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Collins KC, Clark AB, Pomeroy VM, Kennedy NC. The test-retest reliability of non-navigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability early after stroke. Disabil Rehabil 2024:1-8. [PMID: 38634228 DOI: 10.1080/09638288.2024.2337107] [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: 08/03/2021] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Motor evoked potential (MEP) characteristics are potential biomarkers of whether rehabilitation interventions drive motor recovery after stroke. The test-retest reliability of Transcranial Magnetic Stimulation (TMS) measurements in sub-acute stroke remains unclear. This study aims to determine the test-retest reliability of upper limb MEP measures elicited by non-neuronavigated transcranial magnetic stimulation in sub-acute-stroke. METHODS In two identical data collection sessions, 1-3 days apart, TMS measures assessed: motor threshold (MT), amplitude, latency (MEP-L), silent period (SP), recruitment curve slope in the biceps brachii (BB), extensor carpi radialis (ECR), and abductor pollicis brevis (APB) muscles of paretic and non-paretic upper limbs. Test-retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals (CI). Acceptable reliability was set at a lower 95% CI of 0.70 or above. The limits of agreement (LOA) and smallest detectable change (SDC) were calculated. RESULTS 30 participants with sub-acute stroke were included (av 36 days post stroke) reliability was variable between poor to good for the different MEP characteristics. The SDC values differed across muscles and MEP characteristics in both paretic and less paretic limbs. CONCLUSIONS The present findings indicate there is limited evidence for acceptable test-retest reliability of non-navigated TMS outcomes when using the appropriate 95% CI for ICC, SDC and LOA values. CLINICAL TRIAL REGISTRATION Current Controlled Trials: ISCRT 19090862, http://www.controlled-trials.com.
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Affiliation(s)
- Kathryn C Collins
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
- National Institute of Health Research Brain Injury MedTech Cooperative, Cambridge, UK
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Su B, Jia Y, Zhang L, Li D, Shen Q, Wang C, Chen Y, Gao F, Wei J, Huang G, Liu H, Wang L. Reliability of TMS measurements using conventional hand-hold method with different numbers of stimuli for tibialis anterior muscle in healthy adults. Front Neural Circuits 2022; 16:986669. [PMID: 36247728 PMCID: PMC9563236 DOI: 10.3389/fncir.2022.986669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 11/28/2022] Open
Abstract
Objective: The objective of this study was to determine the reliability of corticomotor excitability measurements using the conventional hand-hold transcranial magnetic stimulation (TMS) method for the tibialis anterior (TA) muscle in healthy adults and the number of stimuli required for reliable assessment. Methods: Forty healthy adults participated in three repeated sessions of corticomotor excitability assessment in terms of resting motor threshold (rMT), slope of recruitment curve (RC), peak motor evoked potential amplitude (pMEP), and MEP latency using conventional TMS method. The first two sessions were conducted with a rest interval of 1 h, and the last session was conducted 7–10 days afterward. With the exception of rMT, the other three outcomes measure elicited with the block of first 3–10 stimuli were analyzed respectively. The within-day (session 1 vs. 2) and between-day (session 1 vs. 3) reliability for all four outcome measures were assessed using intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable difference at 95% confidence interval. Results: Good to excellent within-day and between-day reliability was found for TMS-induced outcome measures examined using 10 stimuli (ICC ≥ 0.823), except in pMEP, which showed between-day reliability at moderate level (ICC = 0.730). The number of three stimuli was adequate to achieve minimum acceptable within-day reliability for all TMS-induced parameters and between-day reliability for MEP latency. With regard to between-day reliability of RC slope and pMEP, at least seven and nine stimuli were recommended respectively. Conclusion: Our findings indicated the high reliability of corticomotor excitability measurement by TMS with adequate number of stimuli for the TA muscle in healthy adults. This result should be interpreted with caveats for the specific methodological choices, equipment setting, and the characteristics of the sample in the current study. Clinical Trial Registration:http://www.chictr.org.cn, identifier ChiCTR2100045141.
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Affiliation(s)
- Bin Su
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Yanbing Jia
- School of Rehabilitation Medicine, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Li Zhang
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Duo Li
- Neuro-Rehabilitation Center, JORU Rehabilitation Hospital, Yixing, China
| | - Qianqian Shen
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Chun Wang
- Neuro-Rehabilitation Center, JORU Rehabilitation Hospital, Yixing, China
| | - Yating Chen
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Fanglan Gao
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Jing Wei
- Neuro-Rehabilitation Center, JORU Rehabilitation Hospital, Yixing, China
| | - Guilan Huang
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Hao Liu
- School of Rehabilitation Medicine, Jiangsu Vocational College of Medicine, Yancheng, China
- *Correspondence: Lin Wang Hao Liu
| | - Lin Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- *Correspondence: Lin Wang Hao Liu
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Cleland BT, Sisel E, Madhavan S. Motor evoked potential latency and duration from tibialis anterior in individuals with chronic stroke. Exp Brain Res 2021; 239:2251-2260. [PMID: 34059935 DOI: 10.1007/s00221-021-06144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Ipsilateral motor pathways from the contralesional hemisphere to the paretic limbs may be upregulated to compensate for impaired function after stroke. Onset latency and duration of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) provide insight into compensatory pathways but have been understudied in the lower limb. This study assessed MEP onset latency and duration in the lower limb after stroke, and compared ipsilateral and contralateral MEPs in the paretic and non-paretic limb. We hypothesized that: (1) onset latency would be longer for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb, and (2) duration would be shorter for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb. Data were collected as a part of a pre-test of a randomized controlled trial. TMS was applied to the ipsilateral and contralateral hemisphere of the paretic and non-paretic limb. MEP onset latency and duration were calculated from the tibialis anterior. Thirty-five participants with chronic stroke were included in the final analysis. Onset latency was longer in the paretic than the non-paretic limb (~ 6.0 ms) and longer after ipsilateral than contralateral stimulation (~ 1.8 ms). Duration was longer in the paretic than the non-paretic limb (~ 9.2 ms) and longer after contralateral than ipsilateral stimulation (~ 5.2 ms). Ipsilateral MEPs may be elicited through ipsilateral pathways with fewer fibers with a higher activation threshold and/or greater spinal branching. MEPs from the paretic limb may reflect slower central motor conduction, peripheral changes, or changes in motor pathway.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA
| | - Emily Sisel
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
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Characterization of Motor-Evoked Responses Obtained with Transcutaneous Electrical Spinal Stimulation from the Lower-Limb Muscles after Stroke. Brain Sci 2021; 11:brainsci11030289. [PMID: 33652677 PMCID: PMC7996860 DOI: 10.3390/brainsci11030289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
An increasing number of studies suggests that a novel neuromodulation technique targeting the spinal circuitry enhances gait rehabilitation, but research on its application to stroke survivors is limited. Therefore, we investigated the characteristics of spinal motor-evoked responses (sMERs) from lower-limb muscles obtained by transcutaneous spinal cord stimulation (tSCS) after stroke compared to age-matched and younger controls without stroke. Thirty participants (ten stroke survivors, ten age-matched controls, and ten younger controls) completed the study. By using tSCS applied between the L1 and L2 vertebral levels, we compared sMER characteristics (resting motor threshold (RMT), slope of the recruitment curve, and latency) of the tibialis anterior (TA) and medial gastrocnemius (MG) muscles among groups. A single pulse of stimulation was delivered in 5 mA increments, increasing from 5 mA to 250 mA or until the subjects reached their maximum tolerance. The stroke group had an increased RMT (27–51%) compared to both age-matched (TA: p = 0.032; MG: p = 0.005) and younger controls (TA: p < 0.001; MG: p < 0.001). For the TA muscle, the paretic side demonstrated a 13% increased latency compared to the non-paretic side in the stroke group (p = 0.010). Age-matched controls also exhibited an increased RMT compared to younger controls (TA: p = 0.002; MG: p = 0.007), suggesting that altered sMER characteristics present in stroke survivors may result from both stroke and normal aging. This observation may provide implications for altered spinal motor output after stroke and demonstrates the feasibility of using sMER characteristics as an assessment after stroke.
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Alder G, Signal N, Vandal AC, Olsen S, Jochumsen M, Niazi IK, Taylor D. Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS). Brain Sci 2021; 11:brainsci11020224. [PMID: 33673171 PMCID: PMC7918620 DOI: 10.3390/brainsci11020224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Advances in our understanding of neural plasticity have prompted the emergence of neuromodulatory interventions, which modulate corticomotor excitability (CME) and hold potential for accelerating stroke recovery. Endogenous paired associative stimulation (ePAS) involves the repeated pairing of a single pulse of peripheral electrical stimulation (PES) with endogenous movement-related cortical potentials (MRCPs), which are derived from electroencephalography. However, little is known about the optimal parameters for its delivery. A factorial design with repeated measures delivered four different versions of ePAS, in which PES intensities and movement type were manipulated. Linear mixed models were employed to assess interaction effects between PES intensity (suprathreshold (Hi) and motor threshold (Lo)) and movement type (Voluntary and Imagined) on CME. ePAS interventions significantly increased CME compared to control interventions, except in the case of Lo-Voluntary ePAS. There was an overall main effect for the Hi-Voluntary ePAS intervention immediately post-intervention (p = 0.002), with a sub-additive interaction effect at 30 min’ post-intervention (p = 0.042). Hi-Imagined and Lo-Imagined ePAS significantly increased CME for 30 min post-intervention (p = 0.038 and p = 0.043 respectively). The effects of the two PES intensities were not significantly different. CME was significantly greater after performing imagined movements, compared to voluntary movements, with motor threshold PES (Lo) 15 min post-intervention (p = 0.012). This study supports previous research investigating Lo-Imagined ePAS and extends those findings by illustrating that ePAS interventions that deliver suprathreshold intensities during voluntary or imagined movements (Hi-Voluntary and Hi-Imagined) also increase CME. Importantly, our findings indicate that stimulation intensity and movement type interact in ePAS interventions. Factorial designs are an efficient way to explore the effects of manipulating the parameters of neuromodulatory interventions. Further research is required to ensure that these parameters are appropriately refined to maximise intervention efficacy for people with stroke and to support translation into clinical practice.
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Affiliation(s)
- Gemma Alder
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
- Correspondence:
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
| | - Alain C. Vandal
- Department of Statistics, University of Auckland, Auckland 1142, New Zealand;
- Ko Awatea, Counties Manukau Health, Auckland 2025, New Zealand
| | - Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
| | - Mads Jochumsen
- Department of Health Science and Technology, Aalborg University, 9000 Aalborg, Denmark;
| | - Imran Khan Niazi
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
- Department of Health Science and Technology, Aalborg University, 9000 Aalborg, Denmark;
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
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Dharia AK, Gardi A, Vogel AK, Dutt-Mazumder A, Krishnan C. Evaluation of motor cortical excitability using evoked torque responses: A new tool with high reliability. J Neurosci Methods 2020; 348:108998. [PMID: 33189794 DOI: 10.1016/j.jneumeth.2020.108998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/10/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) are typically recorded via surface electromyography (EMG). However, another suitable alternative may be recording torque output associated with MEPs, especially when studying multiheaded muscles (e.g. quadriceps) for which EMG may not be ideal. METHODS We recorded the motor evoked torque elicited by TMS along with conventional EMG-based MEPs (MEPEMG) over a range of TMS intensities (100-140 % of active motor threshold [AMT]) from twenty healthy young adults on two different days. MEPs were normalized using different normalization procedures (raw, normalized to maximum voluntary isometric contraction [MVIC], and peak MEP). Additionally, motor evoked torque was normalized to TMS-evoked peripheral resting twitch torque. Intraclass correlation coefficients (ICCs) were determined for each of these variables to compute reliability. RESULTS Motor evoked torque showed good to excellent reliability (ICC: 0.65-0.90) at TMS intensities ≥ 110 % AMT, except when normalized by peak MEP. The reliability of raw MEPEMG and MVIC normalized MEPEMG was fair to excellent only at ≥ 130 % AMT (ICC: 0.42-0.82) and at ≥ 120 % AMT (ICC: 0.41-0.83), respectively. The reliability of both MEPEMG and motor evoked torque generally increased with increasing TMS intensities, with motor evoked torque normalized to the resting twitch torque yielding the best ICC scores. COMPARISON WITH EXISTING METHODS When compared with conventional MEPEMG, motor evoked torque offers superior and reliable estimates of corticospinal excitability, particularly when normalized to resting twitch torque. CONCLUSIONS TMS-induced motor evoked torque can reliably be used to measure corticospinal excitability in the quadriceps muscles.
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Affiliation(s)
- Aastha K Dharia
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Adam Gardi
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Amanda K Vogel
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Aviroop Dutt-Mazumder
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- NeuRRo Lab, Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA; Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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7
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Alder G, Signal N, Olsen S, Taylor D. A Systematic Review of Paired Associative Stimulation (PAS) to Modulate Lower Limb Corticomotor Excitability: Implications for Stimulation Parameter Selection and Experimental Design. Front Neurosci 2019; 13:895. [PMID: 31507367 PMCID: PMC6718871 DOI: 10.3389/fnins.2019.00895] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022] Open
Abstract
Non-invasive neuromodulatory interventions have the potential to influence neural plasticity and augment motor rehabilitation in people with stroke. Paired associative stimulation (PAS) involves the repeated pairing of single pulses of electrical stimulation to a peripheral nerve and single pulses of transcranial magnetic stimulation over the contralateral primary motor cortex. Efficacy of PAS in the lower limb of healthy and stroke populations has not been systematically appraised. Optimal protocols including stimulation parameter settings have yet to be determined. This systematic review (a) examines the efficacy of PAS on lower limb corticomotor excitability in healthy and stroke populations and (b) evaluates the stimulation parameters employed. Five databases were searched for randomized, non-randomized, and pre-post experimental studies evaluating lower limb PAS in healthy and stroke populations. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Blacks Tool and the TMS Checklist. Intervention stimulation parameters and TMS measurement details were also extracted and compared. Twelve articles, comprising 24 experiments, met the inclusion criteria. Four articles evaluated PAS in people with stroke. Following a single session of PAS, 21 experiments reported modulation of corticomotor excitability, lasting up to 60 min; however, the research lacked methodological rigor. Intervention stimulation parameters were highly variable across experiments, and whilst these appeared to influence efficacy, variations in the intervention and outcome assessment methods hindered the ability to draw conclusions about optimal parameters. Lower limb PAS research requires further investigation before considering its translation into clinical practice. Eight key recommendations serve as guide for enhancing future research in the field.
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Affiliation(s)
- Gemma Alder
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Effects of Repetitive Transcranial Magnetic Stimulation on Walking and Balance Function after Stroke: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 97:773-781. [PMID: 29734235 DOI: 10.1097/phm.0000000000000948] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke. DESIGN MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively searched for randomized controlled trials published through March 2017 that investigated the effects of rTMS on lower limb function. Main outcomes included walking speed, balance function, motor function, and cortical excitability. RESULTS Nine studies were included. The meta-analysis revealed a significant effect of rTMS on walking speed (standardized mean difference, 0.64; 95% confidence interval [CI], 0.32-0.95), particularly ipsilesional stimulation (standardized mean difference, 0.80; 95% CI, 0.36-1.24). No significant effects were found for balance function (standardized mean difference, 0.10; 95% CI, -0.26 to 0.45), motor function (mean difference, 0.50, 95% CI: -0.68 to 1.68), or cortical excitability (motor-evoked potentials of the affected hemisphere: mean difference, 0.21 mV; 95% CI, -0.11 to 0.54; motor-evoked potentials of the unaffected hemisphere: mean difference, 0.09 mV; 95% CI, -0.16 to -0.02). CONCLUSION These results suggest that rTMS, particularly ipsilesional stimulation, significantly improves walking speed. Future studies with larger sample sizes and an adequate follow-up period are required to further understand the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: 1) Understand the potential neurophysiologic effects of rTMS; 2) Appreciate the potential benefits of rTMS on stroke recovery; and 3) Identify indications for including rTMS in a stroke rehabilitation program. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Impact of a Carbohydrate Mouth Rinse on Quadriceps Muscle Function and Corticomotor Excitability. Int J Sports Physiol Perform 2019; 14:927-933. [PMID: 30676814 DOI: 10.1123/ijspp.2018-0583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this investigation is to determine the effects of different forms of a CHO MR on quadriceps muscle performance and corticospinal motor excitability. METHODS Ten subjects (5 females, 5 males; 25±1 years; 1.71±0.03 m 73±5 kg) completed 4 trials. A different MR condition was applied during each trial (Placebo (PLA), 6.4% glucose (GLU), 6.4% maltose (MAL), 6.4% maltodextrin (MDX)). Maximal voluntary contraction (MVIC) of the right quadriceps and motor-evoked potential (MEP) of the right rectus femoris was determined pre (10 min), immediately after, and post (10 min) MR. MEP was precipitated by transcranial magnetic stimulation (TMS) during muscle contraction (50% of MVIC). MR was held in the mouth for 20 s and treatments were applied using a Latin square design. The relative change in MEP from pre-measures was different across treatments (p=0.025) but was not different across time (p=0.357). RESULTS Relative change in MEP was greater for all CHO conditions immediately after (GLU=2.58±5.33%; MAL=3.92±3.90%; MDX=18.28±5.57%) and 10 min after (GLU=14.09±13.96%; MAL=8.64±8.67%; MDX=31.54±12.77%) MR compared to PLA (Immediately after=-2.19±4.25%, 10 min=-13.41±7.46%). The relative change in MVC was greater for CHO conditions immediately (GLU=3.98±2.49%; MAL=5.89±2.29.90%; MDX=7.66±1.93%) and 10 min after (GLU=7.22±2.77%; MAL=10.26±4.22%; MDX=10.18±1.50%) MR compared to PLA (Immediately after=-3.24±1.50%, 10 min=-6.46±2.22%). CONCLUSIONS CHO MR increased corticospinal motor excitability and quadriceps muscle performance immediately and 10 min after application; however, the form of CHO used did not influence this response.
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Boyne P, Meyrose C, Westover J, Whitesel D, Hatter K, Reisman DS, Cunningham D, Carl D, Jansen C, Khoury JC, Gerson M, Kissela B, Dunning K. Exercise intensity affects acute neurotrophic and neurophysiological responses poststroke. J Appl Physiol (1985) 2018; 126:431-443. [PMID: 30571289 DOI: 10.1152/japplphysiol.00594.2018] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aerobic exercise may acutely prime the brain to be more responsive to rehabilitation, thus facilitating neurologic recovery from conditions like stroke. This aerobic priming effect could occur through multiple mechanisms, including upregulation of circulating brain-derived neurotrophic factor (BDNF), increased corticospinal excitability, and decreased intracortical inhibition. However, optimal exercise parameters for targeting these mechanisms are poorly understood. This study tested the effects of exercise intensity on acute BDNF and neurophysiological responses. Sixteen ambulatory persons >6 mo poststroke performed three different 20-min exercise protocols in random order, approximately 1 wk apart, including the following: 1) treadmill high-intensity interval training (HIT-treadmill); 2) seated-stepper HIT (HIT-stepper); and 3) treadmill moderate-intensity continuous exercise (MCT-treadmill). Serum BDNF and transcranial magnetic stimulation measures of paretic lower limb excitability and inhibition were assessed at multiple time points during each session. Compared with MCT-treadmill, HIT-treadmill elicited significantly greater acute increases in circulating BDNF and corticospinal excitability. HIT-stepper initially showed BDNF responses similar to HIT-treadmill but was no longer significantly different from MCT-treadmill after decreasing the intensity in reaction to two hypotensive events. Additional regression analyses showed that an intensity sufficient to accumulate blood lactate appeared to be important for eliciting BDNF responses, that the interval training approach may have facilitated the corticospinal excitability increases, and that the circulating BDNF response was (negatively) related to intracortical inhibition. These findings further elucidate neurologic mechanisms of aerobic exercise and inform selection of optimal exercise-dosing parameters for enhancing acute neurologic effects. NEW & NOTEWORTHY Acute exercise-related increases in circulating BDNF and corticospinal excitability are thought to prime the brain for learning. Our data suggest that these responses can be obtained among persons with stroke using short-interval treadmill high-intensity interval training, that a vigorous aerobic intensity sufficient to generate lactate accumulation is needed to increase BDNF, that interval training facilitates increases in paretic quadriceps corticospinal excitability, and that greater BDNF response is associated with lesser intracortical inhibition response.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Colleen Meyrose
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer Westover
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Kristal Hatter
- Schubert Research Clinic, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Darcy S Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware , Newark, Delaware
| | - David Cunningham
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University , Cleveland, Ohio.,MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center, Cleveland Functional Electrical Stimulation Center , Cleveland, Ohio
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Connor Jansen
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
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Allali G, Blumen HM, Devanne H, Pirondini E, Delval A, Van De Ville D. Brain imaging of locomotion in neurological conditions. Neurophysiol Clin 2018; 48:337-359. [PMID: 30487063 PMCID: PMC6563601 DOI: 10.1016/j.neucli.2018.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/20/2023] Open
Abstract
Impaired locomotion is a frequent and major source of disability in patients with neurological conditions. Different neuroimaging methods have been used to understand the brain substrates of locomotion in various neurological diseases (mainly in Parkinson's disease) during actual walking, and while resting (using mental imagery of gait, or brain-behavior correlation analyses). These studies, using structural (i.e., MRI) or functional (i.e., functional MRI or functional near infra-red spectroscopy) brain imaging, electrophysiology (i.e., EEG), non-invasive brain stimulation (i.e., transcranial magnetic stimulation, or transcranial direct current stimulation) or molecular imaging methods (i.e., PET, or SPECT) reveal extended brain networks involving both grey and white matters in key cortical (i.e., prefrontal cortex) and subcortical (basal ganglia and cerebellum) regions associated with locomotion. However, the specific roles of the various pathophysiological mechanisms encountered in each neurological condition on the phenotype of gait disorders still remains unclear. After reviewing the results of individual brain imaging techniques across the common neurological conditions, such as Parkinson's disease, dementia, stroke, or multiple sclerosis, we will discuss how the development of new imaging techniques and computational analyses that integrate multivariate correlations in "large enough datasets" might help to understand how individual pathophysiological mechanisms express clinically as an abnormal gait. Finally, we will explore how these new analytic methods could drive our rehabilitative strategies.
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Affiliation(s)
- Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA; Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; EA 7369, URePSSS, Unité de Recherche Pluridisciplinaire Sport Santé Société, Université du Littoral Côte d'Opale, Calais, France
| | - Elvira Pirondini
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Arnaud Delval
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Unité Inserm 1171, Faculté de Médecine, Université de Lille, Lille, France
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Cavaleri R, Thapa T, Beckenkamp PR, Chipchase LS. The influence of kinesiology tape colour on performance and corticomotor activity in healthy adults: a randomised crossover controlled trial. BMC Sports Sci Med Rehabil 2018; 10:17. [PMID: 30410769 PMCID: PMC6211494 DOI: 10.1186/s13102-018-0106-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022]
Abstract
Background There exists conflicting evidence regarding the impact of kinesiology tape on performance and muscle function. One variable that may account for disparities in the findings of previous studies is the colour of the tape applied. Colour is hypothesised to influence sporting performance through modulation of arousal and aggression. However, few studies have investigated the influence of colour on products designed specifically to enhance athletic performance. Further, no studies have investigated the potential influence of colour on other drivers of performance, such as corticomotor activity and neuromuscular function. Thus, the aim of this study was to investigate the influence of kinesiology tape colour on athletic performance, knee extensor torque, and quadriceps neuromuscular function. Methods Thirty two healthy participants were assessed under five conditions, applied in random order: (1) no kinesiology tape (control), (2) beige-coloured kinesiology tape applied with tension (sham A), (3) beige-coloured kinesiology tape applied with no tension (sham B), (4) red-coloured kinesiology tape applied with tension, and (5) blue-coloured kinesiology tape applied with tension. Athletic performance was assessed using a previously validated hop test, knee extensor torque was measured using an isokinetic dynamometer, and transcranial magnetic stimulation was utilised to provide insight into the neuromuscular functioning of the quadriceps musculature. Results Kinesiology tape had no beneficial impact on lower limb performance or muscle strength in healthy adults. The colour of the tape did not influence athletic performance (F (4, 120) = 0.593, p = 0.669), quadriceps strength (F (4, 120) = 0.787, p = 0.536), or neuromuscular function (rectus femoris: F (2.661, 79.827) = 1.237, p = 0.301). Conclusion This study found that kinesiology tape does not alter lower limb performance or muscle function in healthy adults, irrespective of the colour of the tape applied. Future research should seek to confirm these findings beyond the research setting, across a range of sports, and at a range of skill levels. Trial registration Australian New Zealand Clinical Trials Registry. ACTRN12616001506482. Prospectively registered on 01/11/2016.
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Affiliation(s)
- Rocco Cavaleri
- 1Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW 2560 Australia
| | - Tribikram Thapa
- 1Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW 2560 Australia
| | - Paula R Beckenkamp
- 1Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW 2560 Australia.,2Musculoskeletal Health, Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW Australia
| | - Lucy S Chipchase
- 2Musculoskeletal Health, Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW Australia.,3Faculty of Health, University of Canberra, Canberra, ACT Australia
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Kesar TM, Eicholtz S, Lin BJ, Wolf SL, Borich MR. Effects of posture and coactivation on corticomotor excitability of ankle muscles. Restor Neurol Neurosci 2018; 36:131-146. [PMID: 29439363 PMCID: PMC5901671 DOI: 10.3233/rnn-170773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of transcranial magnetic stimulation (TMS) to evaluate corticomotor excitability of lower limb (LL) muscles can provide insights about neuroplasticity mechanisms underlying LL rehabilitation. However, to date, a majority of TMS studies have focused on upper limb muscles. Posture-related activation is an important under-investigated factor influencing corticomotor excitability of LL muscles. OBJECTIVE The purpose of this study was to evaluate effects of posture and background activation on corticomotor excitability of ankle muscles. METHODS Fourteen young neurologically-unimpaired participants (26.1±4.1 years) completed the study. TMS-evoked motor evoked potentials (MEPs) were recorded from the tibialis anterior (TA) and soleus during 4 conditions - standing, standing coactivation, sitting, and sitting coactivation. TA and soleus MEP amplitudes were compared during: (1) standing versus sitting;(2) standing coactivation (standing while activating both TA and soleus) versus sitting coactivation; and (3) standing coactivation versus standing. For each comparison, background EMG for TA and soleus were matched. Trial-to-trial coefficient of variation of MEP amplitude and coil-positioning errors were additional dependent variables. RESULTS No differences were observed in TA or soleus MEP amplitudes during standing versus sitting. Compared to sitting coactivation, larger MEPs were observed during standing coactivation for soleus but not TA. Compared to standing, the standing coactivation task demonstrated larger MEPs and reduced trial-to-trial MEP variability. CONCLUSION Our findings suggest that incorporation of measurements in standing in future TMS studies may provide novel insights into neural circuits controlling LL muscles. Standing and standing coactivation tasks may be beneficial for obtaining functionally-relevant neuroplasticity assessments of LL musculature.
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Affiliation(s)
- Trisha M. Kesar
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Steven Eicholtz
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Bethany J. Lin
- Center for Visual and Neuro-cognitive Rehabilitation, Atlanta Veterans Affairs, Atlanta, GA, USA
| | - Steven L. Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
- Center for Visual and Neuro-cognitive Rehabilitation, Atlanta Veterans Affairs, Atlanta, GA, USA
| | - Michael R. Borich
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA, USA
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Beaulieu LD, Massé-Alarie H, Ribot-Ciscar E, Schneider C. Reliability of lower limb transcranial magnetic stimulation outcomes in the ipsi- and contralesional hemispheres of adults with chronic stroke. Clin Neurophysiol 2017; 128:1290-1298. [DOI: 10.1016/j.clinph.2017.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 04/19/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022]
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Determining the Optimal Number of Stimuli per Cranial Site during Transcranial Magnetic Stimulation Mapping. NEUROSCIENCE JOURNAL 2017; 2017:6328569. [PMID: 28331848 PMCID: PMC5346381 DOI: 10.1155/2017/6328569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/17/2017] [Accepted: 02/06/2017] [Indexed: 01/21/2023]
Abstract
The delivery of five stimuli to each cranial site is recommended during transcranial magnetic stimulation (TMS) mapping. However, this time-consuming practice restricts the use of TMS mapping beyond the research environment. While reducing the number of stimuli administered to each cranial site may improve efficiency and decrease physiological demand, doing so may also compromise the procedure's validity. Therefore, the aim of this study was to determine the minimum number of stimuli per cranial site required to obtain valid outcomes during TMS mapping. Map volume and centre of gravity (CoG) recordings obtained using five stimuli per cranial site were retrospectively compared to those obtained using one, two, three, and four stimuli per cranial site. For CoG longitude, one stimulus per cranial site produced valid recordings (ICC = 0.91, 95% CI 0.82 to 0.95). However, this outcome is rarely explored in isolation. As two stimuli per cranial site were required to obtain valid CoG latitude (ICC = 0.99, 95% CI 0.99 to 0.99) and map volume (ICC = 0.99, 95% CI 0.99 to 0.99) recordings, it is recommended that a minimum of two stimuli be delivered to each cranial site during TMS mapping in order to obtain valid outcomes.
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Navigated Transcranial Magnetic Stimulation: A Biologically Based Assay of Lower Extremity Impairment and Gait Velocity. Neural Plast 2017; 2017:6971206. [PMID: 28243474 PMCID: PMC5294370 DOI: 10.1155/2017/6971206] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 10/10/2016] [Accepted: 12/06/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives. (a) To determine associations among motor evoked potential (MEP) amplitude, MEP latency, lower extremity (LE) impairment, and gait velocity and (b) determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity. Method. 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM), and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the affected tibialis anterior (TA) and soleus (SO). Results. MEP presence was associated with higher LEFM scores in both the TA and SO. MEP latency was larger in subjects with lower LEFM and difficulty walking. Conclusion. MEP latency appears to be an indicator of LE impairment and gait. Significance. Our results support the precept of using TMS, particularly MEP latency, as an adjunctive LE outcome measurement and prognostic technique.
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Beaulieu LD, Flamand VH, Massé-Alarie H, Schneider C. Reliability and minimal detectable change of transcranial magnetic stimulation outcomes in healthy adults: A systematic review. Brain Stimul 2016; 10:196-213. [PMID: 28031148 DOI: 10.1016/j.brs.2016.12.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is used worldwide for noninvasively testing human motor systems but its psychometric properties remain unclear. OBJECTIVE/HYPOTHESIS This work systematically reviewed studies on the reliability of TMS outcome measures of primary motor cortex (M1) excitability in healthy humans, with an emphasis on retrieving minimal detectable changes (MDC). METHODS The literature search was performed in three databases (Pubmed, CINAHL, Embase) up to June 2016 and additional studies were identified through hand-searching. French and English-written studies had to report the reliability of at least one TMS outcome of M1 in healthy humans. Two independent raters assessed the eligibility of potential studies, and eligible articles were reviewed using a structured data extraction form and two critical appraisal scales. RESULTS A total of 34 articles met the selection criteria, which tested the intra- and inter-rater reliability (relative and absolute subtypes) of several TMS outcomes. However, our critical appraisal of studies raised concerns on the applicability and generalization of results because of methodological and statistical pitfalls. Importantly, MDC were generally large and likely affected by various factors, especially time elapsed between sessions and number of stimuli delivered. CONCLUSIONS This systematic review underlined that the evidence about the reliability of TMS outcomes is scarce and affected by several methodological and statistical problems. Data and knowledge of the review provided however relevant insights on the ability of TMS outcomes to track plastic changes within an individual or within a group, and recommendations were made to level up the quality of future work in the field.
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Affiliation(s)
- Louis-David Beaulieu
- Clinical Neuroscience and Neurostimulation Laboratory, CHU de Québec Research Center - Neuroscience Division, Quebec City, Qc, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada.
| | - Véronique H Flamand
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Qc, Canada
| | - Hugo Massé-Alarie
- Clinical Neuroscience and Neurostimulation Laboratory, CHU de Québec Research Center - Neuroscience Division, Quebec City, Qc, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada
| | - Cyril Schneider
- Clinical Neuroscience and Neurostimulation Laboratory, CHU de Québec Research Center - Neuroscience Division, Quebec City, Qc, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada
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Hermsen A, Haag A, Duddek C, Balkenhol K, Bugiel H, Bauer S, Mylius V, Menzler K, Rosenow F. Test–retest reliability of single and paired pulse transcranial magnetic stimulation parameters in healthy subjects. J Neurol Sci 2016; 362:209-16. [DOI: 10.1016/j.jns.2016.01.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/28/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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Lin LF, Huang YZ, Hu CJ, Liou TH, Chang KH, Lin YN. Using surface electromyography to guide the activation during motor-evoked potential measurement: An activation control method for follow-up studies. Brain Inj 2015; 29:1661-6. [DOI: 10.3109/02699052.2015.1075150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schambra HM, Ogden RT, Martínez-Hernández IE, Lin X, Chang YB, Rahman A, Edwards DJ, Krakauer JW. The reliability of repeated TMS measures in older adults and in patients with subacute and chronic stroke. Front Cell Neurosci 2015; 9:335. [PMID: 26388729 PMCID: PMC4555014 DOI: 10.3389/fncel.2015.00335] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/10/2015] [Indexed: 11/21/2022] Open
Abstract
The reliability of transcranial magnetic stimulation (TMS) measures in healthy older adults and stroke patients has been insufficiently characterized. We determined whether common TMS measures could reliably evaluate change in individuals and in groups using the smallest detectable change (SDC), or could tell subjects apart using the intraclass correlation coefficient (ICC). We used a single-rater test-retest design in older healthy, subacute stroke, and chronic stroke subjects. At twice daily sessions on two consecutive days, we recorded resting motor threshold, test stimulus intensity, recruitment curves, short-interval intracortical inhibition, and facilitation, and long-interval intracortical inhibition. Using variances estimated from a random effects model, we calculated the SDC and ICC for each TMS measure. For all TMS measures in all groups, SDCs for single subjects were large; only with modest group sizes did the SDCs become low. Thus, while these TMS measures cannot be reliably used as a biomarker to detect individual change, they can reliably detect change exceeding measurement noise in moderate-sized groups. For several of the TMS measures, ICCs were universally high, suggesting that they can reliably discriminate between subjects. TMS measures should be used based on their reliability in particular contexts. More work establishing their validity, responsiveness, and clinical relevance is still needed.
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Affiliation(s)
- Heidi M Schambra
- Motor Performance Laboratory, Department of Rehabilitation and Regenerative Medicine, Columbia University New York, NY, USA
| | - R Todd Ogden
- Department of Biostatistics, Columbia University New York, NY, USA
| | - Isis E Martínez-Hernández
- Motor Performance Laboratory, Department of Rehabilitation and Regenerative Medicine, Columbia University New York, NY, USA
| | - Xuejing Lin
- Department of Biostatistics, Columbia University New York, NY, USA
| | - Y Brenda Chang
- Department of Biostatistics, Columbia University New York, NY, USA
| | - Asif Rahman
- Neural Engineering Group, Department of Biomedical Engineering, City College of New York NY, USA
| | - Dylan J Edwards
- Non-Invasive Brain Stimulation and Human Motor Control Laboratory, Burke-Cornell Medical Research Institute White Plains, NY, USA
| | - John W Krakauer
- Brain, Learning, Animation, and Movement Lab, Department of Neurology, Johns Hopkins University Baltimore, MD, USA
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O'Leary TJ, Morris MG, Collett J, Howells K. Reliability of single and paired-pulse transcranial magnetic stimulation in the vastus lateralis muscle. Muscle Nerve 2015; 52:605-15. [PMID: 25620286 DOI: 10.1002/mus.24584] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) is an important tool to examine neurological pathologies, movement disorders, and central nervous system responses to exercise, fatigue, and training. The reliability has not been examined in a functional locomotor knee extensor muscle. METHODS Within- (n = 10) and between-day (n = 16) reliability of single and paired-paired pulse TMS was examined from the active vastus lateralis. RESULTS Motor evoked potential amplitude and cortical silent period duration showed good within- and between-day reliability (intraclass correlation coefficient [ICC] ≥ 0.82). Short- and long-interval intracortical inhibition (SICI and LICI, respectively) demonstrated good within-day reliability (ICC ≥ 0.84). SICI had moderate to good between-day reliability (ICC ≥ 0.67), but LICI was not repeatable (ICC = 0.47). Intracortical facilitation showed moderate to good within-day reliability (ICC ≥ 0.73) but poor to moderate reliability between days (ICC ≥ 0.51). CONCLUSIONS TMS can reliably assess cortical function in a knee extensor muscle. This may be useful to examine neurological disorders that affect locomotion.
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Affiliation(s)
- Thomas J O'Leary
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
| | - Martyn G Morris
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
| | - Johnny Collett
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
| | - Ken Howells
- Department of Sport and Health Sciences, Oxford Brookes University, Gipsy Lane, Oxford, Oxon, OX3 0BP, United Kingdom
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How Reproducible Are Transcranial Magnetic Stimulation–Induced MEPs in Subacute Stroke? J Clin Neurophysiol 2014; 31:556-62. [DOI: 10.1097/wnp.0000000000000114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lewis GN, Signal N, Taylor D. Reliability of lower limb motor evoked potentials in stroke and healthy populations: How many responses are needed? Clin Neurophysiol 2014; 125:748-754. [DOI: 10.1016/j.clinph.2013.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
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Beaulieu LD, Massé-Alarie H, Brouwer B, Schneider C. Brain control of volitional ankle tasks in people with chronic stroke and in healthy individuals. J Neurol Sci 2013; 338:148-55. [PMID: 24433928 DOI: 10.1016/j.jns.2013.12.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/04/2013] [Accepted: 12/23/2013] [Indexed: 11/28/2022]
Abstract
This study explored the relationships between motor cortical control of ankle dorsiflexors and clinical impairments of volitional ankle dorsiflexion in people with chronic stroke. Eighteen persons with stroke and 14 controls were evaluated. Clinical tools were used to assess ankle dorsiflexion amplitude and isometric strength. Transcranial magnetic stimulation (TMS) of the primary motor cortex (M1) tested the functional integrity of cortical circuits controlling the tibialis anterior (TA). All clinical scores and most TMS outcomes were impaired in people with chronic stroke. The lower clinical scores were related to the reduction of the strength of corticospinal projections onto spinal motoneurons. Concurrent TMS and clinical testing in chronic stroke provided original data demonstrating relationships between the integrity of cortical and corticospinal components of TA motor control and volitional ankle tasks. Our study proposes that volitional ankle mobilization in chronic stroke may be explained by the residual abnormal M1 circuits which may be responsive for rehabilitation intervention. This should be confirmed in longitudinal studies with larger samples to determine whether TMS outcomes associated with lower limb muscles are predictive of clinical changes or vice versa.
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Affiliation(s)
- L D Beaulieu
- Axe neurosciences du Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - H Massé-Alarie
- Axe neurosciences du Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - B Brouwer
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, ONT, Canada
| | - C Schneider
- Axe neurosciences du Centre de recherche du CHU de Québec, Québec, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada.
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Freitas C, Farzan F, Pascual-Leone A. Assessing brain plasticity across the lifespan with transcranial magnetic stimulation: why, how, and what is the ultimate goal? Front Neurosci 2013; 7:42. [PMID: 23565072 PMCID: PMC3613699 DOI: 10.3389/fnins.2013.00042] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 03/09/2013] [Indexed: 12/30/2022] Open
Abstract
Sustaining brain and cognitive function across the lifespan must be one of the main biomedical goals of the twenty-first century. We need to aim to prevent neuropsychiatric diseases and, thus, to identify and remediate brain and cognitive dysfunction before clinical symptoms manifest and disability develops. The brain undergoes a complex array of changes from developmental years into old age, putatively the underpinnings of changes in cognition and behavior throughout life. A functionally “normal” brain is a changing brain, a brain whose capacity and mechanisms of change are shifting appropriately from one time-point to another in a given individual's life. Therefore, assessing the mechanisms of brain plasticity across the lifespan is critical to gain insight into an individual's brain health. Indexing brain plasticity in humans is possible with transcranial magnetic stimulation (TMS), which, in combination with neuroimaging, provides a powerful tool for exploring local cortical and brain network plasticity. Here, we review investigations to date, summarize findings, and discuss some of the challenges that need to be solved to enhance the use of TMS measures of brain plasticity across all ages. Ultimately, TMS measures of plasticity can become the foundation for a brain health index (BHI) to enable objective correlates of an individual's brain health over time, assessment across diseases and disorders, and reliable evaluation of indicators of efficacy of future preventive and therapeutic interventions.
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Affiliation(s)
- Catarina Freitas
- Department of Neurology, Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
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Neuroplasticity: An Appreciation From Synapse to System. Arch Phys Med Rehabil 2012; 93:1846-55. [DOI: 10.1016/j.apmr.2012.04.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/21/2012] [Accepted: 04/20/2012] [Indexed: 11/19/2022]
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Giordano D, Kavasidis I, Spampinato C, Bella R, Pennisi G, Pennisi M. An integrated computer-controlled system for assisting researchers in cortical excitability studies by using transcranial magnetic stimulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 107:4-15. [PMID: 22172294 DOI: 10.1016/j.cmpb.2011.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 10/13/2011] [Accepted: 10/17/2011] [Indexed: 05/31/2023]
Abstract
Transcranial magnetic stimulation (TMS) is the most important technique currently available to study cortical excitability. Additionally, TMS can be used for therapeutic and rehabilitation purposes, replacing the more painful transcranial electric stimulation (TES). In this paper we present an innovative and easy-to-use tool that enables neuroscientists to design, carry out and analyze scientific studies based on TMS experiments for both diagnostic and research purposes, assisting them not only in the practicalities of administering the TMS but also in each step of the entire study's workflow. One important aspect of this tool is that it allows neuroscientists to specify research designs at will, enabling them to define any parameter of a TMS study starting from data acquisition and sample group definition to automated statistical data analysis and RDF data storage. It also supports the diagnosing process by using on-line support vector machines able to learn incrementally from the diseases instances that are continuously added into the system. The proposed system is a neuroscientist-centred tool where the protocols being followed in TMS studies are made explicit, leaving to the users flexibility in exploring and sharing the results, and providing assistance in managing the complexity of the final diagnosis. This type of tool can make the results of medical experiments more easily exploitable, thus accelerating scientific progress.
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Affiliation(s)
- D Giordano
- Department of Electrical, Electronics and Computer Engineering, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy.
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Knorr S, Rice CL, Garland SJ. Perspective on neuromuscular factors in poststroke fatigue. Disabil Rehabil 2012; 34:2291-9. [DOI: 10.3109/09638288.2012.683233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cortes M, Black-Schaffer RM, Edwards DJ. Transcranial magnetic stimulation as an investigative tool for motor dysfunction and recovery in stroke: an overview for neurorehabilitation clinicians. Neuromodulation 2012; 15:316-25. [PMID: 22624621 DOI: 10.1111/j.1525-1403.2012.00459.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE An improved understanding of motor dysfunction and recovery after stroke has important clinical implications that may lead to the design of more effective rehabilitation strategies for patients with hemiparesis. SCOPE Transcranial magnetic stimulation (TMS) is a safe and painless tool that has been used in conjunction with other existing diagnostic tools to investigate motor pathophysiology in stroke patients. Since TMS emerged more than two decades ago, its application in clinical and basic neuroscience has expanded worldwide. TMS can quantify the corticomotor excitability properties of clinically affected and unaffected muscles and can probe local cortical networks as well as remote but functionally related areas. This provides novel insight into the physiology of neural circuits underlying motor dysfunction and brain reorganization during the motor recovery process. This important tool needs to be used with caution by clinical investigators, its limitations need to be understood, and the results should to be interpreted along with clinical evaluation in this patient population. SUMMARY In this review, we provide an overview of the rationale, implementation, and limitations of TMS to study stroke motor physiology. This knowledge may be useful to guide future rehabilitation treatments by assessing and promoting functional plasticity.
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Affiliation(s)
- Mar Cortes
- Department of Neurology & Neuroscience, Winifred Masterson Burke Medical Research Institute, White Plains, NY, USA
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Impact of treadmill exercise on efficacy expectations, physical activity, and stroke recovery. J Neurosci Nurs 2012; 44:27-35. [PMID: 22210302 DOI: 10.1097/jnn.0b013e31823ae4b5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke survivors are at high risk for cardiovascular mortality which can be in part mitigated by increasing physical activity. Self-efficacy for exercise is known to play a role in adoption of exercise behaviors. This study examines self-reported psychological outcomes in a group of 64 stroke survivors randomized to either a 6-month treadmill training program or a stretching program. Results indicated that, regardless of group, all study participants experienced increased self-efficacy (F = 2.95, p = .09) and outcome expectations for exercise (F = 13.23, p < 0.001) and improvements in activities of daily living as reported on the Stroke Impact Scale (F = 10.97, p = .002). No statistically significant between-group differences were noted, possibly because of the fact that specific interventions designed to enhance efficacy beliefs were not part of the study. Theoretically based interventions should be tested to clarify the role of motivation and potential influence on exercise and physical activity in the stroke survivor population.
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Corticospinal tract integrity correlates with knee extensor weakness in chronic stroke survivors. Clin Neurophysiol 2011; 122:1588-94. [PMID: 21333591 DOI: 10.1016/j.clinph.2011.01.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/05/2011] [Accepted: 01/16/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Muscle weakness develops rapidly after stroke, adversely affecting motor performance, and contributing to reduced functional ability. While the contributions of structural and functional alterations in skeletal muscle to post-stroke weakness have been well described, the relationship between motor pathway integrity, measured using both radiological and electrophysiological techniques, and post-stroke muscle weakness is not clear. This study sought to determine the role of corticospinal tract (CST) integrity on knee extensor weakness in chronic stroke survivors. METHODS Knee extensor strength and activation testing were performed at 90° of knee flexion using an interpolated triplet technique. CST integrity was evaluated using data obtained from Diffusion Tensor Imaging and transcranial magnetic stimulation. RESULTS Recordings in nine stroke subjects indicated substantial knee extensor weakness and activation deficits in the paretic legs of the stroke survivors. Regression analysis revealed that asymmetry in CST integrity was strongly related to between-leg differences in knee strength. CONCLUSIONS The results of this study suggest a strong link between CST integrity and lower extremity strength, and add to the growing evidence of substantial knee extensor weakness and activation impairments in stroke survivors. SIGNIFICANCE The findings from this study further our understanding of the anatomical and neurophysiological contributions to motor impairments after stroke, which may benefit clinicians and researchers in the field of stroke rehabilitation.
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Cacchio A, Paoloni M, Cimini N, Mangone M, Liris G, Aloisi P, Santilli V, Marrelli A. Reliability of TMS-related measures of tibialis anterior muscle in patients with chronic stroke and healthy subjects. J Neurol Sci 2011; 303:90-4. [PMID: 21262510 DOI: 10.1016/j.jns.2011.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022]
Abstract
A lack of normative data for transcranial magnetic stimulation (TMS)-related measures of the lower limb muscles in patients with stroke prevents us from understanding whether changes in TMS-related measures are induced by treatment or are due to their variability and/or the natural evolution of the disease. The purpose of this study was to determine the reliability of three TMS-related measures: motor threshold (MT), motor evoked potential latency (MEP Lat) and MEP amplitude (MEP Amp), linked to the corticospinal control of the tibialis anterior (TA) muscle in sixteen patients with chronic stroke and in sixteen aged-matched healthy subjects. Test-retest reliability was estimated using the intraclass correlation coefficient (ICC) with its 95% confidence interval (95% CI) and standard error of measurement (SEM). In healthy subjects the reliability of all the TMS-related measures yielded an ICC≥0.75. Similar reproducibility levels were found in patients with chronic stroke, with the exception of MEP Amp on the paretic side (ICC=0.38). These results suggest that the TMS-related measures investigated are reliable both in healthy subjects and, with the exception of MEP Amp on the paretic side, in patients with chronic stroke.
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Affiliation(s)
- Angelo Cacchio
- Division of Physical Medicine and Rehabilitation, School of Medicine, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Roma, Italy.
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Madhavan S, Weber KA, Stinear JW. Non-invasive brain stimulation enhances fine motor control of the hemiparetic ankle: implications for rehabilitation. Exp Brain Res 2010; 209:9-17. [PMID: 21170708 DOI: 10.1007/s00221-010-2511-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/23/2010] [Indexed: 11/26/2022]
Abstract
We set out to answer two questions with this study: 1. Can stroke patients improve voluntary control of their paretic ankle by practising a visuo-motor ankle-tracking task? 2. Are practice effects enhanced with non-invasive brain stimulation? A carefully selected sample of chronic stroke patients able to perform the experimental task attended three data collection sessions. Facilitatory transcranial direct current stimulation (tDCS) was applied in a random order over the lower limb primary motor cortex of the lesioned hemisphere or the non-lesioned hemisphere or sham stimulation was delivered over the lesioned hemisphere. In each session, tDCS was applied as patients practiced tracking a sinusoidal waveform for 15 min using dorsiflexion-plantarflexion movements of their paretic ankle. The difference in tracking error prior to, and after, the 15 min of practice was calculated. A practice effect was revealed following sham stimulation, and this effect was enhanced with tDCS applied over the lesioned hemisphere. The practice effect observed following sham stimulation was eliminated by tDCS applied over the non-lesioned hemisphere. The study provides the first evidence that non-invasive brain stimulation applied to the lesioned motor cortex of moderate- to well-recovered stroke patients enhances voluntary control of the paretic ankle. The results provide a basis for examining whether this enhanced ankle control can be induced in patients with greater impairments and whether enhanced control of a single or multiple lower limb joints improves hemiparetic gait patterns.
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Affiliation(s)
- Sangeetha Madhavan
- Department of Physical Therapy, University of Illinois, 1919 W Taylor St, Chicago, IL 60612, USA.
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