The human hand motor area is transiently suppressed by an unexpected auditory stimulus

Auditory confounds can drive online effects of transcranial ultrasonic stimulation in humans

Transcranial ultrasonic stimulation (TUS) is rapidly emerging as a promising non-invasive neuromodulation technique. TUS is already well-established in animal models, providing foundations to now optimize neuromodulatory efficacy for human applications. Across multiple studies, one promising protocol, pulsed at 1000 Hz, has consistently resulted in motor cortical inhibition in humans (Fomenko et al., 2020). At the same time, a parallel research line has highlighted the potentially confounding influence of peripheral auditory stimulation arising from TUS pulsing at audible frequencies. In this study, we disentangle direct neuromodulatory and indirect auditory contributions to motor inhibitory effects of TUS. To this end, we include tightly matched control conditions across four experiments, one preregistered, conducted independently at three institutions. We employed a combined transcranial ultrasonic and magnetic stimulation paradigm, where TMS-elicited motor-evoked potentials (MEPs) served as an index of corticospinal excitability. First, we replicated motor inhibitory effects of TUS but showed through both tight controls and manipulation of stimulation intensity, duration, and auditory masking conditions that this inhibition was driven by peripheral auditory stimulation, not direct neuromodulation. Furthermore, we consider neuromodulation beyond driving overall excitation/inhibition and show preliminary evidence of how TUS might interact with ongoing neural dynamics instead. Primarily, this study highlights the substantial shortcomings in accounting for the auditory confound in prior TUS-TMS work where only a flip-over sham and no active control was used. The field must critically reevaluate previous findings given the demonstrated impact of peripheral confounds. Furthermore, rigorous experimental design via (in)active control conditions is required to make substantiated claims in future TUS studies. Only when direct effects are disentangled from those driven by peripheral confounds can TUS fully realize its potential for research and clinical applications.

Modulation of Corticospinal Excitability during Action Observation in Patients with Disorders of Consciousness

Brain imaging studies have recently provided some evidence in favor of covert cognitive processes that are ongoing in patients with disorders of consciousness (DoC) (e.g., a minimally conscious state and vegetative state/unresponsive wakefulness syndrome) when engaged in passive sensory stimulation or active tasks such as motor imagery. In this exploratory study, we used transcranial magnetic stimulation (TMS) of the motor cortex to assess modulations of corticospinal excitability induced by action observation in eleven patients with DoC. Action observation is known to facilitate corticospinal excitability in healthy subjects, unveiling how the observer's motor system maps others' actions onto her/his motor repertoire. Additional stimuli were non-biological motion and acoustic startle stimuli, considering that sudden and loud acoustic stimulation is known to lower corticospinal excitability in healthy subjects. The results indicate that some form of motor resonance is spared in a subset of patients with DoC, with some significant difference between biological and non-biological motion stimuli. However, there was no covariation between corticospinal excitability and the type of DoC diagnosis (i.e., whether diagnosed with VS/UWS or MCS). Similarly, no covariation was detected with clinical changes between admission and discharge in clinical outcome measures. Both motor resonance and the difference between the resonance with biological/non-biological motion discrimination correlated with the amplitude of the N20 somatosensory evoked potentials, following the stimulation of the median nerve at the wrist (i.e., the temporal marker signaling the activation of the contralateral primary somatosensory cortex). Moreover, the startle-evoking stimulus produced an anomalous increase in corticospinal excitability, suggesting a functional dissociation between cortical and subcortical circuits in patients with DoC. Further work is needed to better comprehend the conditions in which corticospinal facilitation occurs and whether and how they may relate to individual clinical parameters.

Scale-invariant changes in corticospinal excitability reflect multiplexed oscillations in the motor output

In the absence of disease, humans produce smooth and accurate movement trajectories. Despite such 'macroscopic' aspect, the 'microscopic' structure of movements reveals recurrent (quasi-rhythmic) discontinuities. To date, it is unclear how the sensorimotor system contributes to the macroscopic and microscopic architecture of movement. Here, we investigated how corticospinal excitability changes in relation to microscopic fluctuations that are naturally embedded within larger macroscopic variations in motor output. Participants performed a visuomotor tracking task. In addition to the 0.25 Hz modulation that is required for task fulfilment (macroscopic scale), the motor output shows tiny but systematic fluctuations at ∼2 and 8 Hz (microscopic scales). We show that motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) during task performance are consistently modulated at all (time) scales. Surprisingly, MEP modulation covers a similar range at both micro- and macroscopic scales, even though the motor output differs by several orders of magnitude. Thus, corticospinal excitability finely maps the multiscale temporal patterning of the motor output, but it does so according to a principle of scale invariance. These results suggest that corticospinal excitability indexes a relatively abstract level of movement encoding that may reflect the hierarchical organisation of sensorimotor processes. KEY POINTS: Motor behaviour is organised on multiple (time)scales. Small but systematic ('microscopic') fluctuations are engrained in larger and slower ('macroscopic') variations in motor output, which are instrumental in deploying the desired motor plan. Corticospinal excitability is modulated in relation to motor fluctuations on both macroscopic and microscopic (time)scales. Corticospinal excitability obeys a principle of scale invariance, that is, it is modulated similarly at all (time)scales, possibly reflecting hierarchical mechanisms that optimise motor encoding.

Neural coordination of bilateral hand movements: evidence for an involvement of brainstem motor centres

Bilateral hand movements are assumed to be coordinated by a neural coupling mechanism. Neural coupling is experimentally reflected in complex electromyographic (EMG) responses in the forearm muscles of both sides to unilateral electrical arm nerve stimulation (ES). The aim of this study was to examine a potential involvement of the reticulospinal system in neural coupling by the application of loud acoustic stimuli (LAS) known to activate neurons of this system. LAS, ES and combined LAS/ES were applied to healthy subjects during visually guided bilateral hand flexion-extension movements. Muscle responses to the different stimuli were evaluated by electrophysiological recordings. Unilateral electrical ulnar nerve stimulation resulted in neural coupling responses in the forearm extensors (FE) of both sides. Interestingly, LAS evoked bilateral EMG responses that were similar in their configuration to those induced by ES. The presence of startles was associated with a shift of the onset and enhanced amplitude of LAS-induced coupling-like responses. Upon combined LAS/ES application, ES facilitated ipsilateral startles and coupling-like responses. Modulation of coupling-like responses by startles, the similarity of the responses to ES and LAS, and their interaction following combined stimulation suggests that both responses are mediated by the reticulospinal system. Our findings provide novel indirect evidence that the reticulospinal system is involved in the neural coupling of hand movements. This becomes clinically relevant in subjects with a damaged corticospinal system where a dominant reticulospinal system leads to involuntary limb coupling, referred to as associated movements. KEY POINTS: Automatic coordination of hand movements is assumed to be mediated by a neural coupling mechanism reflected by bilateral reflex responses in forearm muscles to unilateral electrical arm nerve stimulation (ES). Loud acoustic stimuli (LAS) were applied to assess a potential involvement of the reticulospinal system in the neural coupling mechanism. LAS evoked a bilateral reflex response in the forearm extensors that was similar to the neural coupling response to ES, and which could be separated from the acoustic startle response. Combined application of LAS and ES resulted in a facilitation of startle and coupling-like responses ipsilateral to ES, thus indicating an interaction of afferences from both stimuli. These novel findings provide indirect evidence that the reticulospinal system is a key motor structure for the coupling of bilateral hand movements.

Functional ultrasound reveals effects of MRI acoustic noise on brain function

Loud acoustic noise from the scanner during functional magnetic resonance imaging (fMRI) can affect functional connectivity (FC) observed in the resting state, but the exact effect of the MRI acoustic noise on resting state FC is not well understood. Functional ultrasound (fUS) is a neuroimaging method that visualizes brain activity based on relative cerebral blood volume (rCBV), a similar neurovascular coupling response to that measured by fMRI, but without the audible acoustic noise. In this study, we investigated the effects of different acoustic noise levels (silent, 80 dB, and 110 dB) on FC by measuring resting state fUS (rsfUS) in awake mice in an environment similar to fMRI measurement. Then, we compared the results to those of resting state fMRI (rsfMRI) conducted using an 11.7 Tesla scanner. RsfUS experiments revealed a significant reduction in FC between the retrosplenial dysgranular and auditory cortexes (0.56 ± 0.07 at silence vs 0.05 ± 0.05 at 110 dB, p=.01) and a significant increase in FC anticorrelation between the infralimbic and motor cortexes (-0.21 ± 0.08 at silence vs -0.47 ± 0.04 at 110 dB, p=.017) as acoustic noise increased from silence to 80 dB and 110 dB, with increased consistency of FC patterns between rsfUS and rsfMRI being found with the louder noise conditions. Event-related auditory stimulation experiments using fUS showed strong positive rCBV changes (16.5% ± 2.9% at 110 dB) in the auditory cortex, and negative rCBV changes (-6.7% ± 0.8% at 110 dB) in the motor cortex, both being constituents of the brain network that was altered by the presence of acoustic noise in the resting state experiments. Anticorrelation between constituent brain regions of the default mode network (such as the infralimbic cortex) and those of task-positive sensorimotor networks (such as the motor cortex) is known to be an important feature of brain network antagonism, and has been studied as a biological marker of brain disfunction and disease. This study suggests that attention should be paid to the acoustic noise level when using rsfMRI to evaluate the anticorrelation between the default mode network and task-positive sensorimotor network.

Mapping subcortical motor pathways in humans with startle-conditioned TMS

Subcortical motor pathways, such as the reticulospinal tract, are critical for producing and modulating voluntary movements and have been implicated in neurological conditions. Previous research has described the presence of ipsilateral motor evoked potentials (iMEPs) in the arm to transcranial magentic stimulation (TMS), and suggested they could be mediated by the uncrossed corticospinal tract or by ipsilateral cortico-reticulospinal connections. Here, we sought to elucidate the role of the reticulospinal tract in mediating iMEPs by assessing their modulation by a startling acoustic stimulus and mapping these responses across multiple upper limb effectors. In a first experiment, we delivered TMS at various intervals (1, 5, 10 and 15 ms) after a startling acoustic stimulus, known to excite the reticular formation, to elicit iMEPs in the arm. We observed robust facilitation of iMEP area when startle conditioning preceded TMS at the 10 ms interval. In a second experiment, we replicated our findings showing that both the area and number of iMEPs in the arm increases with startle conditioning. Using this technique, we observed that iMEPs are more prominent in the arm compared with the hand. In a third experiment, we also observed greater presence of iMEPs in flexor compared with extensor muscles. Together, these findings are consistent with properties of the reticulospinal tract observed in animals, suggesting that iMEPs primarily reflect reticulospinal activity. Our findings imply that we can use this approach to track modulation of cortico-reticulospinal excitability following interventions or neurological conditions where the reticulospinal tract may be involved in motor recovery.

Testing a Novel Wearable Device for Motor Recovery of the Elbow Extensor Triceps Brachii in Chronic Spinal Cord Injury

After corticospinal tract damage, reticulospinal connections to motoneurons strengthen preferentially to flexor muscles. This could contribute to the disproportionately poor recovery of extensors often seen after spinal cord injury (SCI) and stroke. In this study, we paired electrical stimulation over the triceps muscle with auditory clicks, using a wearable device to deliver stimuli over a prolonged period of time. Healthy human volunteers wore the stimulation device for ∼6 h and a variety of electrophysiological assessments were used to measure changes in triceps motor output. In contrast to previous results in the biceps muscle, paired stimulation: (1) did not increase the StartReact effect; (2) did not decrease the suppression of responses to transcranial magnetic brain stimulation (TMS) following a loud sound; (3) did not enhance muscle responses elicited by a TMS coil oriented to induce anterior-posterior current. In a second study, chronic cervical SCI survivors wore the stimulation device for ∼4 h every day for four weeks; this was compared with a four-week period without wearing the device. Functional and electrophysiological assessments were repeated at week 0, week 4, and week 8. No significant changes were observed in electrophysiological assessments after paired stimulation. Functional measurements such as maximal force and variability and speed of trajectories made during a planar reaching task also remained unchanged. Our results suggest that the triceps muscle shows less potential for plasticity than biceps; pairing clicks with muscle stimulation does not seem beneficial in enhancing triceps recovery after SCI.

Multimodal integration and modulation of visual and somatosensory inputs on the corticospinal excitability

OBJECTIVE

Corticospinal excitability may be affected by various sensory inputs under physiological conditions. In this study, we aimed to investigate the corticospinal excitability by using multimodal conditioning paradigms of combined somatosensory electrical and visual stimulation to understand the sensory-motor integration.

METHODS

We examined motor evoked potentials (MEP) obtained by using transcranial magnetic stimulation (TMS) that were conditioned by using a single goggle-light-emitting diode (LED) stimulation, peripheral nerve electrical stimulation (short latency afferent inhibition protocol), or a combination of both (goggle-LED+electrical stimulation) at different interstimulus intervals (ISIs) in 14 healthy volunteers.

RESULTS

We found MEP inhibition at ISIs of 50-60 ms using the conditioned goggle-LED stimulation. The combined goggle-LED stimulation at a 60 ms ISI resulted in an additional inhibition to the electrical stimulation.

CONCLUSIONS

Visual inputs cause significant modulatory effects on the corticospinal excitability. Combined visual and somatosensory stimuli integrate probably via different neural circuits and/or interneuron populations. To our knowledge, multimodal integration of visual and somatosensory inputs by using TMS-short latency inhibition protocol have been evaluated via electrophysiological methods for the first time in this study.

Classical conditioning of faciliatory paired-pulse TMS

In this proof-of-concept study, we questioned whether the influence of TMS on cortical excitability can be applied to classical conditioning. More specifically, we investigated whether the faciliatory influence of paired-pulse TMS on the excitability of the human motor cortex can be transferred to a simultaneously presented auditory stimulus through conditioning. During the conditioning phase, 75 healthy young participants received 170 faciliatory paired TMS pulses (1st pulse at 95% resting motor threshold, 2nd at 130%, interstimulus interval 12 ms), always presented simultaneously with one out of two acoustic stimuli. In the test phase, 20 min later, we pseudorandomly applied 100 single TMS pulses (at 130% MT), 50 paired with the conditioned tone-50 paired with a control tone. Using the Wilcoxon-Signed Rank test, we found significantly enhanced median amplitudes of motor evoked potentials (MEPs) paired with the conditioned tone as compared to the control tone, suggesting successful conditioning (p = 0.031, responder rate 55%, small effect size of r = - 0.248). The same comparison in only those participants with a paired-pulse amplitude < 2 mV in the conditioning phase, increased the responder rate to 61% (n = 38) and effect size to moderate (r = - 0.389). If we considered only those participants with a median paired-pulse amplitude < 1 mV, responder rate increased further to 79% (n = 14) and effect size to r = - 0.727 (i.e., large effect). These findings suggest increasingly stronger conditioning effects for smaller MEP amplitudes during paired-pulse TMS conditioning. These proof-of-concept findings extend the scope of classical conditioning to faciliatory paired-pulse TMS.

Pairing Transcranial Magnetic Stimulation and Loud Sounds Produces Plastic Changes in Motor Output

Most current methods for neuromodulation target the cortex. Approaches for inducing plasticity in subcortical motor pathways, such as the reticulospinal tract, could help to boost recovery after damage (e.g., stroke). In this study, we paired loud acoustic stimulation (LAS) with transcranial magnetic stimulation (TMS) over the motor cortex in male and female healthy humans. LAS activates the reticular formation; TMS activates descending systems, including corticoreticular fibers. Two hundred paired stimuli were used, with 50 ms interstimulus interval at which LAS suppresses TMS responses. Before and after stimulus pairing, responses in the contralateral biceps muscle to TMS alone were measured. Ten, 20, and 30 min after stimulus pairing ended, TMS responses were enhanced, indicating the induction of LTP. No long-term changes were seen in control experiments which used 200 unpaired TMS or LAS, indicating the importance of associative stimulation. Following paired stimulation, no changes were seen in responses to direct corticospinal stimulation at the level of the medulla, or in the extent of reaction time shortening by a loud sound (StartReact effect), suggesting that plasticity did not occur in corticospinal or reticulospinal synapses. Direct measurements in female monkeys undergoing a similar paired protocol revealed no enhancement of corticospinal volleys after paired stimulation, suggesting no changes occurred in intracortical connections. The most likely substrate for the plastic changes, consistent with all our measurements, is an increase in the efficacy of corticoreticular connections. This new protocol may find utility, as it seems to target different motor circuits compared with other available paradigms.SIGNIFICANCE STATEMENT Induction of plasticity by neurostimulation protocols may be promising to enhance functional recovery after damage such as following stroke, but current protocols mainly target cortical circuits. In this study, we developed a novel paradigm which may generate long-term changes in connections between cortex and brainstem. This could provide an additional tool to modulate and improve recovery.

Evolving changes in cortical and subcortical excitability during movement preparation: A study of brain potentials and eye-blink reflexes during loud acoustic stimulation

During preparation for action, the presentation of loud acoustic stimuli (LAS) can trigger movements at very short latencies in a phenomenon called the StartReact effect. It was initially proposed that a special, separate subcortical mechanism that bypasses slower cortical areas could be involved. We sought to examine the evidence for a separate mechanism against the alternative that responses to LAS can be explained by a combination of stimulus intensity effects and preparatory states. To investigate whether cortically mediated preparatory processes are involved in mediating reactions to LAS, we used an auditory reaction task where we manipulated the preparation level within each trial by altering the conditional probability of the imperative stimulus. We contrasted responses to non-intense tones and LAS and examined whether cortical activation and subcortical excitability and motor responses were influenced by preparation levels. Increases in preparation levels were marked by gradual reductions in reaction time (RT) coupled with increases in cortical activation and subcortical excitability - at both condition and trial levels. Interestingly, changes in cortical activation influenced motor and auditory but not visual areas - highlighting the widespread yet selective nature of preparation. RTs were shorter to LAS than tones, but the overall pattern of preparation level effects was the same for both stimuli. Collectively, the results demonstrate that LAS responses are indeed shaped by cortically mediated preparatory processes. The concurrent changes observed in brain and behavior with increasing preparation reinforce the notion that preparation is marked by evolving brain states which shape the motor system for action.

Altered frontoparietal activity in acoustic startle priming tasks during reticulospinal tract facilitation: An fNIRS study

Background

Because it is one of the important pathways for promoting motor recovery after cortical injury, the function of the reticulospinal tract (RST) has received increasing attention in recent years. However, the central regulatory mechanism of RST facilitation and reduction of apparent response time is not well understood.

Objectives

To explore the potential role of RST facilitation in the acoustic startle priming (ASP) paradigm and observe the cortical changes induced by ASP reaching tasks.

Methods

Twenty healthy participants were included in this study. The reaching tasks were performed with their left and right hands. Participants were instructed to get ready after the warning cue and complete the reach as soon as they heard the Go cue. Half of the testing trials were set as control trials with an 80-dB Go cue. The other half of the trials had the Go cue replaced with 114-dB white noise to evoke the StartleReact effect, inducing reticulospinal tract facilitation. The response of the bilateral sternocleidomastoid muscle (SCM) and the anterior deltoid was recorded via surface electromyography. Startle trials were labeled as exhibiting a positive or negative StartleReact effect, according to whether the SCM was activated early (30-130 ms after the Go cue) or late, respectively. Functional near-infrared spectroscopy was used to synchronously record the oxyhemoglobin and deoxyhemoglobin fluctuations in bilateral motor-related cortical regions. The β values representing cortical responses were estimated via the statistical parametric mapping technique and included in the final analyses.

Results

Separate analyses of data from movements of the left or right side revealed significant activation of the right dorsolateral prefrontal cortex during RST facilitation. Moreover, left frontopolar cortex activation was greater in positive startle trials than in control or negative startle trials during left-side movements. Furthermore, decreased activity of the ipsilateral primary motor cortex in positive startle trials during ASP reaching tasks was observed.

Conclusion

The right dorsolateral prefrontal cortex and the frontoparietal network to which it belongs may be the regulatory center for the StartleReact effect and RST facilitation. In addition, the ascending reticular activating system may be involved. The decreased activity of the ipsilateral primary motor cortex suggests enhanced inhibition of the non-moving side during the ASP reaching task. These findings provide further insight into the SE and into RST facilitation.

Does the reticulospinal tract mediate adaptation to resistance training in humans?

Resistance training increases volitional force-producing capacity, and it is widely accepted that such an increase is partly underpinned by adaptations in the central nervous system, particularly in the early phases of training. Despite this, the neural substrate(s) responsible for mediating adaptation remains largely unknown. Most studies have focused on the corticospinal tract, the main descending pathway controlling movement in humans, with equivocal findings. It is possible that neural adaptation to resistance training is mediated by other structures; one such candidate is the reticulospinal tract. The aim of this narrative mini-review is to articulate the potential of the reticulospinal tract to underpin adaptations in muscle strength. Specifically, we 1) discuss why the structure and function of the reticulospinal tract implicate it as a potential site for adaptation; 2) review the animal and human literature that supports the idea of the reticulospinal tract as an important neural substrate underpinning adaptation to resistance training; and 3) examine the potential methodological options to assess the reticulospinal tract in humans.

Engagement of the contralateral limb can enhance the facilitation of motor output by loud acoustic stimuli

When intense sound is presented during light muscle contraction, inhibition of the corticomotoneuronal pathway is observed. During action preparation, this effect is reversed, with sound resulting in excitation of the corticomotoneuronal pathway. We investigated how combined maintenance of a muscle contraction during preparation for a ballistic action impacts the magnitude of the facilitation of motor output by a loud acoustic stimulus (LAS) - a phenomenon known as the StartReact effect. Participants executed ballistic wrist flexion movements and a LAS was presented simultaneously with the imperative signal in a subset of trials. We examined whether the force level or muscle used to maintain a contraction during preparation for the ballistic response impacted reaction time and/or the force of movements triggered by the LAS. These contractions were sustained either ipsilaterally or contralaterally to the ballistic response. The magnitude of facilitation by the LAS was greatest when low force flexion contractions were maintained in the limb contralateral to the ballistic response during preparation. There was little change in facilitation when contractions recruited the contralateral extensor muscle, or when they were sustained in the same limb that executed the ballistic response. We conclude that a larger network of neurons which may be engaged by a contralateral sustained contraction prior to initiation may be recruited by the LAS, further contributing to the motor output of the response. These findings may be particularly applicable in stroke rehabilitation where engagement of the contralesional side may increase the benefits of a LAS to the functional recovery of movement.

Startling Acoustic Stimulation Has Task-Specific Effects on Intracortical Facilitation and Inhibition at Rest and During Visually Guided Isometric Elbow Flexion in Healthy Individuals

Startling acoustic stimulation (SAS) causes a transient effect on the primary motor cortex (M1) nonreflexively. It reduces the cortical excitability at rest, but not during voluntary contraction. However, the effect of SAS on intracortical activity is not clear. The purpose of this study was to investigate the SAS effect on short-interval intracortical inhibition and intracortical facilitation using transcranial magnetic stimulation (TMS). Eleven healthy individuals performed isometric elbow flexion at 10% of maximum voluntary contraction on the dominant side with a real-time visual target (i.e., M1 preactivation) or at rest. TMS was delivered to the M1 ipsilateral to elbow flexion without or with SAS delivered 90 ms prior to TMS. There were three TMS delivery conditions: (a) single pulse, (b) short-interval intracortical inhibition, and (c) intracortical facilitation. TMS-induced motor-evoked potential (MEP) was compared between predetermined TMS and SAS conditions at rest and during ipsilateral voluntary contraction. We confirmed that SAS decreased the MEP amplitude at rest, but not during M1 preactivation. SAS caused task-specific effects on intracortical excitability. Specifically, SAS increased intracortical facilitation at rest and during voluntary contraction. However, SAS decreased short-interval intracortical inhibition only during M1 preactivation. Collectively, our results suggest that SAS transiently influences the motor cortex excitability, possibly via its activation of higher centers, to achieve a visually guided goal-directed task.

The Effect of Sound and Stimulus Expectation on Transcranial Magnetic Stimulation-Elicited Motor Evoked Potentials

The amplitude of motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) over the motor cortex is influenced by multiple factors. TMS delivery is accompanied by an abrupt clicking noise which can induce a startle response. This study investigated how masking/attenuating the sound produced by the TMS system discharging influences MEP amplitudes. In addition, the effects of increasing the time between consecutive stimuli and of making participants aware of the time at which they would be stimulated were studied. MEPs were recorded from the Flexor Carpi Radialis (FCR) muscle at rest by stimulation at motor threshold (MT), 120% MT and 140% MT intensity. Participants (N = 23) received stimulation under normal (NORMAL) conditions and while: wearing sound-attenuating earmuffs (EAR); listening to white noise (NOISE); the interval between stimuli were prolonged (LONG); stimulation timing was presented on a screen (READY). The results showed that masking (p = 0.020) and attenuating (p = 0.004) the incoming sound significantly reduced the amplitude of MEPs recorded across the intensities of stimulation. Increasing the interval between pulses had no effect on the recorded traces if a jitter was introduced (p = 1), but making participants aware of stimulation timing decreased MEP amplitudes (p = 0.049). These findings suggest that the sound produced by TMS at discharging increases MEP amplitudes and that MEP amplitudes are influenced by stimulus expectation. These confounding factors need to be considered when using TMS to assess corticospinal excitability.

Acoustic stimulation increases implicit adaptation in sensorimotor adaptation

Sensorimotor adaptation is an important part of our ability to perform novel motor tasks (i.e., learning of motor skills). Efforts to improve adaptation in healthy and clinical patients using non-invasive brain stimulation methods have been hindered by inter-individual and intra-individual variability in brain susceptibility to stimulation. Here, we explore unpredictable loud acoustic stimulation as an alternative method of modulating brain excitability to improve sensorimotor adaptation. In two experiments, participants moved a cursor towards targets, and adapted to a 30º rotation of cursor feedback, either with or without unpredictable acoustic stimulation. Acoustic stimulation improved initial adaptation to sensory prediction errors in Study 1, and improved overnight retention of adaptation in Study 2. Unpredictable loud acoustic stimulation might thus be a potent method of modulating sensorimotor adaptation in healthy adults.

Evidence for Subcortical Plasticity after Paired Stimulation from a Wearable Device

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.

The knowns and unknowns of neural adaptations to resistance training

The initial increases in force production with resistance training are thought to be primarily underpinned by neural adaptations. This notion is firmly supported by evidence displaying motor unit adaptations following resistance training; however, the precise locus of neural adaptation remains elusive. The purpose of this review is to clarify and critically discuss the literature concerning the site(s) of putative neural adaptations to short-term resistance training. The proliferation of studies employing non-invasive stimulation techniques to investigate evoked responses have yielded variable results, but generally support the notion that resistance training alters intracortical inhibition. Nevertheless, methodological inconsistencies and the limitations of techniques, e.g. limited relation to behavioural outcomes and the inability to measure volitional muscle activity, preclude firm conclusions. Much of the literature has focused on the corticospinal tract; however, preliminary research in non-human primates suggests reticulospinal tract is a potential substrate for neural adaptations to resistance training, though human data is lacking due to methodological constraints. Recent advances in technology have provided substantial evidence of adaptations within a large motor unit population following resistance training. However, their activity represents the transformation of afferent and efferent inputs, making it challenging to establish the source of adaptation. Whilst much has been learned about the nature of neural adaptations to resistance training, the puzzle remains to be solved. Additional analyses of motoneuron firing during different training regimes or coupling with other methodologies (e.g., electroencephalography) may facilitate the estimation of the site(s) of neural adaptations to resistance training in the future.

Distinct Corticospinal and Reticulospinal Contributions to Voluntary Control of Elbow Flexor and Extensor Muscles in Humans with Tetraplegia

Humans with cervical spinal cord injury (SCI) often recover voluntary control of elbow flexors and, to a much lesser extent, elbow extensor muscles. The neural mechanisms underlying this asymmetrical recovery remain unknown. Anatomical and physiological evidence in animals and humans indicates that corticospinal and reticulospinal pathways differentially control elbow flexor and extensor motoneurons; therefore, it is possible that reorganization in these pathways contributes to the asymmetrical recovery of elbow muscles after SCI. To test this hypothesis, we examined motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation over the arm representation of the primary motor cortex, maximal voluntary contractions, the StartReact response (a shortening in reaction time evoked by a startling stimulus), and the effect of an acoustic startle cue on MEPs elicited by cervicomedullary stimulation (CMEPs) on biceps and triceps brachii in males and females with and without chronic cervical incomplete SCI. We found that SCI participants showed similar MEPs and maximal voluntary contractions in biceps but smaller responses in triceps compared with controls, suggesting reduced corticospinal inputs to elbow extensors. The StartReact and CMEP facilitation was larger in biceps but similar to controls in triceps, suggesting enhanced reticulospinal inputs to elbow flexors. These findings support the hypothesis that the recovery of biceps after cervical SCI results, at least in part, from increased reticulospinal inputs and that the lack of these extra inputs combined with the loss of corticospinal drive contribute to the pronounced weakness found in triceps.SIGNIFICANCE STATEMENT Although a number of individuals with cervical incomplete spinal cord injury show limited functional recovery of elbow extensors compared with elbow flexor muscles, to date, the neural mechanisms underlying this asymmetrical recovery remain unknown. Here, we provide for the first time evidence for increased reticulospinal inputs to biceps but not triceps brachii and loss of corticospinal drive to triceps brachii in humans with tetraplegia. We propose that this reorganization in descending control contributes to the asymmetrical recovery between elbow flexor and extensor muscles after cervical spinal cord injury.

Cerebral hemodynamics predicts the cortical area and coding scheme in the human brain for force generation by wrist muscles

The goal of this study is to identify the cortical area maximally active over the primary sensorimotor cortex (SM1) and characterize the cortical encoding for force production by wrist muscles in the human brain. The technique of functional near-infrared spectroscopy (fNIRS) was used to continuously monitor the changes in hemoglobin concentrations from the left hemisphere during isometric contractions of wrist flexion muscles over a broad range of load forces (0 ∼ 8 kgf) on the right hand. As previously shown in primate studies, this action produced hemodynamic activity predominantly in the wrist area localized dorsally to the finger region over SM1 and the hemodynamic response was systematically related to the level of load intensity. The coding scheme for force production in terms of hemodynamic signals was characterized defining eight trajectory parameters (four for amplitude coding and four for temporal coding) and analyzed for the area maximally activated over SM1. The trajectory parameter representing the oxygenated hemoglobin concentration change at the end of motor task (amplitude coding) and the timing of maximum change in oxygenated hemoglobin concentration (temporal coding) was most strongly correlated with the load variation in a superliner manner. All these results indicate the applicability of fNIRS to monitor and decode cortical activity that is correlated with low-level motor control such as isometric muscle contractions. This study may provide not only insights into cortical neural control of muscle force but also predictors of muscle force in clinical diagnostics and neural interfaces for the human brain.

Music Form but Not Music Experience Modulates Motor Cortical Activity in Response to Novel Music

External cues, such as music, improve movement performance in persons with Parkinson’s disease. However, research examining the motor cortical mechanisms by which this occurs is lacking. Research using electroencephalography in healthy young adults has revealed that moving to music can modulate motor cortical activity. Moreover, motor cortical activity is further influenced by music experience. It remains unknown whether these effects extend to corticomotor excitability. Therefore, the primary aim of this study was to determine the effects of novel music on corticomotor excitability using transcranial magnetic stimulation (TMS) in a pilot study of healthy young adults. A secondary aim of this study was to determine the influence of music experience on corticomotor excitability. We hypothesized that corticomotor excitability will change during music conditions, and that it will differ in those with formal music training. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseous using single-pulse TMS in three conditions: (1) No Music, (2) Music Condition I, and (3) Music Condition II. Both pieces were set to novel MIDI piano instrumentation and part-writing conventions typical of early nineteenth-century Western classical practices. Results revealed Music Condition II (i.e., more relaxing music) compared to rest increased MEP amplitude (i.e., corticomotor excitability). Music Condition II as compared to Music Condition I (i.e., more activating music) reduced MEP variability (i.e., corticomotor variability). Finally, years of formal music training did not significantly influence corticomotor excitability while listening to music. Overall, results revealed that unfamiliar music modulates motor cortical excitability but is dependent upon the form of music and possibly music preference. These results will be used to inform planned studies in healthy older adults and people with Parkinson’s disease.

Multimodal stimuli modulate rapid visual responses during reaching

The reticulospinal tract plays an important role in primate upper limb function, but methods for assessing its activity are limited. One promising approach is to measure rapid visual responses (RVRs) in arm muscle activity during a visually cued reaching task; these may arise from a tecto-reticulospinal pathway. We investigated whether changes in reticulospinal excitability can be assessed noninvasively using RVRs, by pairing the visual stimuli of the reaching task with electrical stimulation of the median nerve, galvanic vestibular stimulation, or loud sounds, all of which are known to activate the reticular formation. Surface electromyogram (EMG) recordings were made from the right deltoid of healthy human subjects as they performed fast reaching movements toward visual targets. Stimuli were delivered up to 200 ms before target appearance, and RVR was quantified as the EMG amplitude in a window 75–125 ms after visual target onset. Median nerve, vestibular, and auditory stimuli all consistently facilitated the RVRs, as well as reducing the latency of responses. We propose that this facilitation reflects modulation of tecto-reticulospinal excitability, which is consistent with the idea that the amplitude of RVRs can be used to assess changes in brain stem excitability noninvasively in humans.

NEW & NOTEWORTHY Short-latency responses in arm muscles evoked during a visually driven reaching task have previously been proposed to be tecto-reticulospinal in origin. We demonstrate that these responses can be facilitated by pairing the appearance of a visual target with stimuli that activate the reticular formation: median nerve, vestibular, and auditory stimuli. We propose that this reflects noninvasive measurement and modulation of reticulospinal excitability.

Positive self-perception and corticospinal excitability: Recalling positive behavior expands peripersonal space boundaries

Converging evidence suggests that peripersonal space has dynamic properties, that can be influenced by motor and cognitive factors. Here, we investigated whether changes in self-perception may impact upon peripersonal representation. Specifically, employing non-invasive brain stimulation, we tested whether corticospinal excitability elicited by objects placed in the vertical peripersonal vs extrapersonal space can be influenced by changes in self-perception after recalling a personal experience inducing the feeling of high power (vs. positivity vs. low power). In a preliminary study (Study 1, N = 39) participants were presented with an object, whose position was manipulated in the horizontal vs vertical space. We assessed corticospinal excitability by measuring Motor Evoked Potentials (MEPs) using Transcranial Magnetic Stimulation with Electromyography co-registration (TMS-EMG). In the horizontal condition, we replicated the well-known motor facilitation induced by objects falling in the peri vs extrapersonal space, while in the vertical dimension MEPs were higher in the extrapersonal space. In the main experiment (Study 2), participants (N = 55) were randomly assigned to feel high power, low power, or a general positive emotion and were asked to observe the same object positioned either in the peripersonal or in the extrapersonal vertical space. Results showed that in the low power condition MEPs were higher in the extrapersonal vs peripersonal, as in Study 1, while in high power and positive conditions MEPs were not influenced by distance. Taken together, our findings suggest a dissociable pattern of motor facilitation underlying vertical vs horizontal space perception and, crucially, that changes in self-perception can influence such a representation.

The effects of conditioning startling acoustic stimulation (SAS) on the corticospinal motor system: a SAS-TMS study

A startling acoustic stimulus (SAS) could cause transient effects on the primary motor cortex and its descending tracts after habituation of reflex responses. In the literature, there is evidence that the effects of SAS depend on the status of M1 excitability and delivery time of SAS. In this study, we aimed to comprehensively investigate the effects of SAS on the excitability of primary motor cortex. Eleven healthy subjects participated in this study. Transcranial magnetic stimulation (TMS) was delivered to the hot spot for left biceps at rest and during isometric right elbow flexion (10, 30, and 60% of their maximum voluntary contraction, MVC). There were three SAS conditions: (1) No SAS; (2) SAS was delivered 50 ms prior to TMS (SAS50); (3) SAS 90 ms prior to TMS (SAS90). For each subject, the induced MEP amplitude was normalized to the largest response at rest with No SAS. Two-way ANOVAs (4 force levels × 3 SAS conditions) with repeated measures were used to determine the differences under different conditions. For the MEP amplitude, there were significant force level effect and FORCE LEVEL × SAS interactions. Specifically, the MEP amplitude increased with force level. Furthermore, post hoc analysis showed that the MEP amplitude reduced during SAS50 and SAS90 compared to No SAS only at rest. Our results provide evidence that a conditioning SAS causes a transient suppression of the corticospinal excitability at rest when it is delivered 50 ms and 90 ms prior to TMS. However, a conditioning SAS has no effect when the corticospinal excitability is already elevated with an external visual target.

A startling acoustic stimulation (SAS)-TMS approach to assess the reticulospinal system in healthy and stroke subjects

Reticulospinal (RS) hyperexcitability is observed in stroke survivors with spastic hemiparesis. Habituated startle acoustic stimuli (SAS) can be used to stimulate the RS pathways non-reflexively. However, the role of RS pathways in motor function and its interactions with the corticospinal system after stroke still remain unclear. Therefore, the purpose of this study was to investigate the effects of conditioning SAS on the corticospinal system in healthy subjects and in stroke subjects with spastic hemiparesis. An established conditioning SAS- transcranial magnetic stimulation (TMS) paradigm was used to test the interactions between the RS pathways and the corticospinal system. TMS was delivered to the right hemisphere of eleven healthy subjects and the contralesional hemisphere of eleven stroke subjects during isometric elbow flexor contraction on the non-impaired (or left) side. Conditioning SAS had similar effects on the corticospinal motor system in both healthy and stroke subjects, including similar SAS-induced motor evoked potential (MEP) reduction at rest, but not during voluntary contraction tasks; similar magnitudes of TMS-induced MEP and force increment and shortening of the silent period during voluntary elbow flexor contraction. This study provides evidence that RS excitability on the contralesional side in stroke subjects with spastic hemiparesis is not abnormal, and suggests that RS projections are likely to be primarily unilateral in humans.

Modulation of motor cortical excitability with auditory stimulation

Loud sounds have been demonstrated to increase motor cortex excitability when transcranial magnetic stimulation (TMS) is synchronized with auditory evoked N100 potential measured from electroencephalography (EEG). The N100 potential is generated by an afferent response to sound onset and feature analysis, and upon novel sound it is also related to the arousal reaction. The arousal reaction is known to originate from the ascending reticular activating system of the brain stem and to modulate neuronal activity throughout the central nervous system. In this study we investigated the difference in motor evoked potentials (MEPs) when deviant and novelty stimuli were randomly interspersed in a train of standard tones. Twelve healthy subjects participated in this study. Three types of sound stimuli were used: 1) standard stimuli (800 Hz), 2) deviant stimuli (560 Hz), and 3) novelty stimuli (12 different sounds). In each stimulus sequence 600 stimuli were given. Of these, 90 were deviant stimuli randomly placed between the standard stimuli. Each of 12 novel sounds was presented once in pseudorandomized order. TMS was randomly mixed with the sound stimuli so that it was either synchronized with the individual N100 or trailed the sound onset by 200 ms. All sounds elicited an increase in motor cortex excitability. The type of sound had no significant effect. We also demonstrated that TMS timed at 200-ms intervals caused a significant increment of MEPs. This contradicted our hypothesis that MEP amplitudes to TMS synchronized with N100 would be greater than those to TMS at 200 ms after a sound and remains unexplained. NEW & NOTEWORTHY We demonstrated modulation of motor cortical excitability with parallel auditory stimulus by combining navigated transcranial magnetic stimulation (TMS) with auditory stimuli. TMS was synchronized with auditory evoked potentials considered to be generated by the unconscious attention call process in the auditory system.

Long-latency interhemispheric interactions between motor-related areas and the primary motor cortex: a dual site TMS study

The primary motor cortex (M1) is highly influenced by premotor/motor areas both within and across hemispheres. Dual site transcranial magnetic stimulation (dsTMS) has revealed interhemispheric interactions mainly at early latencies. Here, we used dsTMS to systematically investigate long-latency causal interactions between right-hemisphere motor areas and the left M1 (lM1). We stimulated lM1 using a suprathreshold test stimulus (TS) to elicit motor-evoked potentials (MEPs) in the right hand. Either a suprathreshold or a subthreshold conditioning stimulus (CS) was applied over the right M1 (rM1), the right ventral premotor cortex (rPMv), the right dorsal premotor cortex (rPMd) or the supplementary motor area (SMA) prior to the TS at various CS-TS inter-stimulus intervals (ISIs: 40–150 ms). The CS strongly affected lM1 excitability depending on ISI, CS site and intensity. Inhibitory effects were observed independently of CS intensity when conditioning PMv, rM1 and SMA at a 40-ms ISI, with larger effects after PMv conditioning. Inhibition was observed with suprathreshold PMv and rM1 conditioning at a 150-ms ISI, while site-specific, intensity-dependent facilitation was detected at an 80-ms ISI. Thus, long-latency interhemispheric interactions, likely reflecting indirect cortico-cortical/cortico-subcortical pathways, cannot be reduced to nonspecific activation across motor structures. Instead, they reflect intensity-dependent, connection- and time-specific mechanisms.

Cortical and reticular contributions to human precision and power grip

KEY POINTS

The corticospinal tract contributes to the control of finger muscles during precision and power grip. We explored the neural mechanisms contributing to changes in corticospinal excitability during these gripping configurations. Motor evoked potentials (MEPs) elicited by cortical, but not by subcortical, stimulation were more suppressed during power grip compared with precision grip and index finger abduction. Intracortical inhibition was more reduced during power grip compared with the other tasks. An acoustic startle cue, a stimulus that engages the reticular system, suppressed MEP size during power grip to a lesser extent than during the other tasks at a cortical level and this positively correlated with changes in intracortical inhibition. Our findings suggest that changes in corticospinal excitability during gross more than fine finger manipulations are largely cortical in origin and that the reticular system contributed, at least in part, to these effects.

ABSTRACT

It is well accepted that the corticospinal tract contributes to the control of finger muscles during precision and power grip in humans but the neural mechanisms involved remain poorly understood. Here, we examined motor evoked potentials elicited by cortical and subcortical stimulation of corticospinal axons (MEPs and CMEPs, respectively) and the activity in intracortical circuits (suppression of voluntary electromyography) and spinal motoneurons (F-waves) in an intrinsic hand muscle during index finger abduction, precision grip and power grip. We found that the size of MEPs, but not CMEPs, was more suppressed during power grip compared with precision grip and index finger abduction, suggesting a cortical origin for these effects. Notably, intracortical inhibition was more reduced during power grip compared with the other tasks. To further examine the origin of changes in intracortical inhibition we assessed the contribution of the reticular system, which projects to cortical neurons, and projects to spinal motoneurons controlling hand muscles. An acoustic startle cue, which engages the reticular system, suppressed MEP size during power grip to a lesser extent than during the other tasks and this positively correlated with changes in intracortical inhibition. A startle cue decreased intracortical inhibition, but not CMEPs, during power grip. F-waves remained unchanged across conditions. Our novel findings show that changes in corticospinal excitability present during power grip compared with fine finger manipulations are largely cortical in origin and suggest that the reticular system contributed, at least in part, to these effects.

Long-latency modulation of motor cortex excitability by ipsilateral posterior inferior frontal gyrus and pre-supplementary motor area

The primary motor cortex (M1) is strongly influenced by several frontal regions. Dual-site transcranial magnetic stimulation (dsTMS) has highlighted the timing of early (<40 ms) prefrontal/premotor influences over M1. Here we used dsTMS to investigate, for the first time, longer-latency causal interactions of the posterior inferior frontal gyrus (pIFG) and pre-supplementary motor area (pre-SMA) with M1 at rest. A suprathreshold test stimulus (TS) was applied over M1 producing a motor-evoked potential (MEP) in the relaxed hand. Either a subthreshold or a suprathreshold conditioning stimulus (CS) was administered over ipsilateral pIFG/pre-SMA sites before the TS at different CS-TS inter-stimulus intervals (ISIs: 40-150 ms). Independently of intensity, CS over pIFG and pre-SMA (but not over a control site) inhibited MEPs at an ISI of 40 ms. The CS over pIFG produced a second peak of inhibition at an ISI of 150 ms. Additionally, facilitatory modulations were found at an ISI of 60 ms, with supra- but not subthreshold CS intensities. These findings suggest differential modulatory roles of pIFG and pre-SMA in M1 excitability. In particular, the pIFG -but not the pre-SMA- exerts intensity-dependent modulatory influences over M1 within the explored time window of 40-150 ms, evidencing fine-tuned control of M1 output.

An examination of the startle response during upper limb stretch perturbations

Unexpected presentation of a startling auditory stimulus (SAS>120 decibels) in a reaction time (RT) paradigm results in the startle reflex and an early release (<100ms) of the preplanned motor response (StartReact effect). Mechanical perturbations applied to the upper limbs elicit short- (M1) and long-latency (M2) stretch reflexes and have also been shown to initiate intended motor responses early (<100ms). Ravichandran et al. (2013) recently proposed that unexpected delivery of a perturbation could also elicit a startle response and therefore the StartReact effect may be responsible for the early trigger of a preplanned response. To investigate this further, we examined startle incidence, RT, and stretch reflex modulation for both expected and unexpected perturbations. In Experiment 1, participants performed active (ACT) and passive (DNI) conditions to an expected large perturbation (similar to previous studies examining M2). The startle response was not observed; however, the perturbation still elicited the voluntary response at short latency (<100ms) and goal-dependent modulation of the M2 response was observed. In Experiment 2, participants performed ACT and DNI conditions to a weak auditory stimulus or a small wrist perturbation. On unexpected trials we probed startle circuitry with a large perturbation or SAS. The SAS consistently elicited a startle response in both ACT and DNI conditions, but startle-like activity was only observed on 17.4% of ACT perturbation probe trials. Our findings suggest that while unexpected upper limb perturbations can be startling, startle triggering of the preplanned voluntary response is not the primary mechanism responsible for goal-dependent modulation of the M2 response.

Investigation of timing preparation during response initiation and execution using a startling acoustic stimulus

The purpose of the current study was to examine the processes involved in the preparation of timing during response initiation and execution through the use of a startling acoustic stimulus (SAS). In Experiment 1, participants performed a delayed response task in which a two key-press movement was to be initiated 200 ms after an imperative signal (IS) with either a short (200 ms) or long (500 ms) interval between key-presses. On selected trials, a SAS was presented to probe the preparation processes associated with the initiation delay and execution of the inter-key interval. The SAS resulted in a significant decrease in the initiation time, which was attributed to a speeding of pacemaker pulses used to time the delay interval, caused by an increased activation due to the SAS. Conversely, the SAS delayed the short inter-key interval, which was attributed to temporary interference with cortical processing. In Experiment 2, participants performed a 500-ms delayed response task involving two key-presses 200 ms apart. In this condition, the SAS resulted in significantly decreased initiation time and a delayed inter-key interval (p = .053). Collectively, these results support a different timeline for the preparation of the delay interval, which is thought to be prepared in advance of the IS, and the inter-key interval, which is thought to be prepared following the IS. This conclusion provides novel information with regard to timing preparation that is consistent with models in which response preparation, initiation, and execution are considered separate and dissociable processes.

Different Effects of Startling Acoustic Stimuli (SAS) on TMS-Induced Responses at Rest and during Sustained Voluntary Contraction

Previous studies have shown that a habituated startling acoustic stimulus (SAS) can cause a transient suppression of motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS) during light muscle contraction. However, it is still unknown whether this phenomenon persists when at rest or during a sustained voluntary contraction task. Therefore, the purpose of this study was to determine whether a conditioning SAS has different effects. TMS was delivered to the hot spot for the left biceps on 11 subjects at rest both with and without a conditioning SAS. Of the 11subjects, 9 also had TMS delivered during isometric flexion of the left elbow, also with and without a conditioning SAS. TMS-induced MEPs, TMS-induced force, and silent periods were used to determine the effect of conditioning SAS. Consistent with previous findings, TMS-induced MEPs were smaller with a conditioning SAS (0.49 ± 0.37 mV) as compared without the SAS (0.69 ± 0.52 mV) at rest. However, a conditioning SAS during the voluntary contraction tasks resulted in a significant shortening of the MEP silent period (187.22 ± 22.99 ms with SAS vs. 200.56 ± 29.71 ms without SAS) without any changes in the amplitude of the MEP (1.37 ± 0.9 mV with SAS V.S. 1.32 ± 0.92 mV without SAS) or the TMS-induced force (3.11 ± 2.03 N-m with SAS V.S. 3.62 ± 1.33 N-m without SAS). Our results provide novel evidence that a conditioning SAS has different effects on the excitability of the motor cortex when at rest or during sustained voluntary contractions.

Triggering prepared actions by sudden sounds: reassessing the evidence for a single mechanism

Loud acoustic stimuli can unintentionally elicit volitional acts when a person is in a state of readiness to execute them (the StartReact effect). It has been assumed that the same subcortical pathways and brain regions underlie all instances of the StartReact effect. They are proposed to involve the startle reflex pathways, and the eliciting mechanism is distinct from other ways in which sound can affect the motor system. We present an integrative review which shows that there is no evidence to support these assumptions. We argue that motor command generation for learned, volitional orofacial, laryngeal and distal limb movements is cortical and the StartReact effect for such movements involves transcortical pathways. In contrast, command generation for saccades, locomotor corrections and postural adjustments is subcortical and subcortical pathways are implicated in the StartReact effect for these cases. We conclude that the StartReact effect is not a special phenomenon mediated by startle reflex pathways, but rather is a particular manifestation of the excitatory effects of intense stimulation on the central nervous system.

Two-stage muscle activity responses in decisions about leg movement adjustments during trip recovery

Studies on neural decision making mostly investigated fast corrective adjustments of arm movements. However, fast leg movement corrections deserve attention as well, since they are often required to avoid falling after balance perturbations. The present study aimed at elucidating the mechanisms behind fast corrections of tripping responses by analyzing the concomitant leg muscle activity changes. This was investigated in seven young adults who were tripped in between normal walking trials and took a recovery step by elevating the tripped leg over the obstacle. In some trials, a forbidden landing zone (FZ) was presented behind the obstacle, at the subjects' preferred foot landing position, forcing a step correction. Muscle activity of the tripped leg gastrocnemius medialis (iGM), tibialis anterior (iTA), rectus femoris (iRF), and biceps femoris (iBF) muscles was compared between normal trips presented before any FZ appearance, trips with a FZ, and normal trips presented in between trips with a FZ ("catch" trials). When faced with a real or expected (catch trials) FZ, subjects shortened their recovery steps. The underlying changes in muscle activity consisted of two stages. The first stage involved reduced iGM activity, occurring at a latency shorter than voluntary reaction, followed by reduced iTA and increased iBF and iGM activities occurring at longer latencies. The fast response was not related to step shortening, but longer latency responses clearly were functional. We suggest that the initial response possibly acts as a "pause," allowing the nervous system to integrate the necessary information and prepare the subsequent, functional movement adjustment.

A Hardwired Circuit Supplemented with Endocannabinoids Encodes Behavioral Choice in Zebrafish

Animals constantly make behavioral choices to facilitate moving efficiently through their environment. When faced with a threat, animals make decisions in the midst of other ongoing behaviors through a context-dependent integration of sensory stimuli. In vertebrates, the mechanisms underlying behavioral selection are poorly understood. Here, we show that ongoing swimming in zebrafish is suppressed by escape. The selection of escape over swimming is mediated by switching between two distinct motoneuron pools. A hardwired circuit mediates this switch by acting as a clutch-like mechanism to disengage the swimming motoneuron pool and engage the escape motoneuron pool. Threshold for escape initiation is lowered and swimming suppression is prolonged by endocannabinoid neuromodulation. Thus, our results reveal a novel cellular mechanism involving a hardwired circuit supplemented with endocannabinoids acting as a clutch-like mechanism to engage/disengage distinct motor pools to ensure behavioral selection and a smooth execution of motor action sequences in a vertebrate system.

A startling acoustic stimulus interferes with upcoming motor preparation: Evidence for a startle refractory period

When a startling acoustic stimulus (SAS) is presented in a simple reaction time (RT) task, response latency is significantly shortened. The present study used a SAS in a psychological refractory period (PRP) paradigm to determine if a shortened RT1 latency would be propagated to RT2. Participants performed a simple RT task with an auditory stimulus (S1) requiring a vocal response (R1), followed by a visual stimulus (S2) requiring a key-lift response (R2). The two stimuli were separated by a variable stimulus onset asynchrony (SOA), and a typical PRP effect was found. When S1 was replaced with a 124dB SAS, R1 onset was decreased by 40-50ms; however, rather than the predicted propagation of a shortened RT, significantly longer responses were found for RT2 on startle trials at short SOAs. Furthermore, the 100ms SOA condition exhibited reduced peak EMG for R2 on startle trials, as compared to non-startle trials. These results are attributed to the startling stimulus temporarily interfering with cognitive processing, delaying and altering the execution of the second response. In addition to this "startle refractory period," results also indicated that RT1 latencies were significantly lengthened for trials that immediately followed a startle trial, providing evidence for longer-term effects of the startling stimulus.

Interaction between visual and motor cortex: a transcranial magnetic stimulation study

The major link between the visual and motor systems is via the dorsal stream pathways from visual to parietal and frontal areas of the cortex. Although the pathway appears to be indirect, there is evidence that visual input can reach the motor cortex at relatively short latency. To shed some light on its neural basis, we studied the visuomotor interaction using paired transcranial magnetic stimulation (TMS). Motor-evoked potentials (MEPs) were recorded from the right first dorsal interosseous in sixteen healthy volunteers. A conditioning stimulus (CS) was applied over the phosphene hotspot of the visual cortex, followed by a test stimulus over the left primary motor cortex (M1) with a random interstimulus interval (ISI) in range 12-40 ms. The effects of paired stimulation were retested during visual and auditory reaction-time tasks (RT). Finally, we measured the effects of a CS on short-interval intracortical inhibition (SICI). At rest, a CS over the occiput significantly (P < 0.001) suppressed test MEPs with an ISI in the range 18-40 ms. In the visual RT, inhibition with an ISI of 40 ms (but not 18 ms) was replaced by a time-specific facilitation (P < 0.001), whereas, in the auditory RT, the CS no longer had any effect on MEPs. Finally, an occipital CS facilitated SICI with an ISI of 40 ms (P < 0.01). We conclude that it is possible to study separate functional connections from visual to motor cortices using paired-TMS with an ISI in the range 18-40 ms. The connections are inhibitory at rest and possibly mediated by inhibitory interneurones in the motor cortex. The effect with an ISI of 40 ms reverses into facilitation during a visuomotor RT but not an audiomotor RT. This suggests that it plays a role in visuomotor integration.

Transcranial magnetic stimulation reveals two functionally distinct stages of motor cortex involvement during perception of emotional body language

Studies indicate that perceiving emotional body language recruits fronto-parietal regions involved in action execution. However, the nature of such motor activation is unclear. Using transcranial magnetic stimulation (TMS) we provide correlational and causative evidence of two distinct stages of motor cortex engagement during emotion perception. Participants observed pictures of body expressions and categorized them as happy, fearful or neutral while receiving TMS over the left or right motor cortex at 150 and 300 ms after picture onset. In the early phase (150 ms), we observed a reduction of excitability for happy and fearful emotional bodies that was specific to the right hemisphere and correlated with participants’ disposition to feel personal distress. This ‘orienting’ inhibitory response to emotional bodies was also paralleled by a general drop in categorization accuracy when stimulating the right but not the left motor cortex. Conversely, at 300 ms, greater excitability for negative, positive and neutral movements was found in both hemispheres. This later motor facilitation marginally correlated with participants’ tendency to assume the psychological perspectives of others and reflected simulation of the movement implied in the neutral and emotional body expressions. These findings highlight the motor system’s involvement during perception of emotional bodies. They suggest that fast orienting reactions to emotional cues—reflecting neural processing necessary for visual perception—occur before motor features of the observed emotional expression are simulated in the motor system and that distinct empathic dispositions influence these two neural motor phenomena. Implications for theories of embodied simulation are discussed.

The auditory-evoked arousal modulates motor cortex excitability

Arousal enhances the readiness to process sensory information and respond to it. Rapid increment of arousal, referred to as arousal reaction or startle, increases the level of attention and the chance of survival. Arousal reaction is known to originate from the brainstem ascending reticular activating system and to modulate neuronal activity throughout the central nervous system. In the present study we investigated the effect of arousal on the central motor system by synchronizing transcranial magnetic stimulation (TMS) with acoustically evoked N100 potential. Because of the widespread cortical distribution of N100 to a sudden acoustic stimulus it is thought to be related to arousal reaction. Eight healthy subjects participated in this study. TMS was focused on the primary motor cortex utilizing neuronavigation. Trains of four identical loud tones repeated at 1-s intervals were delivered to the right ear and TMS was randomly placed after one tone in the train. The motor-evoked potentials (MEPs) were measured from the contralateral first dorsal interosseous muscle. The MEPs evoked by TMS timed at N100 after the first tone in train were significantly (p<.001) larger in comparison with the control stimulation without a preceding sound or stimulation placed after the N100, i.e., 120% of the N100 interstimulus interval. Also, the MEPs following the second tone were significantly weaker (p<.05) when compared with the MEPs following the first tone. Our findings suggest that acoustic arousal reaction facilitates, not only the activation of sensory cortices, but also simultaneously the central motor system.

Motor 'surround inhibition' is not correlated with activity in surround muscles

Surround inhibition (SI) is a neural process that has been extensively investigated in the sensory system and has been recently probed in the motor system. Muscle-specific modulation of corticospinal excitability at the onset of an isolated finger movement has been assumed to reflect the presence of SI in the motor system. This study attempted to characterise this phenomenon in a large cohort of normal volunteers and investigate its relationship with muscle activity in the hand. Corticospinal excitability of the pathways projecting to three hand muscles [first dorsal interosseus (FDI), abductor pollicis brevis (APB) and abductor digiti minimi (ADM)] and electromyographic (EMG) activity of the same muscles were assessed in 31 healthy volunteers during an isolated index finger movement. In the agonist FDI muscle both corticospinal excitability and EMG activity were found to be increased at the onset of the movement (P < 0.001 and P < 0.001, respectively). On the contrary, in the surround ADM, there was dissociation between the corticospinal excitability (decreased: P < 0.001) and EMG activity (increased: P < 0.001). Cross-correlation analysis of the EMG activity showed that neuronal signals driving the agonist and surround muscles are not synchronised when SI is present. The results suggest a distinctive origin of the neuronal signals driving the agonist and surround muscles. In addition, they indicate that cortical output might be simultaneously modulated by voluntary and non-voluntary activity, generated in cortical and subcortical structures, respectively.

Corticospinal modulation induced by sounds depends on action preparedness

A loud acoustic stimulus (LAS) presented during movement preparation can induce an early release of the prepared action. Because loud sound has been found to have an inhibitory effect on motor cortex excitability, it is possible that the motor cortex plays little role in the early release of prepared responses. We sought to shed new light on this suggestion by probing changes in corticospinal excitability after LAS presentation during preparation for an anticipatory action. Unexpectedly, we show that the changes in corticospinal excitability after LAS presentation are not fixed. Based on the magnitude of motor-evoked potentials elicited by transcranial magnetic and electric stimulation of the motor cortex, we demonstrate that the effects of auditory stimuli on corticospinal excitability depend on the level of readiness for action: inhibition in early preparation and facilitation close to movement onset. We also show that auditory stimuli can regulate intracortical excitability by increasing intracortical facilitation and reducing short-interval intracortical inhibition. Together, these findings indicate that, at least in part, the early release of motor responses by auditory stimuli involves the motor cortex.

Movement and afferent representations in human motor areas: a simultaneous neuroimaging and transcranial magnetic/peripheral nerve-stimulation study

Neuroimaging combined with transcranial magnetic stimulation (TMS) to primary motor cortex (M1) is an emerging technique that can examine motor-system functionality through evoked activity. However, because sensory afferents from twitching muscles are widely represented in motor areas the amount of evoked activity directly resulting from TMS remains unclear. We delivered suprathreshold TMS to left M1 or gave electrical right median nerve stimulation (MNS) in 18 healthy volunteers while simultaneously conducting functional magnetic resonance imaging and monitoring with electromyography (EMG). We examined in detail the localization of TMS-, muscle afferent- and superficial afferent-induced activity in M1 subdivisions. Muscle afferent- and TMS-evoked activity occurred mainly in rostral M1, while superficial afferents generated a slightly different activation distribution. In 12 participants who yielded quantifiable EMG, differences in brain activity ascribed to differences in movement-size were adjusted using integrated information from the EMGs. Sensory components only explained 10–20% of the suprathreshold TMS-induced activity, indicating that locally and remotely evoked activity in motor areas mostly resulted from the recruitment of neural and synaptic activity. The present study appears to justify the use of fMRI combined with suprathreshold TMS to M1 for evoked motor network imaging.

Repetition suppression in the cortical motor and auditory systems resemble each other--a combined TMS and evoked potential study

Repetition suppression (RS) in cortical sensory systems optimizes the size of neuronal ensemble reacting to repetitive stimuli such as sounds. Recently RS has also been demonstrated to occur with mental imaging of movement. We studied the existence of RS in the motor system using transcranial magnetic stimulation (TMS). Six healthy subjects participated in this study. TMS was focused on the primary motor cortex with neuronavigation and RS was studied by measuring the motor-evoked potentials from the contralateral first dorsal interosseous muscle. At the same time, we measured TMS-induced cortical responses using electroencephalography (EEG). For a comparison baseline, we evaluated RS by recording EEG responses to sounds with the same stimulation protocol as with TMS. Each stimulus train included four identical stimuli repeated at 1-s intervals, and the stimulation trains were repeated at 20-s intervals. The response amplitude was reduced significantly (p<.01) after the first stimulus in all stimulus trains. This suggests that RS may be a general mechanism for adaptation of neuronal population responses in the human cortex.

Cortical hemoglobin concentration changes underneath the coil after single-pulse transcranial magnetic stimulation: a near-infrared spectroscopy study

Using near-infrared spectroscopy (NIRS) and multichannel probes, we studied hemoglobin (Hb) concentration changes when single-pulse transcranial magnetic stimulation (TMS) was applied over the left hemisphere primary motor cortex (M1). Seventeen measurement probes were centered over left M1. Subjects were studied in both active and relaxed conditions, with TMS intensity set at 100%, 120%, and 140% of the active motor threshold. The magnetic coils were placed so as to induce anteromedially directed currents in the brain. Hb concentration changes were more prominent at channels over M1 and posterior to it. Importantly, Hb concentration changes at M1 after TMS differed depending on whether the target muscle was in an active or relaxed condition. In the relaxed condition, Hb concentration increased up to 3–6 s after TMS, peaking at ∼6 s, and returned to the baseline. In the active condition, a smaller increase in Hb concentrations continued up to 3–6 s after TMS (early activation), followed by a decrease in Hb concentration from 9 to 12 s after TMS (delayed deactivation). Hb concentration changes in the active condition at higher stimulus intensities were more pronounced at locations posterior to M1 than at M1. We conclude that early activation occurs when M1 is activated transsynaptically. The relatively late deactivation may result from the prolonged inhibition of the cerebral cortex after activation. The posterior-dominant activation at higher intensities in the active condition may result from an additional activation of the sensory cortex due to afferent inputs from muscle contraction evoked by the TMS.