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Jeong CH, Lim H, Lee J, Lee HS, Ku J, Kang YJ. Attentional state-synchronous peripheral electrical stimulation during action observation induced distinct modulation of corticospinal plasticity after stroke. Front Neurosci 2024; 18:1373589. [PMID: 38606309 PMCID: PMC11007104 DOI: 10.3389/fnins.2024.1373589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Brain computer interface-based action observation (BCI-AO) is a promising technique in detecting the user's cortical state of visual attention and providing feedback to assist rehabilitation. Peripheral nerve electrical stimulation (PES) is a conventional method used to enhance outcomes in upper extremity function by increasing activation in the motor cortex. In this study, we examined the effects of different pairings of peripheral nerve electrical stimulation (PES) during BCI-AO tasks and their impact on corticospinal plasticity. Materials and methods Our innovative BCI-AO interventions decoded user's attentive watching during task completion. This process involved providing rewarding visual cues while simultaneously activating afferent pathways through PES. Fifteen stroke patients were included in the analysis. All patients underwent a 15 min BCI-AO program under four different experimental conditions: BCI-AO without PES, BCI-AO with continuous PES, BCI-AO with triggered PES, and BCI-AO with reverse PES application. PES was applied at the ulnar nerve of the wrist at an intensity equivalent to 120% of the sensory threshold and a frequency of 50 Hz. The experiment was conducted randomly at least 3 days apart. To assess corticospinal and peripheral nerve excitability, we compared pre and post-task (post 0, post 20 min) parameters of motor evoked potential and F waves under the four conditions in the muscle of the affected hand. Results The findings indicated that corticospinal excitability in the affected hemisphere was higher when PES was synchronously applied with AO training, using BCI during a state of attentive watching. In contrast, there was no effect on corticospinal activation when PES was applied continuously or in the reverse manner. This paradigm promoted corticospinal plasticity for up to 20 min after task completion. Importantly, the effect was more evident in patients over 65 years of age. Conclusion The results showed that task-driven corticospinal plasticity was higher when PES was applied synchronously with a highly attentive brain state during the action observation task, compared to continuous or asynchronous application. This study provides insight into how optimized BCI technologies dependent on brain state used in conjunction with other rehabilitation training could enhance treatment-induced neural plasticity.
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Affiliation(s)
- Chang Hyeon Jeong
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Hyunmi Lim
- Department of Biomedical Engineering, Keimyung University, Daegu, Republic of Korea
| | - Jiye Lee
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, Keimyung University, Daegu, Republic of Korea
| | - Youn Joo Kang
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
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Kim MG, Lim H, Lee HS, Han IJ, Ku J, Kang YJ. Brain-computer interface-based action observation combined with peripheral electrical stimulation enhances corticospinal excitability in healthy subjects and stroke patients. J Neural Eng 2022; 19. [PMID: 35675795 DOI: 10.1088/1741-2552/ac76e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/08/2022] [Indexed: 11/12/2022]
Abstract
Objective.Action observation (AO) combined with brain-computer interface (BCI) technology enhances cortical activation. Peripheral electrical stimulation (PES) increases corticospinal excitability, thereby activating brain plasticity. To maximize motor recovery, we assessed the effects of BCI-AO combined with PES on corticospinal plasticity.Approach.Seventeen patients with chronic hemiplegic stroke and 17 healthy subjects were recruited. The participants watched a video of repetitive grasping actions with four different tasks for 15 min: (A) AO alone; (B) AO + PES; (C) BCI-AO + continuous PES; and (D) BCI-AO + triggered PES. PES was applied at the ulnar nerve of the wrist. The tasks were performed in a random order at least three days apart. We assessed the latency and amplitude of motor evoked potentials (MEPs). We examined changes in MEP parameters pre-and post-exercise across the four tasks in the first dorsal interosseous muscle of the dominant hand (healthy subjects) and affected hand (stroke patients).Main results.The decrease in MEP latency and increase in MEP amplitude after the four tasks were significant in both groups. The increase in MEP amplitude was sustained for 20 min after tasks B, C, and D in both groups. The increase in MEP amplitude was significant between tasks A vs. B, B vs. C, and C vs. D. The estimated mean difference in MEP amplitude post-exercise was the highest for A and D in both groups.Significance.The results indicate that BCI-AO combined with PES is superior to AO alone or AO + PES for facilitating corticospinal plasticity in both healthy subjects and patients with stroke. Furthermore, this study supports the idea that synchronized activation of cortical and peripheral networks can enhance neuroplasticity after stroke. We suggest that the BCI-AO paradigm and PES could provide a novel neurorehabilitation strategy for patients with stroke.
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Affiliation(s)
- Min Gyu Kim
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Hyunmi Lim
- Department of Biomedical Engineering, College of medicine, Keimyung University, Daegu, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Jun Han
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, College of medicine, Keimyung University, Daegu, Republic of Korea
| | - Youn Joo Kang
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
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Nito M, Katagiri N, Yoshida K, Koseki T, Kudo D, Nanba S, Tanabe S, Yamaguchi T. Repetitive Peripheral Magnetic Stimulation of Wrist Extensors Enhances Cortical Excitability and Motor Performance in Healthy Individuals. Front Neurosci 2021; 15:632716. [PMID: 33679314 PMCID: PMC7930341 DOI: 10.3389/fnins.2021.632716] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Repetitive peripheral magnetic stimulation (rPMS) may improve motor function following central nervous system lesions, but the optimal parameters of rPMS to induce neural plasticity and mechanisms underlying its action remain unclear. We examined the effects of rPMS over wrist extensor muscles on neural plasticity and motor performance in 26 healthy volunteers. In separate experiments, the effects of rPMS on motor evoked potentials (MEPs), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), direct motor response (M-wave), Hoffmann-reflex, and ballistic wrist extension movements were assessed before and after rPMS. First, to examine the effects of stimulus frequency, rPMS was applied at 50, 25, and 10 Hz by setting a fixed total number of stimuli. A significant increase in MEPs of wrist extensors was observed following 50 and 25 Hz rPMS, but not 10 Hz rPMS. Next, we examined the time required to induce plasticity by increasing the number of stimuli, and found that at least 15 min of 50 and 25 Hz rPMS was required. Based on these parameters, lasting effects were evaluated following 15 min of 50 or 25 Hz rPMS. A significant increase in MEP was observed up to 60 min following 50 and 25 Hz rPMS; similarly, an attenuation of SICI and enhancement of ICF were also observed. The maximal M-wave and Hoffmann-reflex did not change, suggesting that the increase in MEP was due to plastic changes at the motor cortex. This was accompanied by increasing force and electromyograms during wrist ballistic extension movements following 50 and 25 Hz rPMS. These findings suggest that 15 min of rPMS with 25 Hz or more induces an increase in cortical excitability of the relevant area rather than altering the excitability of spinal circuits, and has the potential to improve motor output.
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Affiliation(s)
- Mitsuhiro Nito
- Department of Anatomy and Structural Science, Yamagata University School of Medicine, Yamagata, Japan
| | - Natsuki Katagiri
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Kaito Yoshida
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Tadaki Koseki
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Daisuke Kudo
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Shigehiro Nanba
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake-shi, Japan
| | - Tomofumi Yamaguchi
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan.,Department of Physical Therapy, Faculty of Health Science, Juntendo University, Bunkyo-ku, Japan
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Germann M, Baker SN. Evidence for Subcortical Plasticity after Paired Stimulation from a Wearable Device. J Neurosci 2021; 41:1418-1428. [PMID: 33441436 PMCID: PMC7896019 DOI: 10.1523/jneurosci.1554-20.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022] Open
Abstract
Existing non-invasive stimulation protocols can generate plasticity in the motor cortex and its corticospinal projections; techniques for inducing plasticity in subcortical circuits and alternative descending pathways such as the reticulospinal tract (RST) are less well developed. One possible approach developed by this laboratory pairs electrical muscle stimulation with auditory clicks, using a wearable device to deliver stimuli during normal daily activities. In this study, we applied a variety of electrophysiological assessments to male and female healthy human volunteers during a morning and evening laboratory visit. In the intervening time (∼6 h), subjects wore the stimulation device, receiving three different protocols, in which clicks and stimulation of the biceps muscle were paired at either low or high rate, or delivered at random. Paired stimulation: (1) increased the extent of reaction time shortening by a loud sound (the StartReact effect); (2) decreased the suppression of responses to transcranial magnetic brain stimulation (TMS) following a loud sound; (3) enhanced muscle responses elicited by a TMS coil oriented to induce anterior-posterior (AP) current, but not posterior-anterior (PA) current, in the brain. These measurements have all been suggested to be sensitive to subcortical, possibly reticulospinal, activity. Changes were similar for either of the two paired stimulus rates tested, but absent after unpaired (control) stimulation. Taken together, these results suggest that pairing clicks and muscle stimulation for long periods does indeed induce plasticity in subcortical systems such as the RST.SIGNIFICANCE STATEMENT Subcortical systems such as the reticulospinal tract (RST) are important motor pathways, which can make a significant contribution to functional recovery after cortical damage such as stroke. Here, we measure changes produced after a novel non-invasive stimulation protocol, which uses a wearable device to stimulate for extended periods. We observed changes in electrophysiological measurements consistent with the induction of subcortical plasticity. This protocol may prove an important tool for enhancing motor rehabilitation, in situations where insufficient cortical tissue survives to be a plausible substrate for recovery of function.
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Affiliation(s)
- Maria Germann
- Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Stuart N Baker
- Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
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Hashimoto Y, Kakui T, Ushiba J, Liu M, Kamada K, Ota T. Portable rehabilitation system with brain-computer interface for inpatients with acute and subacute stroke: A feasibility study. Assist Technol 2021; 34:402-410. [PMID: 33085573 DOI: 10.1080/10400435.2020.1836067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The feasibility and safety of brain-computer interface (BCI) systems for patients with acute/subacute stroke have not been established. The aim of this study was to firstly demonstrate the feasibility and safety of a bedside BCI system for inpatients with acute/subacute stroke in a small cohort of inpatients. Four inpatients with early-phase hemiplegic stroke (7-24 days from stroke onset) participated in this study. The portable BCI system showed real-time feedback of sensorimotor rhythms extracted from scalp electroencephalograms (EEGs). Patients attempted to extend the wrist on their affected side, and neuromuscular electrical stimulation was applied only when the system detected significant movement intention-related changes in EEG. Between 120 and 200 training trials per patient were successfully and safely conducted at the bedside over 2-4 days. Our results clearly indicate that the proposed bedside BCI system is feasible and safe. Larger clinical studies are needed to determine the clinical efficacy of the system and its effect size in the population of patients with acute/subacute post-stroke hemiplegia.
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Affiliation(s)
- Yasunari Hashimoto
- Department of Electrical and Electronic Engineering, Kitami Institute of Technology, Kitami, Japan
| | - Toshiyuki Kakui
- Department of Physical Medicine & Rehabilitation, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Kanagawa, Japan.,Keio Institute of Pure and Applied Sciences (Kipas), Kanagawa, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Tetsuo Ota
- Department of Physical Medicine & Rehabilitation, Asahikawa Medical University Hospital, Asahikawa, Japan
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Bandeira JS, Antunes LDC, Soldatelli MD, Sato JR, Fregni F, Caumo W. Functional Spectroscopy Mapping of Pain Processing Cortical Areas During Non-painful Peripheral Electrical Stimulation of the Accessory Spinal Nerve. Front Hum Neurosci 2019; 13:200. [PMID: 31263406 PMCID: PMC6585570 DOI: 10.3389/fnhum.2019.00200] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/28/2019] [Indexed: 01/30/2023] Open
Abstract
Peripheral electrical stimulation (PES), which encompasses several techniques with heterogeneous physiological responses, has shown in some cases remarkable outcomes for pain treatment and clinical rehabilitation. However, results are still mixed, mainly because there is a lack of understanding regarding its neural mechanisms of action. In this study, we aimed to assess its effects by measuring cortical activation as indexed by functional near infrared spectroscopy (fNIRS). fNIRS is a functional optical imaging method to evaluate hemodynamic changes in oxygenated (HbO) and de-oxygenated (HbR) blood hemoglobin concentrations in cortical capillary networks that can be related to cortical activity. We hypothesized that non-painful PES of accessory spinal nerve (ASN) can promote cortical activation of sensorimotor cortex (SMC) and dorsolateral prefrontal cortex (DLPFC) pain processing cortical areas. Fifteen healthy volunteers received both active and sham ASN electrical stimulation in a crossover study. The hemodynamic cortical response to unilateral right ASN burst electrical stimulation with 10 Hz was measured by a 40-channel fNIRS system. The effect of ASN electrical stimulation over HbO concentration in cortical areas of interest (CAI) was observed through the activation of right-DLPFC (p = 0.025) and left-SMC (p = 0.042) in the active group but not in sham group. Regarding left-DLPFC (p = 0.610) and right-SMC (p = 0.174) there was no statistical difference between groups. As in non-invasive brain stimulation (NIBS) top-down modulation, bottom-up electrical stimulation to the ASN seems to activate the same critical cortical areas on pain pathways related to sensory-discriminative and affective-motivational pain dimensions. These results provide additional mechanistic evidence to develop and optimize the use of peripheral nerve electrical stimulation as a neuromodulatory tool (NCT 03295370— www.clinicaltrials.gov).
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Affiliation(s)
- Janete Shatkoski Bandeira
- Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana da Conceição Antunes
- Department of Nutrition, Health Science Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | | | - João Ricardo Sato
- Department of Mathematics and Statistics, Universidade Federal do ABC, Santo André, Brazil
| | - Felipe Fregni
- Physical Medicine & Rehabilitation, Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Department of Pain and Anesthesia in Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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7
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Peres ASC, Souza VH, Catunda JMY, Mazzeto-Betti KC, Santos-Pontelli TEG, Vargas CD, Baffa O, de Araújo DB, Pontes-Neto OM, Leite JP, Garcia MAC. Can somatosensory electrical stimulation relieve spasticity in post-stroke patients? A TMS pilot study. BIOMED ENG-BIOMED TE 2018; 63:501-506. [PMID: 28475487 DOI: 10.1515/bmt-2016-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/28/2017] [Indexed: 11/15/2022]
Abstract
Evidence suggests that somatosensory electrical stimulation (SES) may decrease the degree of spasticity from neural drives, although there is no agreement between corticospinal modulation and the level of spasticity. Thus, stroke patients and healthy subjects were submitted to SES (3 Hz) for 30' on the impaired and dominant forearms, respectively. Motor evoked potentials induced by single-pulse transcranial magnetic stimulation were collected from two forearm muscles before and after SES. The passive resistance of the wrist joint was measured with an isokinetic system. We found no evidence of an acute carry-over effect of SES on the degree of spasticity.
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Affiliation(s)
- André Salles Cunha Peres
- Laboratório de Neuroimagem Funcional, Instituto do Cérebro - Universidade Federal do Rio Grande do Norte - Av. Nascimento de Castro, 2155 - Morro Branco, Natal, RN 59056-450,Brazil.,Instituto Santos Dumont, Instituto Internacional de Neurociências - Rodovia RN 160, 3001 - Distrito Jundiaí, Macaíba 59280-000, Brazil
| | - Victor Hugo Souza
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14040-901,Brazil
| | - João Marcos Yamasaki Catunda
- Programa de Engenharia Biomédica, COPPE - Universidade Federal do Rio de Janeiro - Av. Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Sala 327 - Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ 21941-914,Brazil
| | - Kelley Cristine Mazzeto-Betti
- Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - Taiza Elaine Grespan Santos-Pontelli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - Claudia Domingues Vargas
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho - Universidade Federal do Rio de Janeiro - Av. Carlos Chagas Filho, 373 - Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ 21941-902,Brazil
| | - Oswaldo Baffa
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14040-901,Brazil
| | - Draulio Barros de Araújo
- Laboratório de Neuroimagem Funcional, Instituto do Cérebro - Universidade Federal do Rio Grande do Norte - Av. Nascimento de Castro, 2155 - Morro Branco, Natal, RN 59056-450,Brazil
| | - Octávio Marques Pontes-Neto
- Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - João Pereira Leite
- Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - Marco Antonio Cavalcanti Garcia
- Departamento de Biociências e Atividades Físicas, Escola de Educação Física e Desportos - Universidade Federal do Rio de Janeiro - Avenida Carlos Chagas Filho, 540 - Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ 21941-599,Brazil, Phone: +55(21)3938-6824,
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8
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Hwang KJ, Ryu YU. Whole body vibration may have immediate adverse effects on the postural sway of stroke patients. J Phys Ther Sci 2016; 28:473-7. [PMID: 27064678 PMCID: PMC4792993 DOI: 10.1589/jpts.28.473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/31/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study applied whole body vibration (WBV) at different vibration
frequencies to chronic stroke patients and examined its immediate effect on their postural
sway. [Subjects and Methods] A total of 14 (5 males, 9 females) stroke patients
participated. The subjects were randomly assigned to one of the two vibration frequency
groups (10 Hz and 40 Hz). Right before and after the application of WBV, the subjects
performed quiet standing for 30 seconds, and COP parameters (range, total distance, and
mean velocity) were analyzed. [Results] The 10 Hz WBV did not affect the postural sway of
stroke patients. The 40 Hz WBV increased postural sway in the ML direction. [Conclusion]
The results suggest that WBV application to stroke patients in the clinical field may have
adverse effects and therefore caution is necessary.
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Affiliation(s)
- Ki Jin Hwang
- Department of Physical Therapy, Graduate School, Catholic University of Daegu, Republic of Korea
| | - Young Uk Ryu
- Department of Physical Therapy, College of Medical Science, Catholic University of Daegu, Republic of Korea
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9
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Is the Frequency in Somatosensory Electrical Stimulation the Key Parameter in Modulating the Corticospinal Excitability of Healthy Volunteers and Stroke Patients with Spasticity? Neural Plast 2016; 2016:3034963. [PMID: 26881102 PMCID: PMC4736758 DOI: 10.1155/2016/3034963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022] Open
Abstract
Somatosensory electrical stimulation (SES) has been proposed as an approach to treat patients with sensory-motor impairment such as spasticity. However, there is still no consensus regarding which would be the adequate SES parameters to treat those deficits. Therefore, the aim of this study was to evaluate the effects of applying SES over the forearm muscles at four different frequencies of stimulation (3, 30, 150, and 300 Hz) and in two intervals of time (5′ and 30′) by means of transcranial magnetic stimulation and Hoffmann's reflex (H-reflex) in healthy volunteers (Experiments I and II). A group of stroke patients (Experiment III) was also preliminary evaluated to ascertain SES effects at a low frequency (3 Hz) applied for 30′ over the forearm spastic flexors muscles by measuring the wrist joint passive torque. Motor evoked potentials and the H-reflex were collected from different forearm and hand muscles immediately before and after SES and up to 5′ (Experiment I) and 10′ (Experiments I and II) later. None of the investigated frequencies of SES was able to operate as a key in switching modulatory effects in the central nervous system of healthy volunteers and stroke patients with spasticity.
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10
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Cugy E, Leroi AM, Kerouac-Laplante J, Dehail P, Joseph PA, Gerardin E, Marie JP, Verin É. Effect of submental sensitive transcutaneous electrical stimulation on virtual lesions of the oropharyngeal cortex. Ann Phys Rehabil Med 2016; 59:94-9. [PMID: 26717886 DOI: 10.1016/j.rehab.2015.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/18/2015] [Accepted: 10/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effect of submental sensitive transcutaneous electrical stimulation (SSTES) on pharyngeal cortical representation after the creation of an oropharyngeal cortical virtual lesion in healthy subjects. METHODS Motor-evoked potential amplitude of the mylohyoid muscles was measured with transcranial magnetic stimulation (TMS), the oropharyngeal cortex was mapped by cartography, and videofluoroscopic parameters of swallowing function were measured before and after SSTES (at the end of SSTES [0 min] and at 30 and 60 min), after the creation of a cortical virtual lesion (repetitive TMS, 1 Hz, 20 min on the dominant swallowing hemisphere). RESULTS Nine subjects completed the study. After 20 min of SSTES, motor-evoked potential amplitude increased (P<0.05), as did swallow reaction time after repetitive TMS, as seen on videofluoroscopy, which was reversed after electrical stimulation. On cortical mapping, the number of points with a cortical response increased in the dominant lesioned hemisphere (P<0.05), remaining constant at 60 min (P<0.05). CONCLUSION SSTES may be effective for producing cortical plasticity for mylohyoid muscles and reverses oropharyngeal cortical inhibition in healthy subjects. It could be a simple non-invasive way to treat post-stroke dysphagia.
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Affiliation(s)
- Emmanuelle Cugy
- Service de MPR, centre hospitalier Arcachon, 33260 La Teste de Buch, France; Service de MPR, CHU de Bordeaux, 33076 Bordeaux, France; EA 4136, université de Bordeaux, 33000 Bordeaux, France
| | - Anne-Marie Leroi
- Service de physiologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | | | - Patrick Dehail
- Service de MPR, CHU de Bordeaux, 33076 Bordeaux, France; EA 4136, université de Bordeaux, 33000 Bordeaux, France
| | - Pierre-Alain Joseph
- Service de MPR, CHU de Bordeaux, 33076 Bordeaux, France; EA 4136, université de Bordeaux, 33000 Bordeaux, France
| | | | - Jean-Paul Marie
- EA 3830, université de Rouen, 76000 Rouen, France; Service de chirurgie cervicofaciale, CHU de Rouen, 76031 Rouen, France
| | - Éric Verin
- Service de physiologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; EA 3830, université de Rouen, 76000 Rouen, France; Pôle 3R, CHU de Rouen, 76031 Rouen, France.
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11
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Gallasch E, Christova M, Kunz A, Rafolt D, Golaszewski S. Modulation of sensorimotor cortex by repetitive peripheral magnetic stimulation. Front Hum Neurosci 2015; 9:407. [PMID: 26236220 PMCID: PMC4500907 DOI: 10.3389/fnhum.2015.00407] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/01/2015] [Indexed: 11/13/2022] Open
Abstract
This study examines with transcranial magnetic stimulation (TMS) and with functional magnetic resonance imaging (fMRI) whether 20 min of repetitive peripheral magnetic stimulation (rPMS) has a facilitating effect on associated motor controlling regions. Trains of rPMS with a stimulus intensity of 150% of the motor threshold (MT) were applied over right hand flexor muscles of healthy volunteers. First, with TMS, 10 vs. 25 Hz rPMS was examined and compared to a control group. Single and paired pulse motor evoked potentials (MEPs) from flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles were recorded at baseline (T0), post rPMS (T1), 30 min post (T2), 1 h post (T3) and 2 h post rPMS (T4). Then, with fMRI, 25 Hz rPMS was compared to sham stimulation by utilizing a finger tapping activation paradigm. Changes in bloodoxygen level dependent (BOLD) contrast were examined at baseline (PRE), post rPMS (POST1) and 1 h post rPMS (POST2). With TMS facilitation was observed in the target muscle (FCR) following 25 Hz rPMS: MEP recruitment curves (RCs) were increased at T1, T2 and T3, and intracortical facilitation (ICF) was increased at T1 and T2. No effects were observed following 10 Hz rPMS. With fMRI the BOLD contrast at the left sensorimotor area was increased at POST1. Compared to inductions protocols based on transcutaneous electrical stimulation and mechanical stimulation, the rPMS induced effects appeared shorter lasting.
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Affiliation(s)
- Eugen Gallasch
- Department of Physiology, Medical University of Graz Graz, Austria
| | - Monica Christova
- Department of Physiology, Medical University of Graz Graz, Austria ; Institute of Physiotherapy, University of Applied Sciences FH-Joanneum Graz, Austria
| | - Alexander Kunz
- Department of Neurology, Paracelsus Medical University of Salzburg Salzburg, Austria
| | - Dietmar Rafolt
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna Vienna, Austria
| | - Stefan Golaszewski
- Department of Neurology, Paracelsus Medical University of Salzburg Salzburg, Austria
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Direct and crossed effects of somatosensory stimulation on neuronal excitability and motor performance in humans. Neurosci Biobehav Rev 2014; 47:22-35. [DOI: 10.1016/j.neubiorev.2014.07.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/11/2022]
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Kafri M, Zaltsberg N, Dickstein R. EMG activity of finger flexor muscles and grip force following low-dose transcutaneous electrical nerve stimulation in healthy adult subjects. Somatosens Mot Res 2014; 32:1-7. [PMID: 25059799 DOI: 10.3109/08990220.2014.937413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Somatosensory stimulation modulates cortical and corticospinal excitability and consequently affects motor output. Therefore, low-amplitude transcutaneous electrical nerve stimulation (TENS) has the potential to elicit favorable motor responses. The purpose of the two presented pilot studies was to shed light on TENS parameters that are relevant for the enhancement of two desirable motor outcomes, namely, electromyographic (EMG) activity and contraction strength of the finger flexors and wrist muscles. In 5 and 10 healthy young adults (in Study I and Study II, respectively) TENS was delivered to the volar aspect of the forearm. We manipulated TENS frequency (150 Hz vs. 5 Hz), length of application (10, 20, and 60 min), and side of application (unilateral, right forearm vs. bilateral forearms). EMG amplitude and grip force were measured before (Pre), immediately after (Post), and following 15 min of no stimulation (Study I only). The results indicated that low-frequency bursts of TENS applied to the skin overlying the finger flexor muscles enhance the EMG activity of the finger flexors and grip force. The increase in EMG activity of the flexor muscles was observed after 20 min of stimulation, while grip force was increased only after 1 h. The effects of uni- and bilateral TENS were comparable. These observations allude to a modulatory effect of TENS on the tested motor responses; however, unequivocal conclusions of the findings are hampered by individual differences that affect motor outcomes, such as in level of attention.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa , Haifa , Israel
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15
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Comparison of two protocols of transcranial magnetic stimulation for treatment of chronic tinnitus: a randomized controlled clinical trial of burst repetitive versus high-frequency repetitive transcranial magnetic stimulation. Neurol Sci 2013; 35:227-32. [DOI: 10.1007/s10072-013-1487-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
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Tan T, Xie J, Tong Z, Liu T, Chen X, Tian X. Repetitive transcranial magnetic stimulation increases excitability of hippocampal CA1 pyramidal neurons. Brain Res 2013; 1520:23-35. [PMID: 23651978 DOI: 10.1016/j.brainres.2013.04.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/18/2013] [Accepted: 04/29/2013] [Indexed: 12/11/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is able to induce alteration in cortical activity and excitability that outlast the period of stimulation, which is long-term depre-ssion (LTD) or long-term potentiation (LTP)-like. Accumulating evidence shows that Na(+), Ca(2+) and K(+) channels are important for the regulation of neuronal excitability. To investigate the possible mechanisms of rTMS on regulation of intrinsic excitability in hippocampal neurons, the male or female Sprague-Dawley rats aged 2-3 d or 7-8 d were treated with 14 or 7-d's low frequency (1 Hz) rTMS (400 stimuli/d), respectively. After that, the effects of rTMS on ion channels such as Na(+)-channel, A-type K(+)-channel and Ca(2+)-channel in rat hippocampal CA1 pyramidal neurons were performed by standard whole-cell patch-clamp technique. The results showed that the peak amplitude and maximal rise slope of evoked single action potential (AP) were significantly increased after 14-d's rTMS treatment. Meanwhile, the AP threshold was significantly more depolarized in neurons after 14-d's rTMS treatment than neurons in control group that without rTMS treatment. The spontaneous excitatory post-synaptic currents (sEPSCs) frequency and amplitude of CA1 pyramidal neurons in groups with rTMS treatment (both 7 d and 14 d) were obviously increased compared with the age-matched control group. Furthermore, we found that electrophysiological properties of Na(+)-channel were markedly changed after rTMS treatment, including negative-shifted activation and inactivation curves, as well as fasten recovery rate. After rTMS application, the IA amplitude of K(+)-channel was reduced; the activation and inactivation curves of K(+)-channel were significantly shifted to right. Time constant of recovery from inactivation was also more rapid. Moreover, rTMS induced an obvious increment in the maximal current peak amplitude of Ca(2+)-channel. At the same time, there was a significant rightward shift in the activation curve and inactivation curves of Ca(2+)-channel. These data suggest that rTMS can enhance the AP and sEPSCs of hippocampal CA1 neurons. Altered electrophysiological properties of Na(+)-channel, A-type K(+) channels and Ca(2+) channels contribute to the underling mechanisms of rTMS-induced up-regulation of neural excitability.
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Affiliation(s)
- Tao Tan
- School of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, China.
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Christova M, Golaszewski S, Ischebeck A, Kunz A, Rafolt D, Nardone R, Gallasch E. Mechanical flutter stimulation induces a lasting response in the sensorimotor cortex as revealed with BOLD fMRI. Hum Brain Mapp 2012; 34:2767-74. [PMID: 22611041 DOI: 10.1002/hbm.22102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/02/2012] [Accepted: 03/19/2012] [Indexed: 11/08/2022] Open
Abstract
It has been recently shown that 20 min of mechanical flutter stimulation induces lasting motor cortical excitability changes, as assessed by transcranial magnetic stimulation in relaxed hand muscles. The present functional magnetic resonance imaging (fMRI) study aims to examine if such neuromodulatory changes are reflected in the BOLD signal during a motor test. Therefore, two groups were recruited: one group receiving whole-hand flutter stimulation with a frequency of 25 Hz (FSTIM group, n = 22) and a second group receiving no stimulation (NOSTIM group, n = 22). As motor test finger-to-thumb tapping was performed to activate a wide sensorimotor network during the fMRI measurements. Three fMRI measurements were obtained with this test: before stimulation (PRE), after stimulation (POST1), and 1 h after stimulation (POST2). Three regions of interest (ROIs) were defined: primary motor area (M1), primary somatosensory area (S1), and supplementary motor area. In the absence of baseline differences between both groups, the FSTIM group showed increased movement-related brain activations compared with the NOSTIM group, both at POST1 and POST2. ROI analysis revealed increased blood-oxygenation-level-dependent (BOLD) responses within contralateral S1 (+20%) and M1 (+25%) at POST1, which lasted until POST2. These poststimulatory effects within S1 and M1 obviously reflect neuroplastic changes associated with augmented cortical excitability. These findings are of high clinical relevance, for example, to improve the treatment of stroke patients.
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Affiliation(s)
- Monica Christova
- Department of Physiology, Medical University of Graz, Graz, Austria
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Bergquist AJ, Clair JM, Lagerquist O, Mang CS, Okuma Y, Collins DF. Neuromuscular electrical stimulation: implications of the electrically evoked sensory volley. Eur J Appl Physiol 2011; 111:2409-26. [PMID: 21805156 DOI: 10.1007/s00421-011-2087-9] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 07/11/2011] [Indexed: 11/26/2022]
Affiliation(s)
- A J Bergquist
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, Centre for Neuroscience, University of Alberta, 6-41 General Services Building, Edmonton, AB, Canada
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Christova M, Rafolt D, Golaszewski S, Gallasch E. Outlasting corticomotor excitability changes induced by 25 Hz whole-hand mechanical stimulation. Eur J Appl Physiol 2011; 111:3051-9. [PMID: 21455615 DOI: 10.1007/s00421-011-1933-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 03/17/2011] [Indexed: 12/19/2022]
Affiliation(s)
- Monica Christova
- Department of Physiology, Medical University of Graz, Harrachgasse 21/5, 8010 Graz, Austria.
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Mang CS, Clair JM, Collins DF. Neuromuscular electrical stimulation has a global effect on corticospinal excitability for leg muscles and a focused effect for hand muscles. Exp Brain Res 2011; 209:355-63. [PMID: 21286692 DOI: 10.1007/s00221-011-2556-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
Abstract
The afferent volley generated during neuromuscular electrical stimulation (NMES) can increase the excitability of human corticospinal (CS) pathways to muscles of the leg and hand. Over time, such increases can strengthen CS pathways damaged by injury or disease and result in enduring improvements in function. There is some evidence that NMES affects CS excitability differently for muscles of the leg and hand, although a direct comparison has not been conducted. Thus, the present experiments were designed to compare the strength and specificity of NMES-induced changes in CS excitability for muscles of the leg and hand. Two hypotheses were tested: (1) For muscles innervated by the stimulated nerve (target muscles), CS excitability will increase more for the hand than for the leg. (2) For muscles not innervated by the stimulated nerve (non-target muscles), CS excitability will increase for muscles of the leg but not muscles of the hand. NMES was delivered over the common peroneal (CP) nerve in the leg or the median nerve at the wrist using a 1-ms pulse width in a 20 s on, 20 s off cycle for 40 min. The intensity was set to evoke an M-wave that was ~15% of the maximal M-wave in the target muscle: tibialis anterior (TA) in the leg and abductor pollicis brevis (APB) in the hand. Ten motor-evoked potentials (MEPs) were recorded from the target muscles and from 2 non-target muscles of each limb using transcranial magnetic stimulation delivered over the "hotspot" for each muscle before and after the NMES. MEP amplitude increased significantly for TA (by 45 ± 6%) and for APB (56 ± 8%), but the amplitude of these increases was not different. In non-target muscles, MEPs increased significantly for muscles of the leg (42 ± 4%), but not the hand. Although NMES increased CS excitability for target muscles to the same extent in the leg and hand, the differences in the effect on non-target muscles suggest that NMES has a "global" effect on CS excitability for the leg and a "focused" effect for the hand. These differences may reflect differences in the specificity of afferent projections to the cortex. Global increases in CS excitability for the leg could be advantageous for rehabilitation as NMES applied to one muscle could strengthen CS pathways and enhance function for multiple muscles.
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Affiliation(s)
- C S Mang
- Human Neurophysiology Laboratory, Faculty of Physical Education and Recreation, Centre for Neuroscience, University of Alberta, E-488 Van Vliet Centre, Edmonton, AB T6G 2H9, Canada
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Excitability changes in the ipsilateral primary motor cortex during rhythmic contraction of finger muscles. Neurosci Lett 2010; 488:22-5. [PMID: 21056628 DOI: 10.1016/j.neulet.2010.10.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 10/26/2010] [Accepted: 10/29/2010] [Indexed: 11/22/2022]
Abstract
The aim of this study was to determine whether the excitatory ipsilateral primary motor cortex (ipsi-M1) is affected by changes in the frequency of rhythmic voluntary contraction of the left first dorsal interosseous (FDI) induced by repetitive abduction of the left index-finger. Transcranial magnetic stimulations were delivered to the left M1 during repetitive left index-finger abduction at 1, 2, and 3Hz, and motor evoked potentials (MEPs) were simultaneously evoked in the resting right (Rt)-FDI, Rt-abductor pollicis brevis, and Rt-abductor digiti minimi. The stimulus-response (S-R) curve of the MEP at each frequency was recorded. In addition, F-waves were recorded from the Rt-FDI during these rhythmic contraction tasks in order to examine the changes in spinal motoneuron excitability. MEPs were markedly increased under the 3Hz conditions compared with the other conditions. However, F-waves were hardly changed under these conditions. The S-R curve of the MEP induced under the 3Hz conditions was significantly steeper than the curves produced under other conditions. Our results indicate that the excitability of ipsi-M1 is affected by the frequency of rhythmic voluntary contraction of unilateral finger movement, which may be caused by neural inputs delivered via a transcallosal pathway.
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Changes in corticospinal excitability evoked by common peroneal nerve stimulation depend on stimulation frequency. Exp Brain Res 2010; 203:11-20. [DOI: 10.1007/s00221-010-2202-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/17/2010] [Indexed: 11/28/2022]
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Tokay T, Holl N, Kirschstein T, Zschorlich V, Köhling R. High-frequency magnetic stimulation induces long-term potentiation in rat hippocampal slices. Neurosci Lett 2009; 461:150-4. [DOI: 10.1016/j.neulet.2009.06.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 06/09/2009] [Accepted: 06/11/2009] [Indexed: 11/25/2022]
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Chae J, Harley MY, Hisel TZ, Corrigan CM, Demchak JA, Wong YT, Fang ZP. Intramuscular Electrical Stimulation for Upper Limb Recovery in Chronic Hemiparesis: An Exploratory Randomized Clinical Trial. Neurorehabil Neural Repair 2009; 23:569-78. [DOI: 10.1177/1545968308328729] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Surface electrical stimulation (ES) has been shown to improve the motor impairment of stroke survivors. However, surface ES can be painful and motor activation can be inconsistent from session to session. Percutaneous intramuscular ES may be an effective alternative. Objective. Evaluate the effectiveness of percutaneous intramuscular ES in facilitating the recovery of the hemiparetic upper limb of chronic stroke survivors. Methods. A total of 26 chronic stroke survivors were randomly assigned to percutaneous intramuscular ES for hand opening (n = 13) or percutaneous ES for sensory stimulation only (n = 13). The intramuscular ES group received cyclic, electromyography (EMG)-triggered or EMG-controlled ES depending on baseline motor status. All participants received 1 hour of stimulation per day for 6 weeks. After completion of ES, participants received 18 hours of task-specific functional training. The primary outcome measure was the Fugl-Meyer Motor Assessment. Secondary measures included the Arm Motor Ability Test and delay and termination of EMG activity. Outcomes were assessed in a blinded manner at baseline, at the end of ES, at the end of functional training, and at 1, 3, and 6 months follow-up. Results. Repeated measure analysis of variance did not yield any significant treatment, or time by treatment interaction effects for any of the outcome measures. Conclusion. Percutaneous intramuscular ES does not appear to be any more effective than sensory ES in enhancing the recovery of the hemiparetic upper limb among chronic stroke survivors. However, because of the exploratory nature of the study and its inherent limitations, conclusions must be drawn with caution.
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Affiliation(s)
- John Chae
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio,
| | - Mary Y. Harley
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Terri Z. Hisel
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Catherine M. Corrigan
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Jeffrey A. Demchak
- NeuroControl Corporation, North Ridgeville, Ohio, Life Line Screening, Cleveland, Ohio
| | - Yu-Tung Wong
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio
| | - Zi-Ping Fang
- NeuroControl Corporation, North Ridgeville, Ohio, Nevro Corporation, Palo Alto, California
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Klaiput A, Kitisomprayoonkul W. Increased Pinch Strength in Acute and Subacute Stroke Patients After Simultaneous Median and Ulnar Sensory Stimulation. Neurorehabil Neural Repair 2008; 23:351-6. [DOI: 10.1177/1545968308324227] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Peripheral nerve stimulation may induce cortical adaptations as it improves pinch strength in chronic stroke patients immediately after stimulation. Objective. Test the effects of peripheral sensory stimulation on pinch strength in patients with acute and subacute stroke. Methods. Stroke patients (N = 20) who had onset less than 6 months previously and could voluntarily pinch the thumb to the index finger participated in a randomized, single-blinded, controlled study. Ten patients received 2 hours of simultaneous electrical stimulation over the median and ulnar nerves at the wrist to the level of appreciating paresthesias (peripheral sensory stimulation group). Ten control patients received stimulation to the level of perception (sham-control group). Pinch strength of the thumb pad to tip and to lateral side of the index finger of the paretic hand and the Action Research Arm test were tested before and immediately after the stimulation. Results. Lateral and tip pinch strength were significantly increased in both groups ( P < .05). Mean ± SD of increased lateral pinch strength of peripheral sensory stimulation and sham-control groups were 1.24 ± 0.54 pounds and 0.20 ± 0.28 pounds, respectively. Mean ± SD of increased tip pinch strength of peripheral sensory stimulation and sham-control groups were 1.00 ± 0.72 pounds and 0.37 ± 0.36 pounds, respectively. Increase pinch strength of the peripheral sensory stimulation group was greater than the sham-control group, with significant difference ( P < .05). The Action Research Arm test was not significantly changed after stimulation in both groups ( P > .05). Conclusion. Peripheral sensory stimulation of the paretic hand may increase pinch strength of acute and subacute stroke patients immediately after stimulation.
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Affiliation(s)
- Akkarapol Klaiput
- Department of Rehabilitation Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Wasuwat Kitisomprayoonkul
- Department of Rehabilitation Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand,
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Corticospinal Facilitation Following Prolonged Proprioceptive Stimulation by Means of Passive Wrist Movement. J Clin Neurophysiol 2008; 25:202-9. [DOI: 10.1097/wnp.0b013e31817da170] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Forner-Cordero A, Steyvers M, Levin O, Alaerts K, Swinnen SP. Changes in corticomotor excitability following prolonged muscle tendon vibration. Behav Brain Res 2008; 190:41-9. [PMID: 18378327 DOI: 10.1016/j.bbr.2008.02.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 01/13/2008] [Accepted: 02/04/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Arturo Forner-Cordero
- Motor Control Laboratory, Department of Biomedical Kinesiology, Group Biomedical Sciences, Katholieke Universiteit Leuven, Belgium.
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Meunier S, Russmann H, Simonetta-Moreau M, Hallett M. Changes in Spinal Excitability After PAS. J Neurophysiol 2007; 97:3131-5. [PMID: 17251364 DOI: 10.1152/jn.01086.2006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Repetitive pairing of a peripheral stimulation with a magnetic transcortical stimulation (PAS) is widely used to induce plastic changes in the human motor cortex noninvasively. Based on the contrast between PAS-induced increase of corticospinal excitability and absence of PAS-induced increase of the spinal F wave size, it has been generally accepted that PAS-induced plasticity is cortical in origin. Here, instead of F waves, we used H reflex recruitment curves to assess spinal excitability, and we demonstrate that PAS induces parallel changes in cortical and spinal excitability.
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Affiliation(s)
- Sabine Meunier
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
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Abstract
This review provides a comprehensive overview of the clinical uses of neuromuscular electrical stimulation (NMES) for functional and therapeutic applications in subjects with spinal cord injury or stroke. Functional applications refer to the use of NMES to activate paralyzed muscles in precise sequence and magnitude to directly accomplish functional tasks. In therapeutic applications, NMES may lead to a specific effect that enhances function, but does not directly provide function. The specific neuroprosthetic or "functional" applications reviewed in this article include upper- and lower-limb motor movement for self-care tasks and mobility, respectively, bladder function, and respiratory control. Specific therapeutic applications include motor relearning, reduction of hemiplegic shoulder pain, muscle strengthening, prevention of muscle atrophy, prophylaxis of deep venous thrombosis, improvement of tissue oxygenation and peripheral hemodynamic functioning, and cardiopulmonary conditioning. Perspectives on future developments and clinical applications of NMES are presented.
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Affiliation(s)
- Lynne R Sheffler
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
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Quartarone A, Rizzo V, Bagnato S, Morgante F, Sant'Angelo A, Girlanda P, Siebner HR. Rapid-rate paired associative stimulation of the median nerve and motor cortex can produce long-lasting changes in motor cortical excitability in humans. J Physiol 2006; 575:657-70. [PMID: 16825301 PMCID: PMC1819453 DOI: 10.1113/jphysiol.2006.114025] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) or repetitive electrical peripheral nerve stimulation (rENS) can induce changes in the excitability of the human motor cortex (M1) that is often short-lasting and variable, and occurs only after prolonged periods of stimulation. In 10 healthy volunteers, we used a new repetitive paired associative stimulation (rPAS) protocol to facilitate and prolong the effects of rENS and rTMS on cortical excitability. Sub-motor threshold 5 Hz rENS of the right median nerve was synchronized with submotor threshold 5 Hz rTMS of the left M1 at a constant interval for 2 min. The interstimulus interval (ISI) between the peripheral stimulus and the transcranial stimulation was set at 10 ms (5 Hz rPAS10ms) or 25 ms (5 Hz rPAS25ms). TMS was given over the hot spot of the right abductor pollicis brevis (APB) muscle. Before and after rPAS, we measured the amplitude of the unconditioned motor evoked potential (MEP), intracortical inhibition (ICI) and facilitation (ICF), short- and long-latency afferent inhibition (SAI and LAI) in the conditioned M1. The 5 Hz rPAS25ms protocol but not the 5 Hz rPAS10ms protocol caused a somatotopically specific increase in mean MEP amplitudes in the relaxed APB muscle. The 5 Hz rPAS25ms protocol also led to a loss of SAI, but there was no correlation between individual changes in SAI and corticospinal excitability. These after-effects were still present 6 h after 5 Hz rPAS25ms. There was no consistent effect on ICI, ICF and LAI. The 5 Hz rENS and 5 Hz rTMS protocols failed to induce any change in corticospinal excitability when given alone. These findings show that 2 min of 5 Hz rPAS25ms produce a long-lasting and somatotopically specific increase in corticospinal excitability, presumably by sensorimotor disinhibition.
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Affiliation(s)
- Angelo Quartarone
- Clinica Neurologica 2, Policlinico Universitario, 98125 Messina, Italy.
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Abstract
1. The normal human motor cortex can be made to reorganize by repeated stimulation of proprioceptive inputs, with or without concurrent stimulation of the motor cortex by transcranial magnetic nerve stimulation. Appropriate stimulation induces a focal increase in the excitability of corticospinal projections to specific muscles and, possibly, an increase in the area of the cortex projecting to those muscles. 2. We have shown that repeated stimulation on several successive days causes this 'plastic' reorganization to persist for at least several days. We have also used this approach to determine whether increases in the excitability of the motor cortex can be induced in stroke patients (in whom cortical excitability is usually depressed) and whether this is accompanied by functional changes. 3. The results of these studies were mixed but, in patients in whom plastic changes were induced, there were improvements and sometimes marked improvements in both motor function and some electrophysiological parameters. The reasons for the inconsistent results are not clear, but do not appear to relate to the site, size or nature of the lesion.
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Affiliation(s)
- Timothy S Miles
- Research Centre For Human Movement Control, The University of Adelaide, Adelaide, South Australia, Australia.
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Do electrically stimulated sensory inputs and movements lead to long-term plasticity and rehabilitation gains? Curr Opin Neurol 2003. [DOI: 10.1097/00019052-200312000-00007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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