Amplitude of muscle stretch modulates corticomotor gain during passive movement

Forearm Posture Affects the Corticospinal Excitability of Intrinsic and Extrinsic Hand Muscles in Dominant and Nondominant Sides

Different forearm postures can modulate corticospinal excitability. However, there is no consensus on whether handedness plays a role in such a mechanism. This study investigated the effects of 3 forearm postures (pronation, neutral, and supination) on the corticospinal excitability of muscles from the dominant and nondominant upper limbs. Surface electromyography was recorded from the abductor digiti minimi, flexor pollicis brevis, and flexor carpi radialis from both sides of 12 right-handed volunteers. Transcranial magnetic stimulation pulses were applied to each muscle's hotspot in both cerebral hemispheres. Motor-evoked potential peak-to-peak amplitude and latency and resting motor threshold were measured. The data were evaluated by analysis of variance. The level of significance was set at 5%. The resting motor threshold was similar for the 3 muscles and both sides. Motor-evoked potential peak-to-peak amplitude from flexor pollicis brevis was lower during supination, and the dominant upper limb latency was longer. The flexor carpi radialis presented lower motor-evoked potential peak-to-peak amplitudes for neutral and shorter latencies during supination. Abductor digiti minimi seemed not to be affected by posture or side. Different muscles from dominant and nondominant sides may undergo corticospinal modulation, even distally localized from a particular joint and under rest.

Effect of muscle length in a handgrip task on corticomotor excitability of extrinsic and intrinsic hand muscles under resting and submaximal contraction conditions

The neurophysiological mechanisms underlying muscle force control for different wrist postures still need to be better understood. To further elucidate these mechanisms, the present study aimed to investigate the effects of wrist posture on the corticospinal excitability by transcranial magnetic stimulation (TMS) of extrinsic (flexor [FCR] and extensor carpi radialis [ECR]) and intrinsic (flexor pollicis brevis (FPB)) muscles at rest and during a submaximal handgrip strength task. Fourteen subjects (24.06 ± 2.28 years) without neurological or motor disorders were included. We assessed how the wrist posture (neutral: 0°; flexed: +45°; extended: -45°) affects maximal handgrip strength (HGSmax ) and the motor evoked potentials (MEP) amplitudes during rest and active muscle contractions. HGSmax was higher at 0° (133%) than at -45° (93.6%; p < 0.001) and +45° (73.9%; p < 0.001). MEP amplitudes were higher for the FCR at +45° (83.6%) than at -45° (45.2%; p = 0.019) and at +45° (156%; p < 0.001) and 0° (146%; p = 0.014) than at -45° (106%) at rest and active condition, respectively. Regarding the ECR, the MEP amplitudes were higher at -45° (113%) than at +45° (60.8%; p < 0.001) and 0° (72.6%; p = 0.008), and at -45° (138%) than +45° (96.7%; p = 0.007) also at rest and active conditions, respectively. In contrast, the FPB did not reveal any difference among wrist postures and conditions. Although extrinsic and intrinsic hand muscles exhibit overlapping cortical representations and partially share the same innervation, they can be modulated differently depending on the biomechanical constraints.

Enhanced corticospinal excitability in the tibialis anterior during static stretching of the soleus in young healthy individuals

Corticospinal excitability is known to be affected by afferent inflow arising from the proprioceptors during active or passive muscle movements. Also during static stretching (SS) afferent activity is enhanced, but its effect on corticospinal excitability received limited attention and has only been investigated as a single average value spread over the entire stretching period. Using transcranial magnetic stimulation (TMS) the present study was conducted to explore the time course of corticospinal excitability during 30 seconds SS. Motor evoked potentials (MEPs) after TMS were recorded from soleus (SOL) and tibialis anterior (TA) muscles in 14 participants during: a passive dynamic ankle dorsiflexion (DF), at six different time points during maximal individual SS (3, 6, 9, 18, 21 and 25 seconds into stretching), during a passive dynamic ankle plantar flexion (PF) and following SS. To explore the time course of corticospinal excitability during the static lengthened phase of a muscle stretch, the stretching protocol was repeated several times so that it was possible to collect a sufficient number of stimulations at each specific time point into SS, as well as during DF and PF. During passive DF, MEPs amplitude was greater than baseline in both TA and SOL (p = .001 and p = .005 respectively). During SS, MEPs amplitude was greater than baseline in TA (p = .006), but not in SOL. No differences between the investigated time points were found and no trend was detected throughout the stretching time. No effect in either muscle was observed during passive PF and after SS. These results could suggest that an increased activity of secondary afferents from SOL muscle spindles exert a corticomotor facilitation on TA. The muscle-nonspecific response observed during passive DF could instead be attributed to an increased activation within the sensorimotor cortical areas as a result of the awareness of the foot passive displacements.

A randomized sham-controlled trial on the effects of dual-tDCS "during" physical therapy on lower limb performance in sub-acute stroke and a comparison to the previous study using a "before" stimulation protocol

Background

Dual-transcranial direct current stimulation (tDCS) has been used to rebalance the cortical excitability of both hemispheres following unilateral-stroke. Our previous study showed a positive effect from a single-session of dual-tDCS applied before physical therapy (PT) on lower limb performance. However, it is still undetermined if other timings of brain stimulation (i.e., during motor practice) induce better effects. The objective of this study was to examine the effect of a single-session of dual-tDCS “during” PT on lower limb performance in sub-acute stroke and then compare the results with our previous data using a “before” stimulation paradigm.

Method

For the current “during” protocol, 19 participants were participated in a randomized sham-controlled crossover trial. Dual-tDCS over the M1 of both cortices (2 mA) was applied during the first 20 min of PT. The Timed Up and Go and Five-Times-Sit-To-Stand tests were assessed at pre- and post-intervention and 1-week follow-up. Then, data from the current study were compared with those of the previous “before” study performed in a different group of 19 subjects. Both studies were compared by the difference of mean changes from the baseline.

Results

Dual-tDCS “during” PT and the sham group did not significantly improve lower limb performance. By comparing with the previous data, performance in the “before” group was significantly greater than in the “during” and sham groups at post-intervention, while at follow-up the “before” group had better improvement than sham, but not greater than the “during” group.

Conclusion

A single-session of dual-tDCS during PT induced no additional advantage on lower limb performance. The “before” group seemed to induce better acute effects; however, the benefits of the after-effects on motor learning for both stimulation protocols were probably not different.

Trial registration Current randomized controlled trials was prospectively registered at the clinicaltrials.gov, registration number: NCT04051671. The date of registration was 09/08/2019.

Motor Cortical Excitability Changes in Preparation to Concentric and Eccentric Movements

Specific neural mechanisms operate at corticospinal levels during eccentric and concentric contractions. Here, we investigated the difference in corticospinal excitability (CSE) when preparing these two types of contraction. In this study we enrolled 16 healthy participants. They were asked to perform an instructed-delay reaction time (RT) task involving a concentric or an eccentric contraction of the right first dorsal interosseus muscle, as a response to a proprioceptive cue (Go signal) presented 1 s after a warning signal. We tested CSE at different time points ranging from 300 ms before up to 40 ms after a Go signal. CSE increased 300-150 ms before the Go signal for both contractions. Interestingly, significant changes in CSE in the time interval around the Go signal (from -150 ms to +40 ms) were only revealed in eccentric contraction. We observed a significant decrease in excitability immediately before the Go cue (Pre_50) and a significant increase 40 ms after it (Post_40) with respect to the MEPs recorded at Pre_150. Finally, CSE in eccentric contraction was lower before the Go cue (Pre_50) and greater after it (Post_40) compared to the concentric contraction. A similar result was also found in NoMov paradigm, used to disentangle the effects induced by movement preparation from those induced by the movement preparation linked to the proprioceptive cue. We could conclude that different neural mechanisms observed during concentric and eccentric contractions are mirrored with a different time-specific modulation of CSE in the preparatory phase to the movement.

Static stretch and dynamic muscle activity induce acute similar increase in corticospinal excitability

Even though the acute effects of pre-exercise static stretching and dynamic muscle activity on muscular and functional performance have been largely investigated, their effects on the corticospinal pathway are still unclear. For that reason, this study examined the acute effects of 5×20 s of static stretching, dynamic muscle activity and a control condition on spinal excitability, corticospinal excitability and plantar flexor neuromuscular properties. Fifteen volunteers were randomly tested on separate days. Transcranial magnetic stimulation was applied to investigate corticospinal excitability by recording the amplitude of the motor-evoked potential (MEP) and the duration of the cortical silent period (cSP). Peripheral nerve stimulation was applied to investigate (i) spinal excitability using the Hoffmann reflex (H_max), and (ii) neuromuscular properties using the amplitude of the maximal M-wave (M_max) and corresponding peak twitch torque. These measurements were performed with a background 30% of maximal voluntary isometric contraction. Finally, the maximal voluntary isometric contraction torque and the corresponding electromyography (EMG) from soleus, gastrocnemius medialis and gastrocnemius lateralis were recorded. These parameters were measured immediately before and 10 s after each conditioning activity of plantar flexors. Corticospinal excitability (MEP/M_max) was significantly enhanced after static stretching in soleus (P = 0.001; ES = 0.54) and gastrocnemius lateralis (P<0.001; ES = 0.64), and after dynamic muscle activity in gastrocnemius lateralis (P = 0.003; ES = 0.53) only. On the other hand, spinal excitability (H_max/M_max), cSP duration, muscle activation (EMG/M_max) as well as maximal voluntary and evoked torque remained unaltered after all pre-exercise interventions. These findings indicate the presence of facilitation of the corticospinal pathway without change in muscle function after both static stretching (particularly) and dynamic muscle activity.

Dissociation between cortical and spinal excitability of the antagonist muscle during combined motor imagery and action observation

Inhibitory neural control of antagonist muscle is one of the fundamental neural mechanism of coordinated human limb movement. Previous studies have revealed that motor execution (ME) and motor imagery (MI) share many common neural substrates; however, whether inhibitory neural activity occurs during MI remains unknown. In addition, recent studies have demonstrated that a combined MI and action observation (MI + AO) produces strong neurophysiological changes compared with MI or AO alone. Therefore, we investigated inhibitory changes in cortical and spinal excitability of the antagonist muscle during MI + AO and ME. Single-pulse transcranial magnetic stimulation (TMS) experiments revealed that corticospinal excitability of the antagonist muscle was decreased during MI + AO. Conversely, F-wave experiments showed that F-wave persistence of the antagonist muscle increased. Paired-pulse TMS experiment also demonstrated that short-interval intracortical inhibition (SICI) did not contribute to this inhibition. Therefore, cortical mediated inhibition, except for SICI, may be related to this inhibition. Conversely, such clear inhibition of the antagonist muscle was not observed during ME, presumably owing to the effects of muscle contraction to decelerate the movements and/or sensory input accompanying the joint movements. These findings provide important insights into the neurophysiological differences between MI + AO and ME.

Corticospinal excitability of tibialis anterior and soleus differs during passive ankle movement

The purpose of this study was to assess corticospinal excitability of soleus (SOL) and tibialis anterior (TA) at a segmental level during passive ankle movement. Four experimental components were performed to assess the effects of passive ankle movement and muscle length on corticospinal excitability (MEP/M_max) at different muscle lengths, subcortical excitability at the level of lumbar spinal segments (LEP/M_max), intracortical inhibition (SICI) and facilitation (ICF), and H-reflex in SOL and TA. In addition, the degree of fascicle length changes between SOL and TA was assessed in a subpopulation during passive ankle movement. Fascicles shortened and lengthened with joint movement during passive shortening and lengthening of SOL and TA to a similar degree (p < 0.001). Resting motor threshold was greater in SOL compared to TA (p ≤ 0.014). MEP/M_max was facilitated in TA during passive shortening relative to the static position (p ≤ 0.023) and passive lengthening (p ≤ 0.001), but remained similar during passive ankle movement in SOL (p ≥ 0.497), regardless of muscle length at the point of stimulus (p = 0.922). LEP/M_max (SOL: p = 0.075, TA: p = 0.071), SICI (SOL: p = 0.427, TA: p = 0.540), and ICF (SOL: p = 0.177, TA: p = 0.777) remained similar during passive ankle movement. H-reflex was not different across conditions in TA (p = 0.258), but was reduced during passive lengthening compared to shortening in SOL (p = 0.048). These results suggest a differential modulation of corticospinal excitability between plantar and dorsiflexors during passive movement. The corticospinal behaviour observed might be mediated by an increase in corticospinal drive as a result of reduced afferent input during muscle shortening and appears to be flexor-biased.

Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature

Stretching has long been used in many physical activities to increase range of motion (ROM) around a joint. Stretching also has other acute effects on the neuromuscular system. For instance, significant reductions in maximal voluntary strength, muscle power or evoked contractile properties have been recorded immediately after a single bout of static stretching, raising interest in other stretching modalities. Thus, the effects of dynamic stretching on subsequent muscular performance have been questioned. This review aimed to investigate performance and physiological alterations following dynamic stretching. There is a substantial amount of evidence pointing out the positive effects on ROM and subsequent performance (force, power, sprint and jump). The larger ROM would be mainly attributable to reduced stiffness of the muscle-tendon unit, while the improved muscular performance to temperature and potentiation-related mechanisms caused by the voluntary contraction associated with dynamic stretching. Therefore, if the goal of a warm-up is to increase joint ROM and to enhance muscle force and/or power, dynamic stretching seems to be a suitable alternative to static stretching. Nevertheless, numerous studies reporting no alteration or even performance impairment have highlighted possible mitigating factors (such as stretch duration, amplitude or velocity). Accordingly, ballistic stretching, a form of dynamic stretching with greater velocities, would be less beneficial than controlled dynamic stretching. Notwithstanding, the literature shows that inconsistent description of stretch procedures has been an important deterrent to reaching a clear consensus. In this review, we highlight the need for future studies reporting homogeneous, clearly described stretching protocols, and propose a clarified stretching terminology and methodology.

Neurophysiological Mechanisms Underpinning Stretch-Induced Force Loss

It is well known that prolonged passive muscle stretch reduces maximal muscle force production. There is a growing body of evidence suggesting that adaptations occurring within the nervous system play a major role in this stretch-induced force reduction. This article reviews the existing literature, and some new evidence, regarding acute neurophysiological changes in response to passive muscle stretching. We discuss the possible contribution of supra-spinal and spinal structures to the force reduction after passive muscle stretch. In summary, based on the recent evidence reviewed we propose a new hypothesis that a disfacilitation occurring at the motoneuronal level after passive muscle stretch is a major factor affecting the neural efferent drive to the muscle and, subsequently, its ability to produce maximal force.

Effects of a low-resistance, interval bicycling intervention in Parkinson's Disease

Previous studies have shown that people with Parkinson's disease (PD) benefit from a variety of exercise modalities with respect to symptom management and function. Among the possible exercise modalities, speedwork has been identified as a promising strategy, with direct implications for the rate and amplitude of nervous system involvement. Considering that previous speed-based exercise for PD has often been equipment, personnel and/or facility dependent, and often time intensive, our purpose was to develop a population-specific exercise program that could be self-administered with equipment that is readily found in fitness centers or perhaps the home. Fourteen individuals with PD (Hoehn-Yahr (H-Y) stage of 3.0 or less) participated in twelve 30-min sessions of low-resistance interval training on a stationary recumbent bicycle. Motor examination section of the Unified Parkinson's Disease Rating Scale (UPDRS), 10-meter walk (10mW), timed-up-and-go (TUG), functional reach, four-square step test (4SST), nine-hole peg test (9HPT) and simple reaction time scores all exhibited significant improvements (p < 0.05). These results add further support to the practice of speedwork for people with PD and outline a population-amenable program with high feasibility.

Effects of Passive Finger Movement on Cortical Excitability

This study examined the effects of joint angle and passive movement direction on corticospinal excitability. The subjects were 14 healthy adults from whom consent could be obtained. We performed two experiments. In Experiment 1, we measured motor evoked potential (MEP) amplitude, F-wave and M-wave at 0° and 20° adduction during adduction or abduction movement, in the range of movement from 10° abduction to 30° adduction. In Experiment 2, MEPs were measured at static 0° and 20° adduction during passive adduction from 10° adduction to 30° adduction and static 20° adduction. MEP, F-waves and M-waves were recorded from the right first dorsal interosseous (FDI) muscle. Experiment 1 revealed significantly increased MEP amplitude at 0° during passive adduction compared to static 0° (p < 0.01). No other significant differences in MEP, M-wave and F-wave parameters were observed. In Experiment 2, MEP amplitude was significantly higher at 20° adduction during passive adduction compared with static 0° (p < 0.01). Based on these findings, it appears that fluctuations in MEP amplitude values during passive movement are not influenced by joint angle, but rather it is possible that it is due to intracortical afferent facilitation (AF) dependent on afferent input due to the start of movement and interstimulus interval (ISI) of transcranial magnetic stimulation (TMS).

Corticospinal excitability to the biceps brachii and its relationship to postactivation potentiation of the elbow flexors

We examined the effects of a submaximal voluntary elbow flexor contraction protocol on measures of corticospinal excitability and postactivation potentiation of evoked muscle forces and if these measures were state‐dependent (rest vs. voluntary muscle contraction). Participants completed four experimental sessions where they rested or performed a 5% maximum voluntary contraction (MVC) of the elbow flexors prior to, immediately, and 5 min following a submaximal contraction protocol. During rest or 5% MVC, transcranial magnetic stimulation, transmastoid electrical stimulation, electrical stimulation of biceps brachii motor point and Erb's point were elicited to induce motor‐evoked potentials (MEPs), cervicomedullary MEPs (CMEPs), potentiated twitch (PT) force, and maximal muscle compound action potential (M_max), respectively prior to, immediately, and 5 min postcontraction protocol. MEP amplitudes increased (215 and 165%M_max, P ≤ 0.03) only at 1 and 6s postcontraction protocol, respectively during rest but not 5% MVC. CMEP amplitudes decreased during rest and 5% MVC (range:21–58%M_max, P ≤ 0.04) for up to 81 sec postcontraction protocol. Peak twitch force increased immediately postcontraction protocol and remained elevated for 90 sec (range:122–147% increase, P < 0.05). There was a significant positive correlation between MEP and PT force during rest (r = 0.88, P = 0.01) and a negative correlation between CMEP and PT force during rest (r = −0.85, P < 0.02 and 5% MVC (r = −0.96, P < 0.01) immediately postcontraction protocol. In conclusion, the change in corticospinal and spinal excitability was state‐ and time‐dependent whereas spinal excitability and postactivation potentiation were time‐dependent following the contraction protocol. Changes in corticospinal excitability and postactivation potentiation correlated and were also state‐dependent.

Changes in cortico-spinal excitability following uphill versus downhill treadmill exercise

An acute bout of aerobic exercise induces neuroplasticity in the motor cortex. Moreover, paired associative stimulation (PAS) is known to induce neuroplasticity in M1. However, the possible influence of the type of exercise on the neuroplastic changes remains unknown. The present study investigated the effects of two different modes of muscle contraction produced during locomotor exercise on changes in corticospinal (CS) excitability. Subjects performed two 30-min treadmill exercises at an intensity corresponding to 60% of their maximal heart rate with either a +10% (uphill) or -10% (downhill) slope. These exercises were followed or not by paired associative stimulation method (PAS₂₅) which consisted of 200 paired stimuli (0.25Hz, 15min) of median nerve electrical stimulation followed by transcranial magnetic stimulation of the hand M1 area (ISI 25ms). Motor evoked potentials (MEP), assessed through abductor pollicis brevis (APB) activity were obtained before exercise, at 5min, 15min and 30min after exercise. A significant (P<0.05) increase of the MEP amplitude was observed 30min after both exercises but was not different between the two modes of locomotion. On the contrary, MEP amplitude with PAS₂₅ increased only 30min after downhill exercise. We conclude that sub-maximal treadmill exercise increases CS excitability within a period of 30min. However, the predominant mode of muscle contraction during uphill versus downhill locomotion does not influence CS excitability when assessed using a non-exercised muscle. However, results from PAS₂₅ suggest that specific neuroplastic changes occur likely due to homeostatic mechanisms induced by exercise plus a PAS protocol.

Can passive stretch inhibit motoneuron facilitation in the human plantar flexors?

The purpose of the present study was to examine the possible inhibitory effect of passive plantar flexor muscle stretching on the motoneuron facilitatory system. Achilles tendon vibration (70 Hz) and triceps surae electrical stimulation (20 Hz) were imposed simultaneously in 11 subjects to elicit contraction through reflexive pathways in two experiments. In experiment 1, a vibration-stimulation protocol was implemented with the ankle joint plantar flexed (+10°), neutral (0°), and dorsiflexed (-10°). In experiment 2, the vibration-stimulation protocol was performed twice before (control), then immediately, 5, 10, and 15 min after a 5-min intermittent muscle stretch protocol. Plantar flexor torque and medial and lateral gastrocnemius and soleus (EMGSol) EMG amplitudes measured during and after (i.e., self-sustained motor unit firing) the vibration protocol were used as an indicator of this facilitatory pathway. In experiment 1, vibration torque, self-sustained torque and EMGSol were higher with the ankle at -10° compared with 0° and +10°, suggesting that this method is valid to assess motoneuronal facilitation. In experiment 2, torque during vibration was reduced by ∼ 60% immediately after stretch and remained depressed by ∼ 35% at 5 min after stretch (P < 0.05). Self-sustained torque was also reduced by ∼ 65% immediately after stretch (P < 0.05) but recovered by 5 min. Similarly, medial gastrocnemius EMG during vibration was reduced by ∼ 40% immediately after stretch (P < 0.05), and EMGSol during the self-sustained torque period was reduced by 44% immediately after stretch (P < 0.05). In conclusion, passive stretch negatively affected the motoneuronal amplification for at least 5 min, suggesting that motoneuron disfacilitation is a possible mechanism influencing the stretch-induced torque loss.

Effect of auditory constraints on motor performance depends on stage of recovery post-stroke

In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke.

Corticomotor excitability changes seen in the resting forearm during contralateral rhythmical movement and force manipulations: a TMS study

The aim of this study was to examine changes in corticomotor excitability to a resting wrist extensor muscle during contralateral rhythmical isotonic and static isometric wrist contractions (flexion/extension) at different loads and positions, using transcranial magnetic stimulation (TMS). TMS-induced motor-evoked potentials (MEPs) were recorded from the relaxed right extensor carpi radialis (ECR) and flexor carpi radialis (FCR) respectively, while the left arm underwent unimanual manipulations. Rhythmical isotonic (0.5 Hz) flexion and extension movements of the left wrist under 3 load conditions (no, low and high force) and a frequency matched passive movement condition were collected, along with isometric flexion/extension contractions in each position (low and high force). TMS was delivered at eight positions (4 in the flexion phase and 4 in the extension phase) during the continuous movement conditions and each of these positions was sampled with isometric contraction. The potentials evoked by TMS in right ECR were potentiated when the left ECR was engaged, independent of position within that phase of contraction or contraction type (isotonic and isometric). Motor cortical excitability of the resting right ECR increased as load demands increased to the left wrist. Passive rhythmical movement did not influence excitability to the resting ECR implying that voluntary motor drive is required. Our findings indicated that the increase in corticomotor drive during both rhythmic isotonic and static isometric contractions of the opposite limb is likely mediated by interhemispheric interactions between cortical motor areas. Improving our understanding of these cortical networks can be useful in future methods to enhance neuroplasticity through neurorehabilitation methods.

Characterizing changes in the excitability of corticospinal projections to proximal muscles of the upper limb

BACKGROUND

There has been an explosion of interest in methods of exogenous brain stimulation that induce changes in the excitability of human cerebral cortex. The expectation is that these methods may promote recovery of function following brain injury. To assess their effects on motor output, it is typical to assess the state of corticospinal projections from primary motor cortex to muscles of the hand, via electromyographic responses to transcranial magnetic stimulation. If a range of stimulation intensities is employed, the recruitment curves (RCs) obtained can, at least for intrinsic hand muscles, be fitted by a sigmoid function.

OBJECTIVE/HYPOTHESIS

To establish whether sigmoid fits provide a reliable basis upon which to characterize the input-output properties of the corticospinal pathway for muscles proximal to the hand, and to assess as an alternative the area under the (recruitment) curve (AURC).

METHODS

A comparison of the reliability of these measures, using RCs obtained for muscles that are frequently the targets of rehabilitation.

RESULTS

The AURC is an extremely reliable measure of the state of corticospinal projections to hand and forearm muscles, which has both face and concurrent validity. Construct validity is demonstrated by detection of widely distributed (across muscles) changes in corticospinal excitability induced by paired associative stimulation (PAS).

CONCLUSION(S)

The parameters derived from sigmoid fits are unlikely to provide an adequate means to assess the effectiveness of therapeutic regimes. The AURC can be employed to characterize corticospinal projections to a range of muscles, and gauge the efficacy of longitudinal interventions in clinical rehabilitation.

Active-assisted cycling improves tremor and bradykinesia in Parkinson's disease

OBJECTIVES

To develop a rapid cadence cycling intervention (active-assisted cycling [AAC]) using a motorized bike and to examine physiological perimeters during these sessions in individuals with Parkinson's disease (PD). A secondary goal was to examine whether a single session of AAC at a high cadence would promote improvements in tremor and bradykinesia similar to the on medication state.

DESIGN

Before-after pilot trial with cross-over.

SETTING

University research laboratory.

PARTICIPANTS

Individuals with idiopathic PD (N=10, age 45-74y) in Hoehn and Yahr stages 1 to 3.

INTERVENTION

Forty minutes of AAC.

MAIN OUTCOME MEASURES

Heart rate, pedaling power, and rating of perceived exertion were recorded before, during, and after a bout of AAC. Functional assessments included tremor score during resting, postural, and kinetic tremor.

RESULTS

This AAC paradigm was well tolerated by individuals with PD without excessive fatigue, and most participants showed improvements in tremor and bradykinesia immediately after a single bout of cycling.

CONCLUSIONS

This paradigm could be used to examine changes in motor function in individuals with PD after bouts of high-intensity exercise.

Amplitude- and velocity-dependency of rigidity measured at the wrist in Parkinson's disease

OBJECTIVE

Quantify the effects of increased amplitude and rate of muscle stretch on parkinsonian rigidity.

METHODS

Eighteen subjects with Parkinson's disease participated in this study. Subjects' tested hand was passively displaced through 60° and 90° ranges of wrist flexion and extension at velocities of 50°/s and 280°/s in both treated and untreated conditions. Joint angular position, resistance torque, and surface electromyography (EMG) of the wrist flexors and extensors were recorded. Rigidity was quantified by normalized work scores and normalized angular impulses for flexion and extension, separately. Reflex responses of stretched and shortened muscles were quantified by mean EMG and EMG ratio. A series of ANOVAs was performed to determine the effect of amplitude, velocity and medication on selected variables.

RESULTS

Both work scores and angular impulses revealed that the larger displacement amplitude and the higher velocity were associated with significantly greater rigidity, increased EMG ratio and mean EMG of stretched muscles. Dopaminergic medication was not associated with a reduction in rigidity.

CONCLUSIONS

Parkinsonian rigidity is modulated by the amplitude and rate of muscle stretch.

SIGNIFICANCE

These findings shed light on the biomechanical underpinnings and physiological characteristics of rigidity and may inform clinical rigidity assessment in Parkinson's disease.

Acute effects of passive leg cycling on upper extremity tremor and bradykinesia in Parkinson's disease

BACKGROUND

Previous studies have shown that single bouts of high-rate active cycling (> 80 rpm) improve upper extremity motor function in individuals with Parkinson's disease (PD). It is unknown if passive leg cycling produces a similar effect on upper extremity function. This article examines whether passive leg cycling can promote immediate changes in upper tremor and bradykinesia in PD and if pedaling rates have variable effects.

METHODS

Twenty individuals with mild-to-moderate idiopathic PD completed 4 sessions, with each session taking place 1 week apart. In the second to fourth sessions, a motorized bicycle was set to passively rotate the subjects' legs at rates of 60, 70, or 80 rpm for 30 minutes. Quantitative upper extremity motor assessments were completed immediately before and after each session.

RESULTS

Passive leg cycling was shown to reduce tremor and bradykinesia in PD. However, the rate of passive cycling did not affect the degree of improvement in bradykinesia or tremor.

CONCLUSION

These findings suggest that lower extremity passive cycling can promote changes in upper extremity motor function in individuals with PD.

Corticomotor excitability of wrist flexor and extensor muscles during active and passive movement

The excitability of the corticospinal projection to upper and lower limbs is constantly modulated during voluntary and passive movement; however a direct comparison during a comparable movement has not been reported. In the present study we used transcranial magnetic stimulation (TMS) to compare corticomotor excitability to the extensor and flexor carpi radialis (ECR/FCR) muscles of the forearm during voluntary rhythmic wrist movement (through 45 degrees of range), during a matched (for range and rhythm) passive movement of the wrist, and while the wrist was stationary (in mid-range). TMS was delivered when the wrist was in the neutral position. With passive and active movement, and for both FCR and ECR, corticomotor excitability was reduced during lengthening relative to shortening phases of movement. With active movement, this pattern was maintained and superimposed on an overall increase in excitability to both muscles that was greater for the ECR. The results favor a common pattern of excitability changes shared by extensor and flexor muscles as they undergo lengthening and shortening, which may be mediated by afferent input during both passive and active movement. This is combined with an overall increase in excitability associated with active movement that is greater for extensor muscles perhaps due to differences in the strength of the corticomotor projection to these muscles.

Motor strategies and excitability changes of human hand motor area are dependent on different voluntary drives

The present study examined whether there were different voluntary drives between intended and non-intended muscle contractions. In experiment 1, during intended and non-intended muscle contractions, electromyograms (EMGs) were recorded from the first dorsal interosseous (FDI) and extensor carpi radialis (ECR) muscles when force levels were varied from 10% to 50% maximal voluntary contraction (MVC) in 10% MVC steps. In experiment 2, using transcranial magnetic stimulation, motor-evoked potentials (MEPs) were recorded from the FDI muscle when EMGs were varied from 10% to 40% EMGmax (EMG activities during MVC) in 10% EMGmax steps during intended and non-intended muscle contractions. In experiment 3, at 10% MVC force level MEPs were recorded before and after practice. The results showed that, in the FDI muscle, EMGs during intended muscle contractions were larger than those during non-intended ones at higher force levels (30-50% MVC). In the ECR muscle, reverse results were observed. At comparable EMG levels of the FDI muscle MEPs were the same during intended and non-intended muscle contractions. After practice, MEPs during intended muscle contraction became larger than those during non-intended at 10% MVC force level, while EMGs were the same between two muscle contractions. It is concluded that motor strategies and excitability changes of hand motor area are different during intended and non-intended muscle contractions, and these differences are due to the different voluntary drives of intended and non-intended. The present findings may contribute to the understanding of rehabilitation for patients suffering from damages of the central motor system.

Evidence for positive force feedback during involuntary aftercontractions

We examined the involuntary isotonic muscle aftercontraction which follows a 1-min voluntary contraction at 60% of maximum voluntary force. Aftercontractions provide a unique paradigm for investigating the automatic postural control of the upper limb in man. Previous work has shown that the strength of these contractions in m. deltoid is linearly dependent on the inclination of the subject's body in the gravitational field. The current experiments were designed to test if this was due to the gravitational loading on the arm as this also changes with body inclination. The subject sat with the head stationary to prevent changes in vestibular orientation. Aftercontractions in m. deltoid were evoked with the normal weight of the arm present and also with arm loadings equal to 0, 25, 50 and 75% of this value. These reductions were produced by a counter lever apparatus. The results showed that the EMG amplitude of this involuntary contraction depended linearly on the loading of the arm. This is interpreted as being the result of positive load feedback. Aftercontraction EMG amplitude at 100% load was 2.7 times greater than at 0% load. The results are discussed in the context of recent work on positive load feedback in man and animals.