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Zhang J, McClean ZJ, Khaledi N, Morgan SJ, Millet GY, Aboodarda SJ. Reliability of transcranial magnetic stimulation-evoked responses on knee extensor muscles during cycling. Exp Brain Res 2024; 242:1681-1695. [PMID: 38806709 DOI: 10.1007/s00221-024-06859-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
Transcranial magnetic stimulation (TMS) measures the excitability and inhibition of corticomotor networks. Despite its task-specificity, few studies have used TMS during dynamic movements and the reliability of TMS paired pulses has not been assessed during cycling. This study aimed to evaluate the reliability of motor evoked potentials (MEP) and short- and long-interval intracortical inhibition (SICI and LICI) on vastus lateralis and rectus femoris muscle activity during a fatiguing single-leg cycling task. Nine healthy adults (2 female) performed two identical sessions of counterweighted single-leg cycling at 60% peak power output until failure. Five single pulses and ten paired pulses were delivered to the motor cortex, and two maximal femoral nerve stimulations (Mmax) were administered during two baseline cycling bouts (unfatigued) and every 5 min throughout cycling (fatigued). When comparing both baseline bouts within the same session, MEP·Mmax-1 and LICI (both ICC: >0.9) were rated excellent while SICI was rated good (ICC: 0.7-0.9). At baseline, between sessions, in the vastus lateralis, Mmax (ICC: >0.9) and MEP·Mmax-1 (ICC: 0.7) demonstrated good reliability; LICI was moderate (ICC: 0.5), and SICI was poor (ICC: 0.3). Across the fatiguing task, Mmax demonstrated excellent reliability (ICC > 0.8), MEP·Mmax-1 ranged good to excellent (ICC: 0.7-0.9), LICI was moderate to excellent (ICC: 0.5-0.9), and SICI remained poorly reliable (ICC: 0.3-0.6). These results corroborate the cruciality of retaining mode-specific testing measurements and suggest that during cycling, Mmax, MEP·Mmax-1, and LICI measures are reliable whereas SICI, although less reliable across days, can be reliable within the same session.
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Affiliation(s)
- Jenny Zhang
- Faculty of Kinesiology, University of Calgary, KNB 420, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Zachary J McClean
- Faculty of Kinesiology, University of Calgary, KNB 420, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Neda Khaledi
- Faculty of Kinesiology, University of Calgary, KNB 420, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - Sophie-Jayne Morgan
- Faculty of Kinesiology, University of Calgary, KNB 420, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Guillaume Y Millet
- Inter-university Laboratory of Human Movement Biology, Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Lyon 1, Saint-Etienne, F-42023, France
| | - Saied Jalal Aboodarda
- Faculty of Kinesiology, University of Calgary, KNB 420, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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2
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Lewis A, Toufexis C, Goldsmith C, Robinson R, Howie G, Rattray B, Flood A. The Effects of Transcranial Direct Current Stimulation and Exercise on Salivary S100B Protein Indicated Blood-Brain Barrier Permeability: A Pilot Study. Neuromodulation 2023:S1094-7159(23)00984-4. [PMID: 38159099 DOI: 10.1016/j.neurom.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study aimed to assess the effect of transcranial direct current stimulation (tDCS) and exercise on blood-brain barrier (BBB) permeability in humans as assessed through the quantification of the salivary protein biomarker S100B. It was hypothesized that active tDCS would induce a significant increase in salivary S100B concentration when compared with sham stimulation and no stimulation. It also was hypothesized that the increase in salivary S100B concentration would be greater after active tDCS and exercise than after tDCS or exercise alone. MATERIALS AND METHODS A total of 13 healthy adults (five male, eight female), ranging in age from 21 to 32 years, underwent three experimental conditions (active tDCS, sham tDCS, inactive control). To assess exercise- and tDCS-induced changes in BBB permeability, S100B in saliva was measured. Saliva samples were taken before tDCS, after tDCS, and immediately after a ramped cycling time-to-exhaustion (TTE) task. Active tDCS involved the application of anodal stimulation over the primary motor cortex for 20 minutes at 2 mA. RESULTS S100B concentrations in the control condition did not differ significantly from the active condition (estimate = 0.10, SE = 0.36, t = 0.27, p = 0.79) or the sham condition (estimate = 0.33, SE = 0.36, t = 0.89, p = 0.38). Similarly, S100B concentrations at baseline did not differ significantly from post-intervention (estimate = -0.35, SE = 0.34, t = -1.03, p = 0.31) or post-TTE (estimate = 0.66, SE = 0.34, t = 1.93, p = 0.06). CONCLUSIONS This research provides novel insight into the effect of tDCS and exercise on S100B-indicated BBB permeability in humans. Although the effects of tDCS were not significant, increases in salivary S100B after a fatiguing cycling task may indicate exercise-induced changes in BBB permeability.
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Affiliation(s)
- Aidan Lewis
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia; University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia.
| | - Constantino Toufexis
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Chloe Goldsmith
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rebecca Robinson
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Grace Howie
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Ben Rattray
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Andrew Flood
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia; University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
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3
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Parmigiani S, Ross JM, Cline CC, Minasi CB, Gogulski J, Keller CJ. Reliability and Validity of Transcranial Magnetic Stimulation-Electroencephalography Biomarkers. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:805-814. [PMID: 36894435 PMCID: PMC10276171 DOI: 10.1016/j.bpsc.2022.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/15/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Noninvasive brain stimulation and neuroimaging have revolutionized human neuroscience with a multitude of applications, including diagnostic subtyping, treatment optimization, and relapse prediction. It is therefore particularly relevant to identify robust and clinically valuable brain biomarkers linking symptoms to their underlying neural mechanisms. Brain biomarkers must be reproducible (i.e., have internal reliability) across similar experiments within a laboratory and be generalizable (i.e., have external reliability) across experimental setups, laboratories, brain regions, and disease states. However, reliability (internal and external) is not alone sufficient; biomarkers also must have validity. Validity describes closeness to a true measure of the underlying neural signal or disease state. We propose that these metrics, reliability and validity, should be evaluated and optimized before any biomarker is used to inform treatment decisions. Here, we discuss these metrics with respect to causal brain connectivity biomarkers from coupling transcranial magnetic stimulation (TMS) with electroencephalography (EEG). We discuss controversies around TMS-EEG stemming from the multiple large off-target components (noise) and relatively weak genuine brain responses (signal), as is unfortunately often the case in noninvasive human neuroscience. We review the current state of TMS-EEG recordings, which consist of a mix of reliable noise and unreliable signal. We describe methods for evaluating TMS-EEG biomarkers, including how to assess internal and external reliability across facilities, cognitive states, brain networks, and disorders and how to validate these biomarkers using invasive neural recordings or treatment response. We provide recommendations to increase reliability and validity, discuss lessons learned, and suggest future directions for the field.
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Affiliation(s)
- Sara Parmigiani
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California; Wu Tsai Neuroscience Institute, Stanford, California
| | - Jessica M Ross
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California; Wu Tsai Neuroscience Institute, Stanford, California
| | - Christopher C Cline
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California; Wu Tsai Neuroscience Institute, Stanford, California
| | - Christopher B Minasi
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California; Wu Tsai Neuroscience Institute, Stanford, California
| | - Juha Gogulski
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California; Wu Tsai Neuroscience Institute, Stanford, California; Department of Clinical Neurophysiology, HUS Diagnostic Center, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California; Wu Tsai Neuroscience Institute, Stanford, California.
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Young KM, Rush JL, Lepley AS, Girmann AM, Norte GE. Intersession Reliability of Quadriceps Corticospinal Excitability: A Functional Transcranial Magnetic Stimulation Study. Brain Res 2023; 1808:148348. [PMID: 36972836 DOI: 10.1016/j.brainres.2023.148348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
Recording transcranial magnetic stimulation-derived measures during a closed kinetic chain task can serve as a functional technique to assess corticomotor function, which may have implications for activities of daily living or lower extremity injury in physically active individuals. Given the novelty of TMS use in this way, our purpose was to first determine the intersession reliability of quadriceps corticospinal excitability during a single-leg squat. We used a descriptive laboratory study to assess 20 physically active females (22.1 ± 2.5 years, 1.7 ± 0.7 m, 66.3 ± 13.6 kg, Tegner Activity Scale: 5.90 ± 1.12) over a 14-day period. Two-way mixed effects Intraclass Correlation Coefficients (3,1) (ICC) for absolute agreement were used to assess intersession reliability. The active motor threshold (AMT) and normalized motor evoked potential (MEP) amplitudes were assessed in the vastus medialis of each limb. The dominant limb AMTs demonstrated moderate-to-good reliability (ICC = 0.771, 95% CI = 0.51-0.90; p < 0.001). The non-dominant limb AMTs (ICC = 0.364, 95% CI = 0.00-0.68, p = 0.047), dominant limb MEPs (ICC = 0.192, 95% CI = 0.00-0.71; p = 0.340), and non-dominant limb MEPs (ICC = 0.272, 95% CI = 0.00-0.71; p = 0.235) demonstrated poor-to-moderate reliability. These findings may provide insight into corticomotor function during activities requiring weight-bearing, single-leg movement. However, variability in agreement suggests further work is warranted to improve the standardization of this technique prior to incorporating in clinical outcomes research.
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Affiliation(s)
- Kiana M Young
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America
| | - Justin L Rush
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America.
| | - Adam S Lepley
- Exercise and Sport Science Initiative, School of Kinesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Adam M Girmann
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America
| | - Grant E Norte
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America
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Hu N, Avela J, Kidgell DJ, Nevanperä S, Walker S, Piirainen JM. Reliability of transcranial magnetic stimulation and H-reflex measurement during balance perturbation tasks. Front Physiol 2022; 13:957650. [PMID: 36311220 PMCID: PMC9614306 DOI: 10.3389/fphys.2022.957650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Following ankle movement, posterior balance perturbation evokes short- (SLR ∼30–50 ms), medium- (MLR ∼50–60 ms), and long-latency responses (LLR ∼70–90 ms) in soleus muscle before voluntary muscle contraction. Transcranial magnetic stimulation (TMS) and Hoffmann-reflex (H-reflex) measurements can provide insight into the contributions of corticospinal and spinal mechanisms to each response. Motor evoked potential (MEP) and H-reflex responses have shown good reliability in some dynamic muscle contraction tasks. However, it is still unclear how reliable these methods are in dynamic balance perturbation and corticospinal modulation during long amplitude balance perturbation tasks. 14 subjects completed two test sessions in this study to evaluate the reliability of MEPs, H-reflex, and corticospinal modulation during balance perturbation. In each session, the balance perturbation system operated at 0.25 m/s, accelerating at 2.5 m/s2 over 0.3 m displacement. MEPs and H-reflexes were elicited in the right leg soleus muscle at four delays after ankle movement (10 ms, 40 ms, 80 ms, and 140 ms), respectively. Test-retest reliability of MEP and H-reflex amplitudes were assessed via intraclass correlation coefficients (ICC) both between- and within-session. Between-session test-retest reliability for MEPs was excellent (ICC = 0.928–0.947), while H-reflex demonstrated moderate-to-good reliability (ICC = 0.626–0.887). Within-session reliability for both MEPs and H-reflex was excellent (ICC = 0.927–0.983). TMS and H-reflex measurements were reliable at different delays after perturbation between- and within-sessions, which indicated that these methods can be used to measure corticospinal excitability during balance perturbation.
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Affiliation(s)
- Nijia Hu
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Nijia Hu,
| | - Janne Avela
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Dawson J. Kidgell
- School of Primary and Allied Health Care, Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Samuli Nevanperä
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Simon Walker
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jarmo M. Piirainen
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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6
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Liu HH, Wang RY, Cheng SJ, Liao KK, Zhou JH, Yang YR. Balance Training Modulates Cortical Inhibition in Individuals with Parkinson's Disease: A Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:613-620. [PMID: 36004820 DOI: 10.1177/15459683221119761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most individuals with Parkinson's disease (PD) develop balance dysfunction. Previous studies showed that individuals with PD have abnormal corticomotor changes related to severity of motor symptoms and disease progression. Cortical disinhibition was observed in PD and this alteration can be an early sign of PD. Balance training seems to be an effective intervention to improve balance in individuals with PD. However, it is not much known about the effect of balance training on cortical neuroplasticity in PD population. OBJECTIVE To investigate the effects of balance training on corticomotor excitability in individuals with PD. METHODS Twenty-eight PD participants were recruited and randomly assigned to either the balance training (BT) or the control (CON) group. Both groups underwent 16 training sessions over 8 weeks. Outcome measures for corticomotor inhibition included the cortical silent period (CSP) and short-interval intracortical inhibition (SICI) on transcranial magnetic stimulation. Balance performance was measured using the Mini-Balance Evaluation Systems Test (Mini-BEST) and the Timed Up and Go (TUG) test. RESULTS Participants in the BT group showed a significant increase in corticomotor inhibition (CSP: P = .028, SICI: P = .04) and a significant improvement in balance performance (Mini-BEST: P = .001, TUG: P = .04) after training. Compared to the CON group, the BT group showed a greater increase in corticomotor inhibition (CSP: P = .017, SICI: P = .046) and better improvement in balance (Mini-BEST: P = .046). CONCLUSION Balance training could modulate corticomotor inhibition in the primary motor cortex and improve balance performance in individuals with PD.
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Affiliation(s)
- Hsin-Hsuan Liu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei
| | - Shih-Jung Cheng
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei.,Department of Neurology, MacKay Memorial Hospital, Taipei
| | - Kwong-Kum Liao
- Department of Neurology, Taipei Veterans General Hospital, Taipei
| | - Jun-Hong Zhou
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei.,Preventive Medicine Research Center, National Yang-Ming University, Taipei
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7
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Proessl F, Canino MC, Beckner ME, Conkright WR, LaGoy AD, Sinnott AM, Eagle SR, Martin BJ, Sterczala AJ, Roma PG, Dretsch MN, Mi Q, Ferrarelli F, Germain A, Connaboy C, Nindl BC, Flanagan SD. Use-dependent corticospinal excitability is associated with resilience and physical performance during simulated military operational stress. J Appl Physiol (1985) 2022; 132:187-198. [PMID: 34855522 PMCID: PMC8791840 DOI: 10.1152/japplphysiol.00628.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Simulated military operational stress (SMOS) provides a useful model to better understand resilience in humans as the stress associated with caloric restriction, sleep deficits, and fatiguing exertion degrades physical and cognitive performance. Habitual physical activity may confer resilience against these stressors by promoting favorable use-dependent neuroplasticity, but it is unclear how physical activity, resilience, and corticospinal excitability (CSE) relate during SMOS. To examine associations between corticospinal excitability, physical activity, and physical performance during SMOS. Fifty-three service members (age: 26 ± 5 yr, 13 women) completed a 5-day and -night intervention composed of familiarization, baseline, SMOS (2 nights/days), and recovery days. During SMOS, participants performed rigorous physical and cognitive activities while receiving half of normal sleep (two 2-h blocks) and caloric requirements. Lower and upper limb CSE were determined with transcranial magnetic stimulation (TMS) stimulus-response curves. Self-reported resilience, physical activity, military-specific physical performance (TMT), and endocrine factors were compared in individuals with high (HIGH) and low CSE based on a median split of lower limb CSE at baseline. HIGH had greater physical activity and better TMT performance throughout SMOS. Both groups maintained physical performance despite substantial psychophysiological stress. Physical activity, resilience, and TMT performance were directly associated with lower limb CSE. Individual differences in physical activity coincide with lower (but not upper) limb CSE. Such use-dependent corticospinal excitability directly relates to resilience and physical performance during SMOS. Future studies may use noninvasive neuromodulation to clarify the interplay among CSE, physical activity, and resilience and improve physical and cognitive performance.NEW & NOTEWORTHY We demonstrate that individual differences in physical activity levels coincide with lower limb corticospinal excitability. Such use-dependent corticospinal excitability directly relates to resilience and physical performance during a 5-day simulation of military operational stress with caloric restriction, sleep restriction and disruption, and heavy physical and cognitive exertion.
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Affiliation(s)
- F. Proessl
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M. C. Canino
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M. E. Beckner
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - W. R. Conkright
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - A. D. LaGoy
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania,4Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - A. M. Sinnott
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - S. R. Eagle
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - B. J. Martin
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - A. J. Sterczala
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - P. G. Roma
- 2Behavioral Health & Performance Laboratory, Biomedical Research and Environmental Sciences Division, Human Health and Performance Directorate, NASA Johnson Space Center/KBR, Houston, Texas
| | - M. N. Dretsch
- 3U.S. Army Medical Research Directorate-West, Walter Reed
Army Institute of Research, Joint Base Lewis-McChord, Washington
| | - Qi Mi
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - F. Ferrarelli
- 4Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - A. Germain
- 4Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - C. Connaboy
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - B. C. Nindl
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - S. D. Flanagan
- 1Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
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