to a selective loss of motoneurons with high threshold and high axonal conduction velocity or due to a muscle fibre transition from type II to type I. There was no decrease of the proportion of motoneurons with high threshold and high axonal conduction velocity. Monoclonal antibodies against fast and slow myosin heavy chains (MHC) were used as histochemical markers and many muscle fibres of type I according to ATPase stainability showed a binding of both anti-fast and anti-slow MHC. It is suggested that the type I muscle fibre dominance in prior polio subjects with excessive use of TA during walking is due to a muscle fibre transition from type II to type I and not to a loss of one class of motor units.

Fast axonal transport of labeled proteins in motoneurons of exercise-trained rats

In this study, the fast orthograde axonal transport of radiolabeled proteins was measured to determine the effects of endurance-running training on transport velocity and amounts of transported proteins in rat sciatic motoneurons. Female rats were subjected to a progressive running-training program for 10-12 wk. Twenty-four hours after the last training session, rats underwent right L4-L5 dorsal root ganglionectomy. The next day, 20 microCi of [3H]leucine was injected bilaterally in the vicinity of the motoneuronal cell bodies supplying the sciatic nerve, to study axonal transport parameters. Results showed that peak and average transport velocities of labeled proteins were significantly (P less than 0.05) increased by 22 and 29%, respectively, in the deafferented nerves of the runners as compared with controls. Moreover, the amount of total transported protein-bound radioactivity was increased in both left (40%) and right (37%) sciatic nerves of the runners. An exhaustive exercise session reduced (P less than 0.05) peak displacement (8%) and total transported protein-bound radioactivity (36%) in the sciatic nerves of control rats, whereas no changes were noticed in trained animals. The data suggest that chronic endurance running induces significant adaptations in the fast axonal transport of labeled proteins.

Recovery of muscle from tetrodotoxin-induced disuse and the influence of daily exercise. 1. Contractile properties

The extent of recovery in rat gastrocnemius muscles which have undergone atrophic changes due to 4 weeks of inactivity caused by sciatic nerve superfusion of tetrodotoxin, was investigated. Control and tetrodotoxin-treated female Sprague-Dawley rats were subjected to either a daily program of grid-climbing or swim-training for 4 weeks, or benefited from cage activity only. In situ contractile properties of the gastrocnemius were then measured. Twenty-eight days of recovery was insufficient to allow a complete reversal of the changes produced by 28 days of inactivity. The gastrocnemius remained atrophied (25%) and tetanically weaker than normal in the recovered animals. The maximal rate of rise of the twitch was partially recovered whereas that developed during a maximal contraction was normal. Maximal rate of rise expressed relative to the tension output was elevated, however, for both twitch (%Pt/ms) and maximal contraction (%Po/ms). Swimming did not influence the recovery of muscle size or strength. Grid-climbing, on the other hand, produced heavier and stronger muscles and a faster recovery of %Pt/ms. This study clearly illustrates the importance of muscle load in regulating muscle size and strength.

Effect of exercise on the motor unit

The motoneuron part of this review deals with the changes in recruitment and firing rates of the motor unit types upon changes from a physically inactive life to endurance or strength training. The muscle fibers react to prolonged exercise by adaptation to a higher level of performance. A matter of discussion is the prerequisites for a transformation between the basic muscle fiber types, slow twitch and fast twitch, during voluntary (transsynaptic) activity, which is demonstrated after artificial nerve stimulation. The review includes current knowledge of muscle fiber transformation as an adaptive response to increased usage either by electrical stimulation or by transsynaptic neuronal activity. The metabolic adaptation related to increased endurance is reviewed with special reference to effects on muscle fibers. The increase in strength as a result of high resistance training is mainly the result of increased muscle cross-section. Whether this is solely the result of an increase in size of individual fibers or an increased fiber number is a controversial matter.

Peripheral nerve morphometry in stroke patients

Sural nerve biopsy specimens from affected and non-affected limbs of stroke patients were examined morphometrically. Two principle abnormalities of peripheral nerve were found in hemiparetic and hemiplegic limbs. First, the frequency of abnormal teased nerve fibers was significantly increased with abnormal internodes frequently "clustered" and showing a 50% or more reduction in myelin thickness. Second, the mean diameter of myelinated nerve fibers was reduced. These results suggest a primary atrophy of peripheral nerve fibers in the affected limbs of stroke patients with secondary demyelination. Possible aetiological factors include disuse, transynaptic degeneration, ischemia, pressure effect, and decreased axoplasmic flow. It would seem that the structural integrity of peripheral nerve is frequently compromised following a cerebral lesion.

Activity-induced morphologic changes in rat soleus nerve

The effects of 8 to 12 weeks of intense running or swimming on the morphology of the soleus nerve of the adult male albino rat were investigated. Nerve fiber diameter and number, axon diameter, and myelin area were determined. Mean fiber diameter (5.50 +/- 0.47) of the trained rats was smaller (P less than 0.05) than for sedentary control rats (6.19 +/- 0.27). The decrease in fiber size in the trained rats appeared to be reflected by a combination of smaller (P greater than 0.05) mean axon diameter and myelin area. Total fiber number was not different in the control (means = 113 +/- 6) and trained (means = 108 +/- 4) rats. These results provide further evidence that a chronic, intense but physiologic exercise can impose a functional demand on peripheral nerves that can alter morphologic features that are closely related to conduction velocity and commonly are associated with neuronal cell size.

Spinal radiculoneuropathy in aging rats: demyelination secondary to neuronal dwindling?

Temporal development of radicular demyelination was studied in male albino rats examined sequentially throughout the lifespan of the animals. The rats were perfusion-fixed with paraformaldehyde and glutaraldehyde and areas of their nervous system including the lumbar spinal roots, the spinal cord, and the peripheral sciatic nerve, were embedded in epoxy resin and submitted to microscopic examination in semithin and ultrathin sections. In addition, a vital fat stain, teasing of single nerve fibers, and estimates of axon diameter and fiber number were obtained. Degenerative changes occurred earlier in the distal portions of nerve fibers than in the spinal roots. The radicular lesion consisted of swelling of myelin and demyelination possibly secondary to shrinkage of axons, resulting in focal accumulation of lipid debris within the spinal roots of old rats. Although the causation of senile neuronal atrophy affecting rat peripheral neurons is not fully obvious, this condition may be exacerbated by such factors as pressure on the nerves and hypoactivity.

Research on the adaptation of skeletal muscle to hypogravity: past and future directions

Our current understanding of hypogravity-induced atrophy of skeletal muscles is based primarily on studies comparing pre- and post-flight properties of muscles. Interpretations are necessarily qualified by the assumption that the stress of reentry and readjustment to terrestrial gravity do not alter the parameters being analyzed. The neuromuscular system is highly responsive to changes in functional demands and capable of rapid adaptation, making this assumption questionable. A reexamination of the changes in the connective tissue and synaptic terminals of soleus muscles from rats orbited in biosatellites and sampled postflight indicates that these structural alterations represent adaptative responses of the atrophic muscles to the increased workload of returning to 1 G, rather than hypogravity per se. The atrophy of weightlessness is postulated to result because muscles are both underloaded and used less often. Proper testing of this hypothesis requires quantitation of muscle function by monitoring electromyography, force output and length changes during the flight. Experiments conducted in space laboratories, like those being developed for the Space Shuttle, will avoid the complications of reentry before tissue sampling and allow time course atudies of the rate of development of adaptive changes to zero gravity. Another area of great importance for future studies of muscle atrophy is inflight measurement of plasma levels of hormones and tissue receptor levels. Glucocorticoids, thyroid hormone and insulin exert dramatic regulatory influences on muscle structure. Prevention of neuromuscular atrophy becomes increasingly more important as spaceflights increase in duration. Definition of the atrophic mechanism is essential to developing means of preventing neuromuscular atrophy.

Porphyric neuropathy: an ultrastructural and quantitative case study

We report a case of acute neuropathy in a 46 year old female with porphyria variegata. Histologic, electron microscopic, and quantitative examinations of peripheral nerves were performed at onset of the neuropathy and at autopsy. The results revealed severe qualitative and quantitative changes in myelinated and unmyelinated fibers showing features indicative of an axonopathy with a distribution in keeping with a dying-back phenomenon.

Long-term effects of axotomy on neural activity during cat locomotion

1. Neural activity was recorded from cats during locomotion on a treadmill using electrodes in Silastic cuffs placed around the sciatic nerve and the lateral gastrocnemius-soleus, medial gastrocnemius, common peroneal and tibial nerve branches. Each branch gave characteristic patterns of activity which were studied before and after it was cut distal to the recording cuffs. Sensory and motor components were separated and measured using cross-correlation techniques. The amplitude of the cross-correlation peaks was compared with the amplitude of compound action potentials evoked by electrical stimulation and recorded from the same sites in the anaesthetized animal. 2. Sensory activity declined rapidly following axotomy and did not recover unless reinnervation occurred. Sensory activity even 5 months after nerve section and resuture had recovered to only a fraction of the control values. This reduction is attributed to a decline in the evoked compound potentials and to many fibres being unsuccessful in regenerating to appropriate sensory organs. 3. Motor activity declined more than could be accounted for by a decline in evoked potentials over the first month after axotomy. The extra reduction represents a decline in the number of impulses generated by alpha-motoneurones after axotomy. If regeneration was permitted, motor activity recovered to higher levels than did the evoked potentials for the whole nerve. Even if regeneration was prevented by nerve ligation, motoneurones continued to generate activity at a stable level over a period of months during which whole nerve compound potentials continued to decline. 4. The modulation of motor activity in ligated nerves during the step cycle was still appropriate to the required movement. Thus, activity recorded from severed nerves in human amputees may be useful in controlling powered artificial limbs. The persistence of motor activity may be responsible for the lesser degree of atrophy found in motor fibres than in sensory fibres following ligation (Hoffer, Stein & Gordon, 1979b).

Selective type II fibre muscular atrophy in patients with osteoarthritis of the hip

The size and the distribution of type I and tye II fibres was determined in the gluteus maximus (21 cases), gluteus medius (56 cases) and tensor faciae latae (27 cases) muscles of patients with osteoarthritis of the hip. The patients were of both sexes, aged between 37 and 64 years (younger group) and between 65 and 78 years (older group). Autopsy material of the two comparable age groups and of a group of "normal" adults (aged 22-44 years) served as controls. It was shown statistically that the diameter of both types of fibres and the relative number of type II fibres diminished with progressing age. In patients with osteoarthritis the degree of the selective atrophy of type II fibres was significantly higher than in the control groups. The atrophy is interpreted as a consequence of diminished muscular activity. No neurogenic lesions were detected either in the muscles of the patients or in those of the control groups.

Morphometric analysis of the effects of exenteration and enucleation on the development of third and sixth cranial nerves in the rat

The effects on rat cranial nerve growth of removing various amounts of extraocular muscle was studied using morphometric techniques. Growth in the third cranial nerves was found to be severely retarded when most of the muscle tissue was removed. By contrast, removal of the eye alone, leaving extraocular muscles relatively intact, was found to have little or no effect on the subsequent growth of third and sixth cranial nerve fibers and of extraocular muscle fibers. This conclusion could be drawn only through the application of statistical methods which take into account several generally unrecognized facts: frequency distributions of axon circumference and myelin sheath thickness are highly variable from nerve to nerve even in normal rats, which often have more large fibers in left than in right nerves. The bimodal nature of peripheral nerve fiber distributions precludes the use of such parametric tests as the commonly and inappropriately used t-test, but a non-parametric test such as the Kolmogorov-Smirnov test, extensively used in these studies, is inadequate for data comprising several sets of distributions to be compared. The application of the analysis of variance to some of the data and the merits of the procedure are discussed.

Regeneration distal to a prolonged conduction block

In 6 baboons a tourniquet round the knee was used to produce a prolonged local conduction block. This was followed, within a few days, by a surgical crush of the tibial or deep peroneal nerve at the ankle, in order to produce Wallerian degeneration distally. Electrophysiological recordings from small foot muscles were then used to study the time-course of regeneration in motor fibres. When the results were compared with those from crushed but unblocked nerves of the opposite leg, there was no evidence that either reinnervation of muscles or the subsequent maturation of the regenerating motor nerve fibres was delayed by the prolonged proximal conduction block.

Testosterone-induced changes of choline acetyl-transferase and cholinesterase activities in rat levator ani muscle

One year after castration the activities of choline acetyltransferase (ChAc) and of cholinesterase (ChE) in the levator ani (LA) muscle of male rats were lowered by 42 and 79% respectively. The weight of the muscle corresponded to 15% of control values. These changes were not accompanied by a decrease in the number of the muscle fibres. Treatment with testosterone rapidly increased the activity of ChAc and the weight of the muscle near to control values; the restoration of ChE was less complete. Testosterone produced an increase in the size of the muscle fibres and increased the histochemically observed activity of ChE in the postsynaptic part of the motor end-plates. In non-castrated rats the administration of testosterone increased the weight ofthe LA muscle, but was not accompanied by an increase of ChAc above control values.

Nerve fiber hypertrophy in posterior tibial nerves of mice in response to voluntary running activity during aging

Three-month-old male C57BL/10 mice were exercised by voluntary running activity in vertically revolving wheels for two hours each day until 24 months of age. Activity scores were recorded each day and the animals were regularly weighed and inspected for abnormalities. Control animals were similarly treated except that the activity wheels were immobilized. At the end of the exercise period, survival was 84% for the exercise group and 64% for the controls. Light microscopic examination of the posterior tibial nerve of the surviving animals showed a significant fiber hypertrophy in response to the exercise. The number of myelinated fibers in nerves from exercised animals did not differ from those of the controls. On the basis of these data, it is suggested that prolonged exercise does not prevent the loss of peripheral nerve fibers associated with age but rather, may exert an effect on the nervous system by modifying the surviving cells.