Scaling of motor cortical excitability during unimanual force generation

Entropy in Electroencephalographic Signals Modulates with Force Magnitude During Grasping - A Preliminary Report

The ability to hold objects relies on neural processes underlying grip force control during grasping. Brain activity lateralized to contralateral hemisphere averaged over trials is associated with grip force applied on an object. However, the involvement of neural variability within-trial during grip force control remains unclear. We examined dependence of neural variability over frontal, central, and parietal regions of interest (ROI) on grip force magnitude using noninvasive electroencephalography (EEG). We utilized our existing EEG dataset comprised of healthy young adults performing an isometric force control task, cued to exert 5, 10, or 15% of their maximum voluntary contraction (MVC) across trials and received visual feedback of their grip force. We quantified variability in EEG signal via sample entropy (sequence-dependent) and standard deviation (sequence-independent measure) over ROI. We found lateralized modulation in EEG sample entropy with force magnitude over central electrodes but not over frontal or parietal electrodes. However, modulation was not observed for standard deviation in the EEG activity. These findings highlight lateralized and spatially constrained modulation in sequence-dependent, but not sequence-independent component of EEG variability. We contextualize these findings in applications requiring finer precision (e.g., prosthesis), and propose directions for future studies investigating role of neural entropy in behavior.

Structural Learning Benefits in a Visuomotor Adaptation Task Generalize to a Contralateral Effector

Structural learning is characterized by facilitated adaptation following training on a set of sensory perturbations all belonging to the same structure (e.g., 'visuomotor rotations'). This generalization of learning is a core feature of the motor system and is often studied in the context of interlimb transfer. However, such transfer has only been demonstrated when participants learn to counter a specific perturbation in the sensory feedback of their movements; we determined whether structural learning in one limb generalized to the contralateral limb. We trained 13 participants to counter random visual feedback rotations between +/-90 degrees with the right hand and subsequently tested the left hand on a fixed rotation. The structural training group showed faster adaptation in the left hand in both feedforward and feedback components of reaching compared to 13 participants who trained with veridical reaching, with lower initial reaching error, and straighter, faster, and smoother movements than in the control group. The transfer was ephemeral - benefits were confined to roughly the first 20 trials. The results demonstrate that the motor system can extract invariant properties of seemingly random environments in one limb, and that this information can be accessed by the contralateral limb.

Transcranial magnetic stimulation input-output curve slope differences suggest variation in recruitment across muscle representations in primary motor cortex

Measurement of the input-output (IO) curves of motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) can be used to assess corticospinal excitability and motor recruitment. While IO curves have been used to study disease and pharmacology, few studies have compared the IO curves across the body. This study sought to characterize IO curve parameters across the dominant and non-dominant sides of upper and lower limbs in healthy participants. Laterality preferences were assessed in eight healthy participants and IO curves were measured bilaterally for the first dorsal interosseous (FDI), biceps brachii (BB), and tibialis anterior (TA) muscles. Results show that FDI has lower motor threshold than BB which is, in turn, lower than TA. In addition, both BB and TA have markedly shallower logarithmic IO curve slopes from small to large MEP responses than FDI. After normalizing these slopes by their midpoints to account for differences in motor thresholds, which could result from geometric factors such as the target depth, large differences in logarithmic slopes remain present between all three muscles. The differences in slopes between the muscles could not be explained by differences in normalized IO curve spreads, which relate to the extent of the cortical representation and were comparable across the muscles. The IO curve differences therefore suggest muscle-dependent variations in TMS-evoked recruitment across the primary motor cortex, which should be considered when utilizing TMS-evoked MEPs to study disease states and treatment effects.

Accuracy of Force Generation and Preparatory Prefrontal Oxygenation in Ballistic Hand Power and Precision Grips

It remains unclear whether accurate motor performance and cortical activation differ among grasping forms across several force levels. In the present study, a ballistic target force matching task (20%, 40%, 60%, and 80% of maximum voluntary force) with power grip, side pinch, and pulp pinch was utilized to explore the accuracy of the forces generated as well as the muscular activity of intrinsic and extrinsic hand muscles. By using near-infrared spectroscopy, we also examined bilateral dorsolateral prefrontal cortex (DLPFC) activation during the preparatory phase (initial 10 s) of the task. The accuracy of the power grip and pulp pinch was relatively higher than that of the side pinch, and the electromyographic activity of intrinsic hand muscles exhibited a similar trend for power grip and side pinch, while the opposite muscle recruitment pattern was observed for pulp pinch. The increment of DLPFC oxygenation across force levels differed among grasping forms, with greater activity at relatively higher levels in the power grip and side pinch, and at relatively lower levels in the pulp pinch. Taken together, the differential contribution of the DLPFC may be responsible for force generation depending on different grasping forms and force levels.

Greater task difficulty during unilateral motor tasks changes intracortical inhibition and facilitation in the ipsilateral primary motor cortex in young men

This study aimed to clarify the changes in short-interval intracortical inhibition (SICI) and facilitation (ICF) in the ipsilateral primary motor cortex (iM1) when the task difficulty during unilateral force-matching tasks was manipulated. Twelve young male adults matched their left index finger abduction force to a displayed target force. Task difficulty was manipulated by varying the acceptable force range of the mean target force (5% MVC). Briefly, unilateral force-matching tasks with lesser and greater task difficulty (EASY and DIFF, respectively) were assigned acceptable force ranges of ± 7% and ± 0% of the target force, respectively. To evaluate SICI and ICF in iM1, paired-pulse transcranial magnetic stimulation with 2-ms and 10-ms interstimulus intervals was applied to correct motor-evoked potentials (MEPs) from the first dorsal interosseous muscle during each task. Test stimulus intensity to evoke the MEP with a peak-to-peak amplitude of approximately 0.5-1.5 mV for each task was lower in DIFF than in EASY (P = 0.001), indicating that DIFF increased corticospinal excitability of the ipsilateral hemisphere compared with EASY. The MEPs in SICI and ICF were significantly larger in DIFF than in EASY (P < 0.050). These results suggest that greater corticospinal excitability in the ipsilateral hemisphere during DIFF is associated with reduced SICI and increased ICF.

Lateralized Neural Entropy modulates with Grip Force during Precision Grasping

When holding a coffee mug filled to the brim, we strive to avoid spilling the coffee. This ability relies on the neural processes underlying the control of finger forces on a moment-to-moment basis. The brain activity lateralized to the contralateral hemisphere averaged over a trial and across the trials is known to be associated with the magnitude of grip force applied on an object. However, the mechanistic involvement of the variability in neural signals during grip force control remains unclear. In this study, we examined the dependence of neural variability over the frontal, central, and parietal regions assessed using noninvasive electroencephalography (EEG) on grip force magnitude during an isometric force control task. We hypothesized laterally specific modulation in EEG variability with higher magnitude of the grip force exerted during grip force control. We utilized an existing EEG dataset (64 channel) comprised of healthy young adults, who performed an isometric force control task while receiving visual feedback of the force applied. The force magnitude to be exerted on the instrumented object was cued to participants during the task, and varied pseudorandomly among 5, 10, and 15% of their maximum voluntary contraction (MVC) across the trials. We quantified neural variability via sample entropy (sequence-dependent measure) and standard deviation (sequence-independent measure) of the temporal EEG signal over the frontal, central, and parietal electrodes. The EEG sample entropy over the central electrodes showed lateralized, nonlinear, localized, modulation with force magnitude. Similar modulation was not observed over frontal or parietal EEG activity, nor for standard deviation in the EEG activity. Our findings highlight specificity in neural control of grip forces by demonstrating the modulation in sequence-dependent but not sequence-independent component of EEG variability. This modulation appeared to be lateralized, spatially constrained, and functionally dependent on the grip force magnitude. We discuss the relevance of these findings in scenarios where a finer precision is essential to enable grasp application, such as prosthesis and associated neural signal integration, and propose directions for future studies investigating the mechanistic role of neural entropy in grip force control.

Efficacy of contralaterally controlled functional electrical stimulation compared to cyclic neuromuscular electrical stimulation and task-oriented training for recovery of hand function after stroke: study protocol for a multi-site randomized controlled trial

BACKGROUND

Multi-site studies in stroke rehabilitation are important for determining whether a technology and/or treatment can be successfully administered by sites other than the originating site and with similar positive outcomes. This study is the first multi-site clinical trial of a novel intervention for post-stroke upper limb rehabilitation called contralaterally controlled functional electrical stimulation (CCFES). Previous pilot and single-site studies showed positive effects of CCFES on upper limb impairment and hand dexterity in stroke survivors. The main purpose of this study is to confirm and demonstrate the efficacy of CCFES in a larger group of most likely responders across multiple clinical sites.

METHODS

Up to 129 stroke survivors with moderate to severe upper extremity hemiparesis at 4 clinical trial sites will be randomized to CCFES, cyclic neuromuscular electrical stimulation (cNMES), or task-oriented-training (TOT). Participants will receive 12 weeks of group-specific therapy. Blinded assessments of upper limb impairment and activity limitation, quality of life, and neurophysiology will be used to compare outcomes at baseline, after treatment, and up to 6 months post-treatment. The primary endpoint is change in dexterity from baseline to 6 months post-treatment.

DISCUSSION

Loss of hand function following stroke is a major rehabilitation problem affecting millions of people per year globally. More effective rehabilitation therapies are needed to restore hand function in these individuals. This study will determine whether CCFES therapy produces greater improvements in upper extremity function than cNMES or TOT, and will begin to elucidate the different mechanisms underlying each of the three treatments. This multi-site study is a critical step in advancing a novel method of rehabilitation toward clinical translation and widespread dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03574623 . Registered prior to first enrollment; July 2, 2018.

"Tricking the Brain" Using Immersive Virtual Reality: Modifying the Self-Perception Over Embodied Avatar Influences Motor Cortical Excitability and Action Initiation

To offer engaging neurorehabilitation training to neurologic patients, motor tasks are often visualized in virtual reality (VR). Recently introduced head-mounted displays (HMDs) allow to realistically mimic the body of the user from a first-person perspective (i.e., avatar) in a highly immersive VR environment. In this immersive environment, users may embody avatars with different body characteristics. Importantly, body characteristics impact how people perform actions. Therefore, alternating body perceptions using immersive VR may be a powerful tool to promote motor activity in neurologic patients. However, the ability of the brain to adapt motor commands based on a perceived modified reality has not yet been fully explored. To fill this gap, we "tricked the brain" using immersive VR and investigated if multisensory feedback modulating the physical properties of an embodied avatar influences motor brain networks and control. Ten healthy participants were immersed in a virtual environment using an HMD, where they saw an avatar from first-person perspective. We slowly transformed the surface of the avatar (i.e., the "skin material") from human to stone. We enforced this visual change by repetitively touching the real arm of the participant and the arm of the avatar with a (virtual) hammer, while progressively replacing the sound of the hammer against skin with stone hitting sound via loudspeaker. We applied single-pulse transcranial magnetic simulation (TMS) to evaluate changes in motor cortical excitability associated with the illusion. Further, to investigate if the "stone illusion" affected motor control, participants performed a reaching task with the human and stone avatar. Questionnaires assessed the subjectively reported strength of embodiment and illusion. Our results show that participants experienced the "stone arm illusion." Particularly, they rated their arm as heavier, colder, stiffer, and more insensitive when immersed with the stone than human avatar, without the illusion affecting their experienced feeling of body ownership. Further, the reported illusion strength was associated with enhanced motor cortical excitability and faster movement initiations, indicating that participants may have physically mirrored and compensated for the embodied body characteristics of the stone avatar. Together, immersive VR has the potential to influence motor brain networks by subtly modifying the perception of reality, opening new perspectives for the motor recovery of patients.

Determinants of Neural Plastic Changes Induced by Motor Practice

Short-term motor practice leads to plasticity in the primary motor cortex (M1). The purpose of this study is to investigate the factors that determine the increase in corticospinal tract (CST) excitability after motor practice, with special focus on two factors; “the level of muscle activity” and “the presence/absence of a goal of keeping the activity level constant.” Fifteen healthy subjects performed four types of rapid thumb adduction in separate sessions. In the “comfortable task” (C) and “forceful task” (F), the subjects adducted their thumb using comfortable and strong forces. In the “comfortable with a goal task” (CG) and “forceful with a goal task” (FG), subjects controlled the muscle activity at the same level as in the C and F, respectively, by adjusting the peak electromyographic amplitude within the target ranges. Paired associative stimulation (PAS), which combines peripheral nerve (median nerve) stimulation and transcranial magnetic stimulation (TMS), with an inter-stimulus interval of 25 ms (PAS25) was also done. Before and after the motor tasks and PAS25, TMS was applied to the M1. None of the four tasks showed any temporary changes in behavior, meaning no learning occurred. Motor-evoked potential (MEP) amplitude increased only after the FG and it exhibited a positive correlation with the MEP increase after PAS25, suggesting that FG and PAS25 share at least similar plasticity mechanisms in the M1. Resting motor threshold (RMT) decreased only after FG, suggesting that FG would also be associated with the membrane depolarization of M1 neurons. These results suggest task-dependent plasticity from the synergistic effect of forceful muscle activity and of setting a goal of keeping the activity level constant.

Neural noise and cortical inhibition in schizophrenia

BACKGROUND

Neural information processing is subject to noise and this leads to variability in neural firing and behavior. Schizophrenia has been associated with both more variable motor control and impaired cortical inhibition, which is crucial for excitatory/inhibitory balance in neural commands.

HYPOTHESIS

In this study, we hypothesized that impaired intracortical inhibition in motor cortex would contribute to task-related motor noise in schizophrenia.

METHODS

We measured variability of force and of electromyographic (EMG) activity in upper limb and hand muscles during a visuomotor grip force-tracking paradigm in patients with schizophrenia (N = 25), in unaffected siblings (N = 17) and in healthy control participants (N = 25). Task-dependent primary motor cortex (M1) excitability and inhibition were assessed using transcranial magnetic stimulation (TMS).

RESULTS

During force maintenance patients with schizophrenia showed increased variability in force and EMG, despite similar mean force and EMG magnitudes. Compared to healthy controls, patients with schizophrenia also showed increased M1 excitability and reduced cortical inhibition during grip-force tracking. EMG variability and force variability correlated negatively to cortical inhibition in patients with schizophrenia. EMG variability also correlated positively to negative symptoms. Siblings had similar variability and cortical inhibition compared to controls. Increased EMG and force variability indicate enhanced motor noise in schizophrenia, which relates to reduced motor cortex inhibition.

CONCLUSION

The findings suggest that excessive motor noise in schizophrenia may arise from an imbalance of M1 excitation/inhibition of GABAergic origin. Thus, higher motor noise may provide a useful marker of impaired cortical inhibition in schizophrenia.

Fluctuations in Human Corticospinal Activity Prior to Grasp

Neuronal firing rate variability prior to movement onset contributes to trial-to-trial variability in primate behavior. However, in humans, whether similar mechanisms contribute to trial-to-trial behavioral variability remains unknown. We investigated the time-course of trial-to-trial variability in corticospinal excitability (CSE) using transcranial magnetic stimulation (TMS) during a self-paced reach-to-grasp task. We hypothesized that CSE variability will be modulated prior to the initiation of reach and that such a modulation would explain trial-to-trial behavioral variability. Able-bodied individuals were visually cued to plan their grip force before exertion of either 30% or 5% of their maximum pinch force capacity on an object. TMS was delivered at six time points (0.5, 0.75, 1, 1.1, 1.2, and 1.3 s) following a visual cue that instructed the force level. We first modeled the relation between CSE magnitude and its variability at rest (n = 12) to study the component of CSE variability pertaining to the task but not related to changes in CSE magnitude (n = 12). We found an increase in CSE variability from 1.2 to 1.3 s following the visual cue at 30% but not at 5% of force. This effect was temporally dissociated from the decrease in CSE magnitude that was observed from 0.5 to 0.75 s following the cue. Importantly, the increase in CSE variability explained at least ∼40% of inter-individual differences in trial-to-trial variability in time to peak force rate. These results were found to be repeatable across studies and robust to different analysis methods. Our findings suggest that the neural mechanisms underlying modulation in CSE variability and CSE magnitude are distinct. Notably, the extent of modulation in variability in corticospinal system prior to grasp within individuals may explain their trial-to-trial behavioral variability.

Contraction intensity-dependent variations in the responses to brain and corticospinal tract stimulation after a single session of resistance training in men

The aim of this study was to determine the effects of acute resistance training (RT) intensity on motor-evoked potentials (MEPs) generated by transcranial magnetic brain stimulation and on cervicomedullary motor-evoked potentials (CMEPs) produced by electrical stimulation of the corticospinal tract. In four experimental sessions, 14 healthy young men performed 12 sets of eight isometric contractions of the elbow flexors at 0 (Control session), 25, 50, and 75% of the maximal voluntary contraction (MVC). Before and after each session, MEPs, CMEPs, and the associated twitch forces were recorded at rest. MEPs increased by 39% (P < 0.05 versus 25% in the control condition, Effect size (ES) = 1.04 and 1.76, respectively) after the 50% session and by 70% (P < 0.05 vs. all other conditions, ES = 0.91-2.49) after the 75% session. In contrast, CMEPs increased similarly after the 25%, 50%, and 75% sessions with an overall increase of 27% (P < 0.05 vs. control condition, ES = 1.34). The amplitude of maximal compound muscle action potentials (M_max) was unchanged during the experiment. The MEP- and CMEP-associated twitch forces also increased after RT, but training intensity affected only the increases in MEP twitch forces. The data tentatively suggest that the intensity of muscle contraction used in acute bouts of RT affects cortical excitability.NEW & NOTEWORTHY Resistance training (RT) can acutely increase the efficacy of the corticospinal-motoneuronal synapse, motoneuron excitability and motor cortical excitability. We show that motor-evoked potential generated by transcranial magnetic stimulation but not cervicomedullary electrical stimulation increased in proportion to the intensity of training used during a single session of RT. The data suggest that the intensity of muscle contraction used in acute bouts of RT affects cortical excitability.

Visual feedback alters force control and functional activity in the visuomotor network after stroke

Modulating visual feedback may be a viable option to improve motor function after stroke, but the neurophysiological basis for this improvement is not clear. Visual gain can be manipulated by increasing or decreasing the spatial amplitude of an error signal. Here, we combined a unilateral visually guided grip force task with functional MRI to understand how changes in the gain of visual feedback alter brain activity in the chronic phase after stroke. Analyses focused on brain activation when force was produced by the most impaired hand of the stroke group as compared to the non-dominant hand of the control group. Our experiment produced three novel results. First, gain-related improvements in force control were associated with an increase in activity in many regions within the visuomotor network in both the stroke and control groups. These regions include the extrastriate visual cortex, inferior parietal lobule, ventral premotor cortex, cerebellum, and supplementary motor area. Second, the stroke group showed gain-related increases in activity in additional regions of lobules VI and VIIb of the ipsilateral cerebellum. Third, relative to the control group, the stroke group showed increased activity in the ipsilateral primary motor cortex, and activity in this region did not vary as a function of visual feedback gain. The visuomotor network, cerebellum, and ipsilateral primary motor cortex have each been targeted in rehabilitation interventions after stroke. Our observations provide new insight into the role these regions play in processing visual gain during a precisely controlled visuomotor task in the chronic phase after stroke.

Corticospinal excitability for hand muscles during motor imagery of foot changes with imagined force level

The object of this study was to clarify whether corticospinal excitability controlling hand muscles changes concurrently with increases in the imagined contraction level of foot dorsiflexion. Twelve participants performed actual and imagined dorsiflexion of their right foot at three different EMG levels (10, 40 or 80% of the maximum voluntary contraction). During isometric actual- or imagined- dorsiflexion, transcranial magnetic stimulation (TMS) was delivered to the right hand area of the left primary motor cortex. Motor evoked potentials (MEPs) were recorded from the right extensor carpi radialis (ECR) and flexor carpi radialis (FCR). During actual contraction, MEP amplitudes of ECR and FCR increased with an increased EMG level of dorsiflexion. Similarly, during imagery contraction, MEP amplitudes of ECR and FCR increased with the intensity of imagery contraction. Furthermore, a correlation between MEP amplitude during actual contraction and imagery contraction was observed for both ECR and FCR. Motor imagery of foot contraction induced an enhancement of corticospinal excitability for hand muscles that was dependent on the imagined contraction levels, just as what was observed when there was an actual contraction.

Cortical contributions to sensory gating in the ipsilateral somatosensory cortex during voluntary activity

KEY POINTS

It has long been known that the somatosensory cortex gates sensory inputs from the contralateral side of the body. Here, we examined the contribution of the ipsilateral somatosensory cortex (iS1) to sensory gating during index finger voluntary activity. The amplitude of the P25/N33, but not other somatosensory evoked potential (SSEP) components, was reduced during voluntary activity compared with rest. Interhemispheric inhibition between S1s and intracortical inhibition in the S1 modulated the amplitude of the P25/N33. Note that changes in interhemispheric inhibition between S1s correlated with changes in cortical circuits in the ipsilateral motor cortex. Our findings suggest that cortical circuits, probably from somatosensory and motor cortex, contribute to sensory gating in the iS1 during voluntary activity in humans.

ABSTRACT

An important principle in the organization of the somatosensory cortex is that it processes afferent information from the contralateral side of the body. The role of the ipsilateral somatosensory cortex (iS1) in sensory gating in humans remains largely unknown. Using electroencephalographic (EEG) recordings over the iS1 and electrical stimulation of the ulnar nerve at the wrist, we examined somatosensory evoked potentials (SSEPs; P14/N20, N20/P25 and P25/N33 components) and paired-pulse SSEPs between S1s (interhemispheric inhibition) and within (intracortical inhibition) the iS1 at rest and during tonic index finger voluntary activity. We found that the amplitude of the P25/N33, but not other SSEP components, was reduced during voluntary activity compared with rest. Interhemispheric inhibition increased the amplitude of the P25/N33 and intracortical inhibition reduced the amplitude of the P25/N33, suggesting a cortical origin for this effect. The P25/N33 receives inputs from the motor cortex, so we also examined the contribution of distinct sets of cortical interneurons by testing the effect of ulnar nerve stimulation on motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation over the ipsilateral motor cortex with the coil in the posterior-anterior (PA) and anterior-posterior (AP) orientation. Afferent input attenuated PA, but not AP, MEPs during voluntary activity compared with rest. Notably, changes in interhemispheric inhibition correlated with changes in PA MEPs. Our novel findings suggest that interhemispheric projections between S1s and intracortical circuits, probably from somatosensory and motor cortex, contribute to sensory gating in the iS1 during voluntary activity in humans.

Effects of non-target leg activation, TMS coil orientation, and limb dominance on lower limb motor cortex excitability

Transcranial magnetic stimulation (TMS) is used to examine corticospinal tract integrity after stroke, however, generating motor-evoked potentials (MEPs) in the lower limb (LL) can be difficult. Previous studies have used activation of the target leg to facilitate MEPs in the LL but this may not be possible after stroke due to hemiplegia. The dominance of the target limb may also be important, however the neurophysiological effects of LL dominance are not known. We investigated whether voluntary activation of the non-target leg combined with optimal TMS coil orientation increases corticomotor excitability in healthy adults, and whether limb dominance influences these results. TMS was delivered to induce a posterior-anterior (PA) and a medial-lateral (ML) cortical current in 22 healthy adults. MEPs were recorded in tibialis anterior (TA) with the participant at rest and when activating the non-target leg. We found that non-target leg activation increased corticomotor excitability in the target leg (reduced rest motor threshold (RMT) and MEP latency, and increased recruitment curve slope). ML cortical current also reduced RMT and MEP latency. The degree of footedness correlated with the degree of RMT asymmetry, with a PA but not ML cortical current direction. In summary, cross-facilitation by activating the non-target leg in a task requiring postural stabilisation and inducing ML current increase corticomotor excitability regardless of limb dominance. This protocol may have practical application in testing CST integrity after stroke when paretic limb thresholds are high, by increasing the likelihood of eliciting a MEP.

Mirror illusion reduces motor cortical inhibition in the ipsilateral primary motor cortex during forceful unilateral muscle contractions

Forceful, unilateral contractions modulate corticomotor paths targeting the resting, contralateral hand. However, it is unknown whether mirror-viewing of a slowly moving but forcefully contracting hand would additionally affect these paths. Here we examined corticospinal excitability and short-interval intracortical inhibition (SICI) of the right-ipsilateral primary motor cortex (M1) in healthy young adults under no-mirror and mirror conditions at rest and during right wrist flexion at 60% maximal voluntary contraction (MVC). During the no-mirror conditions neither hand was visible, whereas in the mirror conditions participants looked at the right hand's reflection in the mirror. Corticospinal excitability increased during contractions in the left flexor carpi radialis (FCR) (contraction 0.41 mV vs. rest 0.21 mV) and extensor carpi radialis (ECR) (contraction 0.56 mV vs. rest 0.39 mV), but there was no mirror effect (FCR: P = 0.743, ηp (2) = 0.005; ECR: P = 0.712, ηp (2) = 0.005). However, mirror-viewing of the contracting and moving wrist attenuated SICI relative to test pulse in the left FCR by ∼9% compared with the other conditions (P < 0.05, d ≥ 0.62). Electromyographic activity in the resting left hand prior to stimulation was not affected by the mirror (FCR: P = 0.255, ηp (2) = 0.049; ECR: P = 0.343, ηp (2) = 0.035) but increased twofold during contractions. Thus viewing the moving hand in the mirror and not just the mirror image of the nonmoving hand seems to affect motor cortical inhibitory networks in the M1 associated with the mirror image. Future studies should determine whether the use of a mirror could increase interlimb transfer produced by cross-education, especially in patient groups with unilateral orthopedic and neurological conditions.

Activity of right premotor-parietal regions dependent upon imagined force level: an fMRI study

In this study, we utilized functional magnetic resonance imaging (fMRI) to measure blood oxygenation level-dependent (BOLD) signals. This allowed us to evaluate the relationship between brain activity and imagined force level. Subjects performed motor imagery of repetitive right hand grasping with three different levels of contractile force; 10%, 30%, and 60% of their maximum voluntary contraction (MVC). We observed a common activation among each condition in the following brain regions; the dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), supplementary motor area (SMA), premotor area (PM), insula, and inferior parietal lobule (IPL). In addition, the BOLD signal changes were significantly larger at 60% MVC than at 10% MVC in the right PM, the right IPL, and the primary somatosensory cortex (SI). These findings indicate that during motor imagery right fronto-parietal activity increases as the imagined contractile force level is intensified. The present finding that the right brain activity during motor imagery is clearly altered depending on the imagined force level suggests that it may be possible to decode intended force level during the motor imagery of patients or healthy subjects.

Increased bilateral interactions in middle-aged subjects

A hallmark of the age-related neural reorganization is that old versus young adults execute typical motor tasks by a more diffuse neural activation pattern including stronger ipsilateral activation during unilateral tasks. Whether such changes in neural activation are present already at middle age and affect bimanual interactions is unknown. We compared the amount of associated activity, i.e., muscle activity and force produced by the non-task hand and motor evoked potentials (MEPs) produced by magnetic brain stimulation between young (mean 24 years, n = 10) and middle-aged (mean 50 years, n = 10) subjects during brief unilateral (seven levels of % maximal voluntary contractions, MVCs) and bilateral contractions (4 × 7 levels of % MVC combinations), and during a 120-s-long MVC of sustained unilateral index finger abduction. During the force production, the excitability of the ipsilateral (iM1) or contralateral primary motor cortex (cM1) was assessed. The associated activity in the "resting" hand was ~2-fold higher in middle-aged (28% of MVC) versus young adults (11% of MVC) during brief unilateral MVCs. After controlling for the background muscle activity, MEPs in iM1 were similar in the two groups during brief unilateral contractions. Only at low (bilateral) forces, MEPs evoked in cM1 were 30% higher in the middle-aged versus young adults. At the start of the sustained contraction, the associated activity was higher in the middle-aged versus young subjects and increased progressively in both groups (30 versus 15% MVC at 120 s, respectively). MEPs were greater at the start of the sustained contraction in middle-aged subjects but increased further during the contraction only in young adults. Under these experimental conditions, the data provide evidence for the reorganization of neural control of unilateral force production as early as age 50. Future studies will determine if the altered neural control of such inter-manual interactions are of functional significance.

Aberrant crossed corticospinal facilitation in muscles distant from a spinal cord injury

Crossed facilitatory interactions in the corticospinal pathway are impaired in humans with chronic incomplete spinal cord injury (SCI). The extent to which crossed facilitation is affected in muscles above and below the injury remains unknown. To address this question we tested 51 patients with neurological injuries between C2-T12 and 17 age-matched healthy controls. Using transcranial magnetic stimulation we elicited motor evoked potentials (MEPs) in the resting first dorsal interosseous, biceps brachii, and tibialis anterior muscles when the contralateral side remained at rest or performed 70% of maximal voluntary contraction (MVC) into index finger abduction, elbow flexion, and ankle dorsiflexion, respectively. By testing MEPs in muscles with motoneurons located at different spinal cord segments we were able to relate the neurological level of injury to be above, at, or below the location of the motoneurons of the muscle tested. We demonstrate that in patients the size of MEPs was increased to a similar extent as in controls in muscles above the injury during 70% of MVC compared to rest. MEPs remained unchanged in muscles at and within 5 segments below the injury during 70% of MVC compared to rest. However, in muscles beyond 5 segments below the injury the size of MEPs increased similar to controls and was aberrantly high, 2-fold above controls, in muscles distant (>15 segments) from the injury. These aberrantly large MEPs were accompanied by larger F-wave amplitudes compared to controls. Thus, our findings support the view that corticospinal degeneration does not spread rostral to the lesion, and highlights the potential of caudal regions distant from an injury to facilitate residual corticospinal output after SCI.

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.

Modulation of corticospinal excitability dependent upon imagined force level

Motor imagery is defined as the mental execution of a movement without any muscle activity. In the present study, corticospinal excitability was assessed by motor evoked potentials (MEPs) when the subjects imagined isometric elbow flexion at various force levels. Electromyography was recorded from the right brachioradialis, the biceps brachii and the triceps brachii muscles. First, the maximum voluntary contraction (MVC) of elbow flexion was recorded in each subject. Subjects practiced performing 10, 30 and 60 % MVC using visual feedback. After the practice, MEPs were recorded during the imagery of elbow flexion with the forces of 10, 30 and 60 % MVC without any feedback. After the MEPs recording, we assigned subjects to reproduce the actual elbow flexion force at 10, 30 and 60 % MVC. The MEPs amplitudes in the brachioradialis and biceps brachii in the 60 % MVC condition were significantly greater than those in the 10 % MVC condition (p < 0.05). These findings suggest that the enhancement of corticospinal excitability during motor imagery is associated with an increase in imagined force level.

Ipsilateral motor pathways after stroke: implications for non-invasive brain stimulation

In humans the two cerebral hemispheres have essential roles in controlling the upper limb. The purpose of this article is to draw attention to the potential importance of ipsilateral descending pathways for functional recovery after stroke, and the use of non-invasive brain stimulation (NBS) protocols of the contralesional primary motor cortex (M1). Conventionally NBS is used to suppress contralesional M1, and to attenuate transcallosal inhibition onto the ipsilesional M1. There has been little consideration of the fact that contralesional M1 suppression may also reduce excitability of ipsilateral descending pathways that may be important for paretic upper limb control for some patients. One such ipsilateral pathway is the cortico-reticulo-propriospinal pathway (CRPP). In this review we outline a neurophysiological model to explain how contralesional M1 may gain control of the paretic arm via the CRPP. We conclude that the relative importance of the CRPP for motor control in individual patients must be considered before using NBS to suppress contralesional M1. Neurophysiological, neuroimaging, and clinical assessments can assist this decision making and facilitate the translation of NBS into the clinical setting.

Change in the ipsilateral motor cortex excitability is independent from a muscle contraction phase during unilateral repetitive isometric contractions

The aim of this study was to investigate the difference in a muscle contraction phase dependence between ipsilateral (ipsi)- and contralateral (contra)-primary motor cortex (M1) excitability during repetitive isometric contractions of unilateral index finger abduction using a transcranial magnetic stimulation (TMS) technique. Ten healthy right-handed subjects participated in this study. We instructed them to perform repetitive isometric contractions of the left index finger abduction following auditory cues at 1 Hz. The force outputs were set at 10, 30, and 50% of maximal voluntary contraction (MVC). Motor evoked potentials (MEP) were obtained from the right and left first dorsal interosseous muscles (FDI). To examine the muscle contraction phase dependence, TMS of ipsi-M1 or contra-M1 was triggered at eight different intervals (0, 20, 40, 60, 80, 100, 300, or 500 ms) after electromyogram (EMG) onset when each interval had reached the setup triggering level. Furthermore, to demonstrate the relationships between the integrated EMG (iEMG) in the active left FDI and the ipsi-M1 excitability, we assessed the correlation between the iEMG in the left FDI for the 100 ms preceding TMS onset and the MEP amplitude in the resting/active FDI for each force output condition. Although contra-M1 excitability was significantly changed after the EMG onset that depends on the muscle contraction phase, the modulation of ipsi-M1 excitability did not differ in response to any muscle contraction phase at the 10% of MVC condition. Also, we found that contra-M1 excitability was significantly correlated with iEMG in all force output conditions, but ipsi-M1 excitability was not at force output levels of below 30% of MVC. Consequently, the modulation of ipsi-M1 excitability was independent from the contraction phase of unilateral repetitive isometric contractions at least low force output.

Submovement composition of head movement

Limb movement is smooth and corrections of movement trajectory and amplitude are barely noticeable midflight. This suggests that skeletomuscular motor commands are smooth in transition, such that the rate of change of acceleration (or jerk) is minimized. Here we applied the methodology of minimum-jerk submovement decomposition to a member of the skeletomuscular family, the head movement. We examined the submovement composition of three types of horizontal head movements generated by nonhuman primates: head-alone tracking, head-gaze pursuit, and eye-head combined gaze shifts. The first two types of head movements tracked a moving target, whereas the last type oriented the head with rapid gaze shifts toward a target fixed in space. During head tracking, the head movement was composed of a series of episodes, each consisting of a distinct, bell-shaped velocity profile (submovement) that rarely overlapped with each other. There was no specific magnitude order in the peak velocities of these submovements. In contrast, during eye-head combined gaze shifts, the head movement was often comprised of overlapping submovements, in which the peak velocity of the primary submovement was always higher than that of the subsequent submovement, consistent with the two-component strategy observed in goal-directed limb movements. These results extend the previous submovement composition studies from limb to head movements, suggesting that submovement composition provides a biologically plausible approach to characterizing the head motor recruitment that can vary depending on task demand.

Task-related enhancement in corticomotor excitability during haptic sensing with the contra- or ipsilateral hand in young and senior adults

Background

Haptic sensing with the fingers represents a unique class of manipulative actions, engaging motor, somatosensory and associative areas of the cortex while requiring only minimal forces and relatively simple movement patterns. Using transcranial magnetic stimulation (TMS), we investigated task-related changes in motor evoked potential (MEP) amplitude associated with unimanual haptic sensing in two related experiments. In Experiment I, we contrasted changes in the excitability of the hemisphere controlling the task hand in young and old adults under two trial conditions, i.e. when participants either touched a fine grating (smooth trials) or touched a coarse grating to detect its groove orientation (grating trials). In Experiment II, the same contrast between tasks was performed but with TMS applied over the hemisphere controlling the resting hand, while also addressing hemispheric (right vs. left) and age differences.

Results

In Experiment I, a main effect of trial type on MEP amplitude was detected (p = 0.001), MEPs in the task hand being ~50% larger during grating than smooth trials. No interaction with age was detected. Similar results were found for Experiment II, trial type having a large effect on MEP amplitude in the resting hand (p < 0.001) owing to selective increase in MEP size (~2.6 times greater) for grating trials. No interactions with age or side (right vs. left) were detected.

Conclusions

Collectively, these results indicate that adding a haptic component to a simple unilateral finger action can elicit robust corticomotor facilitation not only in the working hemisphere but also in the opposite hemisphere. The fact that this facilitation seems well preserved with age, when task difficulty is adjusted, has some potential clinical implications.

Impaired crossed facilitation of the corticospinal pathway after cervical spinal cord injury

In uninjured humans, it is well established that voluntary contraction of muscles on one side of the body can facilitate transmission in the contralateral corticospinal pathway. This crossed facilitatory effect may favor interlimb coordination and motor performance. Whether this aspect of corticospinal function is preserved after chronic spinal cord injury (SCI) is unknown. Here, using transcranial magnetic stimulation, we show in patients with chronic cervical SCI (C(5)-C(8)) that the size of motor evoked potentials (MEPs) in a resting intrinsic hand muscle remained unchanged during increasing levels of voluntary contraction with a contralateral distal or proximal arm muscle. In contrast, MEP size in a resting hand muscle was increased during the same motor tasks in healthy control subjects. The magnitude of voluntary electromyography was negatively correlated with MEP size after chronic cervical SCI and positively correlated in healthy control subjects. To examine the mechanisms contributing to MEP crossed facilitation we examined short-interval intracortical inhibition (SICI), interhemispheric inhibition (IHI), and motoneuronal behavior by testing F waves and cervicomedullary MEPs (CMEPs). During strong voluntary contractions SICI was unchanged after cervical SCI and decreased in healthy control subjects compared with rest. F-wave amplitude and persistence and CMEP size remained unchanged after cervical SCI and increased in healthy control subjects compared with rest. In addition, during strong voluntary contractions IHI was unchanged in cervical SCI compared with rest. Our results indicate that GABAergic intracortical circuits, interhemispheric glutamatergic projections between motor cortices, and excitability of index finger motoneurons are neural mechanisms underlying, at least in part, the lack of crossed corticospinal facilitation observed after SCI. Our data point to the spinal motoneurons as a critical site for modulating corticospinal transmission after chronic cervical SCI.

The bilateral movement condition facilitates maximal but not submaximal paretic-limb grip force in people with post-stroke hemiparesis

OBJECTIVES

Although healthy individuals have less force production capacity during bilateral muscle contractions compared to unilateral efforts, emerging evidence suggests that certain aspects of paretic upper limb task performance after stroke may be enhanced by moving bilaterally instead of unilaterally. We investigated whether the bilateral movement condition affects grip force differently on the paretic side of people with post-stroke hemiparesis, compared to their non-paretic side and both sides of healthy young adults.

METHODS

Within a single session, we compared: (1) maximal grip force during unilateral vs. bilateral contractions on each side, and (2) force contributed by each side during a 30% submaximal bilateral contraction.

RESULTS

Healthy controls produced less grip force in the bilateral condition, regardless of side (-2.4% difference), and similar findings were observed on the non-paretic side of people with hemiparesis (-4.5% difference). On the paretic side, however, maximal grip force was increased by the bilateral condition in most participants (+11.3% difference, on average). During submaximal bilateral contractions in each group, the two sides each contributed the same percentage of unilateral maximal force.

CONCLUSIONS

The bilateral condition facilitates paretic limb grip force at maximal, but not submaximal levels.

SIGNIFICANCE

In some people with post-stroke hemiparesis, the paretic limb may benefit from bilateral training with high force requirements.

Probing for hemispheric specialization for motor skill learning: a transcranial direct current stimulation study

Convergent findings point to a left-sided specialization for the representation of learned actions in right-handed humans, but it is unknown whether analogous hemispheric specialization exists for motor skill learning. In the present study, we explored this question by comparing the effects of anodal transcranial direct current stimulation (tDCS) over either left or right motor cortex (M1) on motor skill learning in either hand, using a tDCS montage to better isolate stimulation to one hemisphere. Results were compared with those previously found with a montage more commonly used in the field. Six groups trained for three sessions on a visually guided sequential pinch force modulation task with their right or left hand and received right M1, left M1, or sham tDCS. A linear mixed-model analysis for motor skill showed a significant main effect for stimulation group (left M1, right M1, sham) but not for hand (right, left) or their interaction. Left M1 tDCS induced significantly greater skill learning than sham when hand data were combined, a result consistent not only with the hypothesized left hemisphere specialization for motor skill learning but also with possible increased left M1 responsiveness to tDCS. The unihemispheric montage effect size was one-half that of the more common montage, and subsequent power analysis indicated that 75 subjects per group would be needed to detect differences seen with only 12 subjects with the customary bihemispheric montage.

Excitability of the motor cortex ipsilateral to the moving body side depends on spatio-temporal task complexity and hemispheric specialization

Unilateral movements are mainly controlled by the contralateral hemisphere, even though the primary motor cortex ipsilateral (M1_ipsi) to the moving body side can undergo task-related changes of activity as well. Here we used transcranial magnetic stimulation (TMS) to investigate whether representations of the wrist flexor (FCR) and extensor (ECR) in M1_ipsi would be modulated when unilateral rhythmical wrist movements were executed in isolation or in the context of a simple or difficult hand-foot coordination pattern, and whether this modulation would differ for the left versus right hemisphere. We found that M1_ipsi facilitation of the resting ECR and FCR mirrored the activation of the moving wrist such that facilitation was higher when the homologous muscle was activated during the cyclical movement. We showed that this ipsilateral facilitation increased significantly when the wrist movements were performed in the context of demanding hand-foot coordination tasks whereas foot movements alone influenced the hand representation of M1_ipsi only slightly. Our data revealed a clear hemispheric asymmetry such that MEP responses were significantly larger when elicited in the left M1_ipsi than in the right. In experiment 2, we tested whether the modulations of M1_ipsi facilitation, caused by performing different coordination tasks with the left versus right body sides, could be explained by changes in short intracortical inhibition (SICI). We found that SICI was increasingly reduced for a complex coordination pattern as compared to rest, but only in the right M1_ipsi. We argue that our results might reflect the stronger involvement of the left versus right hemisphere in performing demanding motor tasks.

Ipsilateral motor cortical responses to TMS during lengthening and shortening of the contralateral wrist flexors

Unilateral lengthening contractions provide a greater stimulus for neuromuscular adaptation than shortening contractions in the active and non-active contralateral homologous muscle, although little is known of the potential mechanism. Here we examined the possibility that corticospinal and spinal excitability vary in a contraction-specific manner in the relaxed right flexor carpi radialis (FCR) when humans perform unilateral lengthening and shortening contractions of the left wrist flexors at the same absolute force. Corticospinal excitability in the relaxed right FCR increased more during lengthening than shortening at 80% and 100% of maximum voluntary contraction (MVC). Short-interval intracortical inhibition diminished during shortening contractions, and it became nearly abolished during lengthening. Intracortical facilitation lessened during shortening but increased during lengthening. Interhemispheric inhibition to the 'non-active' motor cortex diminished during shortening, and became nearly abolished during lengthening at 90% MVC. The amplitude of the Hoffman reflex in the relaxed right FCR decreased during and remained depressed for 20 s after lengthening and shortening of the left wrist flexors. We discuss the possibility that instead of the increased afferent input, differences in the descending motor command and activation of brain areas that link function of the motor cortices during muscle lengthening vs. shortening may cause the contraction-specific modulation of ipsilateral motor cortical output. In conclusion, ipsilateral motor cortex responses to transcranial magnetic stimulation are contraction-specific; unilateral lengthening and shortening contractions reduced contralateral spinal excitability, but uniquely modulated ipsilateral corticospinal excitability and the networks involved in intracortical and interhemispheric connections, which may have clinical implications.