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Popesco T, Bet da Rosa Orssatto L, Hug F, Blazevich AJ, Trajano GS, Place N. Motoneuron persistent inward current contribution to increased torque responses to wide-pulse high-frequency neuromuscular electrical stimulation. Eur J Appl Physiol 2024:10.1007/s00421-024-05538-8. [PMID: 38940932 DOI: 10.1007/s00421-024-05538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/07/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To assess the effect of a remote handgrip contraction during wide-pulse high-frequency (WPHF) neuromuscular electrical stimulation (NMES) on the magnitude of extra torque, progressive increase in torque during stimulation, and estimates of the persistent inward current (PIC) contribution to motoneuron firing in the plantar flexors. METHODS Ten participants performed triangular shaped contractions to 20% of maximal plantar flexion torque before and after WPHF NMES with and without a handgrip contraction, and control conditions. Extra torque, the relative difference between the initial and final torque during stimulation, and sustained electromyographic (EMG) activity were assessed. High-density EMG was recorded during triangular shaped contractions to calculate ∆F, an estimate of PIC contribution to motoneuron firing, and its variation before vs after the intervention referred to as ∆F change score. RESULTS While extra torque was not significantly increased with remote contraction (WPHF + remote) vs WPHF (+ 37 ± 63%, p = 0.112), sustained EMG activity was higher in this condition than WPHF (+ 3.9 ± 4.3% MVC EMG, p = 0.017). Moreover, ∆F was greater (+ 0.35 ± 0.30 Hz) with WPHF + remote than control (+ 0.03 ± 0.1 Hz, p = 0.028). A positive correlation was found between ∆F change score and extra torque in the WPHF + remote (r = 0.862, p = 0.006). DISCUSSION The findings suggest that the addition of remote muscle contraction to WPHF NMES enhances the central contribution to torque production, which may be related to an increased PIC contribution to motoneuron firing. Gaining a better understanding of these mechanisms should enable NMES intervention optimization in clinical and rehabilitation settings, improving neuromuscular function in clinical populations.
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Affiliation(s)
- Timothée Popesco
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Lucas Bet da Rosa Orssatto
- Faculty of Health, School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - François Hug
- LAMHESS, Université Côte d'Azur, Nice, France
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anthony John Blazevich
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, WA, Australia
| | - Gabriel Siqueira Trajano
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Nicolas Place
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
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Kim SH, Joung JY, Lee YH, Son CG. Anatomical Exploration of the KI1 Acupoint: Implications for Medial and Lateral Plantar Nerve Stimulation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:535. [PMID: 38674181 PMCID: PMC11051973 DOI: 10.3390/medicina60040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: This study aims to identify the precise anatomical location and therapeutic mechanisms of the KI1 acupoint (Yongquan) in relation to foot muscles and nerves, known for treating neurological disorders and pain. Materials and Methods: Dissection of six cadavers at Chungnam National University College of Medicine examined KI1's relation to the foot's four-layer structure. Results: The KI1 acupoint was located in the superficial and deep layers of the plantar foot, adjacent to significant nerves like the medial and lateral plantar nerves. Differences in the acupoint's exact location between genders were noted, reflecting variances in foot morphology. KI1 acupuncture was found to stimulate the muscle spindles and nerve fibers essential for balance and bipedal locomotion. This stimulation may enhance sensory feedback, potentially improving cognitive functions and balance control. Conclusions: This anatomical insight into KI1 acupuncture underpins its potential in neurological therapies and pain management.
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Affiliation(s)
- Sang Hyun Kim
- Catholic Institute for Applied Anatomy, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Jin-Yong Joung
- Department of Korean Medicine, Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34530, Republic of Korea;
| | - Young Ho Lee
- Department of Anatomy, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea
| | - Chang-Gue Son
- Department of Korean Medicine, Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34530, Republic of Korea;
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Chaney R, Leger C, Wirtz J, Fontanier E, Méloux A, Quirié A, Martin A, Prigent-Tessier A, Garnier P. Cerebral Benefits Induced by Electrical Muscle Stimulation: Evidence from a Human and Rat Study. Int J Mol Sci 2024; 25:1883. [PMID: 38339161 PMCID: PMC10855504 DOI: 10.3390/ijms25031883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Physical exercise (EX) is well established for its positive impact on brain health. However, conventional EX may not be feasible for certain individuals. In this regard, this study explores electromyostimulation (EMS) as a potential alternative for enhancing cognitive function. Conducted on both human participants and rats, the study involved two sessions of EMS applied to the quadriceps with a duration of 30 min at one-week intervals. The human subjects experienced assessments of cognition and mood, while the rats underwent histological and biochemical analyses on the prefrontal cortex, hippocampus, and quadriceps. Our findings indicated that EMS enhanced executive functions and reduced anxiety in humans. In parallel, our results from the animal studies revealed an elevation in brain-derived neurotrophic factor (BDNF), specifically in the hippocampus. Intriguingly, this increase was not associated with heightened neuronal activity or cerebral hemodynamics; instead, our data point towards a humoral interaction from muscle to brain. While no evidence of increased muscle and circulating BDNF or FNDC5/irisin pathways could be found, our data highlight lactate as a bridging signaling molecule of the muscle-brain crosstalk following EMS. In conclusion, our results suggest that EMS could be an effective alternative to conventional EX for enhancing both brain health and cognitive function.
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Affiliation(s)
- Rémi Chaney
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
| | - Clémence Leger
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
| | - Julien Wirtz
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
| | - Estelle Fontanier
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
| | - Alexandre Méloux
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
| | - Aurore Quirié
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
| | - Alain Martin
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France;
| | - Anne Prigent-Tessier
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
| | - Philippe Garnier
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000 Dijon, France; (R.C.); (C.L.); (J.W.); (E.F.); (A.M.); (A.Q.); (P.G.)
- Département Génie Biologique, IUT, F-21000 Dijon, France
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Cui Y, Cong F, Huang F, Zeng M, Yan R. Cortical activation of neuromuscular electrical stimulation synchronized mirror neuron rehabilitation strategies: an fNIRS study. Front Neurol 2023; 14:1232436. [PMID: 37602262 PMCID: PMC10437114 DOI: 10.3389/fneur.2023.1232436] [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: 06/05/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background The mirror neuron system (MNS) plays a key role in the neural mechanism underlying motor learning and neural plasticity. Action observation (AO), action execution (AE), and a combination of both, known as action imitation (AI), are the most commonly used rehabilitation strategies based on MNS. It is possible to enhance the cortical activation area and amplitude by combining traditional neuromuscular electrical stimulation (NMES) with other top-down and active rehabilitation strategies based on the MNS theory. Objective This study aimed to explore the cortical activation patterns induced by NMES synchronized with rehabilitation strategies based on MNS, namely NMES+AO, NMES+AE, and NMES+AI. In addition, the study aimed to assess the feasibility of these three novel rehabilitative treatments in order to provide insights and evidence for the design, implementation, and application of brain-computer interfaces. Methods A total of 70 healthy adults were recruited from July 2022 to February 2023, and 66 of them were finally included in the analysis. The cortical activation patterns during NMES+AO, NMES+AE, and NMES+AI were detected using the functional Near-Infrared Spectroscopy (fNIRS) technique. The action to be observed, executed, or imitated was right wrist and hand extension, and two square-shaped NMES electrodes were placed on the right extensor digitorum communis. A block design was adopted to evaluate the activation intensity of the left MNS brain regions. Results General linear model results showed that compared with the control condition, the number of channels significantly activated (PFDR < 0.05) in the NMES+AO, NMES+AE, and NMES+AI conditions were 3, 9, and 9, respectively. Region of interest (ROI) analysis showed that 2 ROIs were significantly activated (PFDR < 0.05) in the NMES+AO condition, including BA6 and BA44; 5 ROIs were significantly activated in the NMES+AE condition, including BA6, BA40, BA44, BA45, and BA46; and 6 ROIs were significantly activated in the NMES+AI condition, including BA6, BA7, BA40, BA44, BA45, and BA46. Conclusion The MNS was activated during neuromuscular electrical stimulation combined with an AO, AE, and AI intervention. The synchronous application of NMES and mirror neuron rehabilitation strategies is feasible in clinical rehabilitation. The fNIRS signal patterns observed in this study could be used to develop brain-computer interface and neurofeedback therapy rehabilitation devices.
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Affiliation(s)
- Yao Cui
- Department of Physical Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Fang Cong
- Department of Physical Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Fubiao Huang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Occupational Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Ming Zeng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, The Second Hospital of Jiaxing City, Jiaxing, Zhejiang, China
| | - Ruxiu Yan
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Occupational Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
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Zhou S, Zhang J, Chen F, Wong TWL, Ng SSM, Li Z, Zhou Y, Zhang S, Guo S, Hu X. Automatic theranostics for long-term neurorehabilitation after stroke. Front Aging Neurosci 2023; 15:1154795. [PMID: 37261267 PMCID: PMC10228725 DOI: 10.3389/fnagi.2023.1154795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Sa Zhou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jianing Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Thomson Wai-Lung Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids Beijing, Beijing, China
| | - Yongjin Zhou
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Shaomin Zhang
- Key Laboratory of Biomedical Engineering of Education Ministry, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Department of Biomedical Engineering, School of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Song Guo
- Department of Computing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
- University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Papavasileiou A, Xenofondos A, Baudry S, Lapole T, Amiridis IG, Metaxiotis D, Tsatalas T, Patikas DA. Protocols Targeting Afferent Pathways via Neuromuscular Electrical Stimulation for the Plantar Flexors: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:2347. [PMID: 36850945 PMCID: PMC9967278 DOI: 10.3390/s23042347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This systematic review documents the protocol characteristics of studies that used neuromuscular electrical stimulation protocols (NMES) on the plantar flexors [through triceps surae (TS) or tibial nerve (TN) stimulation] to stimulate afferent pathways. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, was registered to PROSPERO (ID: CRD42022345194) and was funded by the Greek General Secretariat for Research and Technology (ERA-NET NEURON JTC 2020). Included were original research articles on healthy adults, with NMES interventions applied on TN or TS or both. Four databases (Cochrane Library, PubMed, Scopus, and Web of Science) were systematically searched, in addition to a manual search using the citations of included studies. Quality assessment was conducted on 32 eligible studies by estimating the risk of bias with the checklist of the Effective Public Health Practice Project Quality Assessment Tool. Eighty-seven protocols were analyzed, with descriptive statistics. Compared to TS, TN stimulation has been reported in a wider range of frequencies (5-100, vs. 20-200 Hz) and normalization methods for the contraction intensity. The pulse duration ranged from 0.2 to 1 ms for both TS and TN protocols. It is concluded that with increasing popularity of NMES protocols in intervention and rehabilitation, future studies may use a wider range of stimulation attributes, to stimulate motor neurons via afferent pathways, but, on the other hand, additional studies may explore new protocols, targeting for more optimal effectiveness. Furthermore, future studies should consider methodological issues, such as stimulation efficacy (e.g., positioning over the motor point) and reporting of level of discomfort during the application of NMES protocols to reduce the inherent variability of the results.
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Affiliation(s)
- Anastasia Papavasileiou
- Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
| | - Anthi Xenofondos
- Physical Education and Sports Sciences, Frederick University, 1036 Nicosia, Cyprus
| | - Stéphane Baudry
- Laboratory of Applied Biology, Research Unit in Applied Neurophysiology (LABNeuro), Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Thomas Lapole
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, F-42023 Saint-Etienne, France
| | - Ioannis G. Amiridis
- Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
| | | | - Themistoklis Tsatalas
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
| | - Dimitrios A. Patikas
- Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
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7
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Senin-Camargo F, Martínez-Rodríguez A, Chouza-Insua M, Raposo-Vidal I, Jácome MA. Effects on venous flow of transcutaneous electrical stimulation, neuromuscular stimulation, and sham stimulation on soleus muscle: A randomized crossover study in healthy subjects. Medicine (Baltimore) 2022; 101:e30121. [PMID: 36107611 PMCID: PMC9439730 DOI: 10.1097/md.0000000000030121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Activation of venous flow has been shown with different types of electrical stimulation. The aim of this study is to compare the hemodynamic effects of transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), and sham stimulation on healthy young people. METHODS This randomized crossover study was conducted during June 2018 in the Faculty of Physical Therapy of A Coruña (Spain). Twenty-four university students (50% male) received in a randomized order 5 Hz-TENS, NMES, and sham stimulation on soleus muscle. Flow volume (FV) and peak velocity (PV) from popliteal vein were recorded via Doppler ultrasound, and relative changes from baseline were determined. Discomfort among the 3 stimulations was also compared. RESULTS The differences among the 3 stimulations were assessed using the ANOVA for repeated measured, the Friedman test and the Kendall tau test, according to the type of measurement to be compared. FV (mL/min) and PV (cm/s) increased significantly after NMES (percentual increase 37.2 ± 62.0%, P = .002; 264.4 ± 152.2%, P < .001, respectively) and TENS (226.2 ± 190.3%, P < .001; 202.7 ± 144.6%, P < .001, respectively). These percentual changes from basal level in hemodynamics were statistically different to those after placebo, which was ineffective enhancing hemodynamics. The improvements in FV were statistically higher with TENS than with NMES (P < .001), but there was no statistical difference in PV (P = .531). Despite NMES was applied at a significantly lower amplitude than TENS (P < .001), NMES protocol was the worst tolerated, though the differences in discomfort were not statistically significant. CONCLUSION Both active electrical protocols but not sham stimulation increased hemodynamics in healthy people. TENS obtained higher flow volume increase from baseline than NMES, considered globally at not only in its on-time.
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Affiliation(s)
- Francisco Senin-Camargo
- Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
| | - Alicia Martínez-Rodríguez
- Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
| | - Marcelo Chouza-Insua
- NEUROcom Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
- *Correspondence: Marcelo Chouza-Insua, NEUROcom Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, Campus de Oza, 15006, A Coruña, Spain (e-mail: )
| | - Isabel Raposo-Vidal
- Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
| | - M. Amalia Jácome
- MODES Group, CITIC, Department of Mathematics, Faculty of Sciences, Universidade da Coruña, A Coruña, Spain
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Transcutaneous spinal stimulation alters cortical and subcortical activation patterns during mimicked-standing: A proof-of-concept fMRI study. NEUROIMAGE: REPORTS 2022; 2. [DOI: 10.1016/j.ynirp.2022.100090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Chaney R, Garnier P, Quirié A, Martin A, Prigent-Tessier A, Marie C. Region-Dependent Increase of Cerebral Blood Flow During Electrically Induced Contraction of the Hindlimbs in Rats. Front Physiol 2022; 13:811118. [PMID: 35492591 PMCID: PMC9040888 DOI: 10.3389/fphys.2022.811118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Elevation of cerebral blood flow (CBF) may contribute to the cerebral benefits of the regular practice of physical exercise. Surprisingly, while electrically induced contraction of a large muscular mass is a potential substitute for physical exercise to improve cognition, its effect on CBF remains to be investigated. Therefore, the present study investigated CBF in the cortical area representing the hindlimb, the hippocampus and the prefrontal cortex in the same anesthetized rats subjected to either acute (30 min) or chronic (30 min for 7 days) electrically induced bilateral hindlimb contraction. While CBF in the cortical area representing the hindlimb was assessed from both laser doppler flowmetry (LDFCBF) and changes in p-eNOSSer1177 levels (p-eNOSCBF), CBF was evaluated only from changes in p-eNOSSer1177 levels in the hippocampus and the prefrontal cortex. The contribution of increased cardiac output and increased neuronal activity to CBF changes were examined. Stimulation was associated with tachycardia and no change in arterial blood pressure. It increased LDFCBF with a time- and intensity-dependent manner as well as p-eNOSCBF in the area representing the hindlimb. By contrast, p-eNOSCBF was unchanged in the two other regions. The augmentation of LDFCBF was partially reduced by atenolol (a ß1 receptor antagonist) and not reproduced by the administration of dobutamine (a ß1 receptor agonist). Levels of c-fos as a marker of neuronal activation selectively increased in the area representing the hindlimb. In conclusion, electrically induced bilateral hindlimb contraction selectively increased CBF in the cortical area representing the stimulated muscles as a result of neuronal hyperactivity and increased cardiac output. The absence of CBF changes in cognition-related brain regions does not support flow-dependent neuroplasticity in the pro-cognitive effect of electrically induced contraction of a large muscular mass.
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Affiliation(s)
- Remi Chaney
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, Dijon, France
| | - Philippe Garnier
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, Dijon, France.,Département Génie Biologique, IUT, Dijon, France
| | - Aurore Quirié
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, Dijon, France
| | - Alain Martin
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Anne Prigent-Tessier
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, Dijon, France
| | - Christine Marie
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences de Santé, Dijon, France
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Cao N, Sasaki A, Yuasa A, Popovic MR, Milosevic M, Nakazawa K. Short-term facilitation effects elicited by cortical priming through theta burst stimulation and functional electrical stimulation of upper-limb muscles. Exp Brain Res 2022; 240:1565-1578. [PMID: 35359173 DOI: 10.1007/s00221-022-06353-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
Abstract
Non-invasive theta burst stimulation (TBS) can elicit facilitatory or inhibitory changes in the central nervous system when applied intermittently (iTBS) or continuously (cTBS). Conversely, neuromuscular electrical stimulation (NMES) can activate the muscles to send a sensory volley, which is also known to affect the excitability of the central nervous system. We investigated whether cortical iTBS (facilitatory) or cTBS (inhibitory) priming can affect subsequent NMES-induced corticospinal excitability. A total of six interventions were tested, each with 11 able-bodied participants: cortical priming followed by NMES (iTBS + NMES and cTBS + NMES), NMES only (iTBSsham + NMES and cTBSsham + NMES), and cortical priming only (iTBS + rest and cTBS + rest). After iTBS or cTBS priming, NMES was used to activate right extensor capri radialis (ECR) muscle intermittently for 10 min (5 s ON/5 s OFF). Single-pulse transcranial magnetic stimulation motor evoked potentials (MEPs) and maximum motor response (Mmax) elicited by radial nerve stimulation were compared before and after each intervention for 30 min. Our results showed that associative facilitatory iTBS + NMES intervention elicited greater MEP facilitation that lasted for at least 30 min after the intervention, while none of the interventions alone were effective to produce effects. We conclude that facilitatory iTBS priming can make the central nervous system more susceptible to changes elicited by NMES through sensory recruitment to enhance facilitation of corticospinal plasticity, while cTBS inhibitory priming efficacy could not be confirmed.
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Affiliation(s)
- Na Cao
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan.,Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Atsushi Sasaki
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan.,Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada.,KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.,CRANIA, University Health Network and University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Matija Milosevic
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, 560-8531, Japan.
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
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11
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Jiang YF, Zhang D, Zhang J, Hai H, Zhao YY, Ma YW. A Randomized Controlled Trial of Repetitive Peripheral Magnetic Stimulation applied in Early Subacute Stroke: Effects on Severe Upper-limb Impairment. Clin Rehabil 2022; 36:693-702. [PMID: 34985366 DOI: 10.1177/02692155211072189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive method that activates peripheral nerves and enhances muscle strength. This study aimed to investigate the effect of rPMS applied in early subacute stroke on severe upper extremity impairment. DESIGN Randomized controlled trial. SETTING Rehabilitation department of a university hospital. SUBJECTS People aged 30-80 years with no practical arm function within four weeks of a first stroke. INTERVENTIONS Participants were randomly assigned to either the rPMS group (n = 24, 20Hz and 2400 pulses of rPMS to triceps brachii and extensor digitorum muscles daily for two weeks in addition to conventional physiotherapy) or the control group (n = 20, conventional physiotherapy). MAIN MEASURES The primary outcome was the upper extremity motor section of Fugl-Meyer Assessment after treatment. Secondary outcomes included Barthel Index and root mean square of surface electromyography for muscle strength and stretch-induced spasticity of critical muscles of the upper extremity. Data presented: mean (SD) or median (IQR). RESULTS The rPMS group showed more significant improvements in the Fugl-Meyer Assessment (12.5 (2.5) vs. 7.0 (1.4), P < 0.001), Barthel Index (15 (5) vs. 10 (3.7), P < 0.001), and strength-root mean square (biceps brachii: 20.5 (4.8) vs. 6.2 (2.7), p < 0.001; triceps brachii: 14.9 (5.8) vs. 4.3 (1.2), p < 0.001; flexor digitorum: 5.1 (0.8) vs. 4.0 (1.1), p < 0.001) compared with the control group. CONCLUSION In patients with no functional arm movement, rPMS of upper limb extensors improves arm function and muscle strength for grip and elbow flexion and extension.
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Affiliation(s)
- Yi-Fan Jiang
- Department of Rehabilitation Medicine, the 159407First Affiliated Hospital of China Medical University, Shenyang, China *Equal contribution
| | - Dai Zhang
- Department of Rehabilitation Medicine, the 159407First Affiliated Hospital of China Medical University, Shenyang, China *Equal contribution
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12
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Cortico-muscular interaction to monitor the effects of neuromuscular electrical stimulation pedaling training in chronic stroke. Comput Biol Med 2021; 137:104801. [PMID: 34481180 DOI: 10.1016/j.compbiomed.2021.104801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/21/2022]
Abstract
Neuromuscular electrical stimulation (NMES) has been widely utilized in post-stroke motor restoration. However, its impact on the closed-loop sensorimotor control process remains largely unclear. This is the first study to investigate the directional changes in cortico-muscular interactions after repetitive rehabilitation training by measuring the noninvasive electroencephalogram (EEG) and electromyography (EMG) signals. In this study, 10 subjects with chronic stroke received 20 sessions of NMES-pedaling interventions, and each training session included three 10-min NMES-driven pedaling trials. In addition, pre- and post-intervention assessments of lower limb isometric contraction were conducted before and after the whole NMES-pedaling interventions. The EEG (128 channels) and EMG (3 bilateral lower limb sensors) signals were collected during the isometric contraction tasks for the paretic and non-paretic lower limbs. Both the cortico-muscular coherence (CMC) and generalized partial directed coherence (GPDC) values were analyzed between eight selected EEG channels in the central primary motor cortex and EMG channels. The results revealed significant clinical improvements. Additionally, rehabilitation training facilitated cortico-muscular interaction of the ipsilesional brain and paretic lower limbs (p = 0.004). Moreover, both the descending and ascending cortico-muscular pathways were altered after NMES-training (p = 0.001, p < 0.001). Therefore, the results implied potential applications of EEG-EMG in understanding neuromuscular changes during the post-stroke motor rehabilitation process.
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13
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Vidaurre C, Jorajuría T, Ramos-Murguialday A, Müller KR, Gómez M, Nikulin VV. Improving motor imagery classification during induced motor perturbations. J Neural Eng 2021; 18. [PMID: 34233305 DOI: 10.1088/1741-2552/ac123f] [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] [Received: 01/29/2021] [Accepted: 07/07/2021] [Indexed: 11/11/2022]
Abstract
Objective.Motor imagery is the mental simulation of movements. It is a common paradigm to design brain-computer interfaces (BCIs) that elicits the modulation of brain oscillatory activity similar to real, passive and induced movements. In this study, we used peripheral stimulation to provoke movements of one limb during the performance of motor imagery tasks. Unlike other works, in which induced movements are used to support the BCI operation, our goal was to test and improve the robustness of motor imagery based BCI systems to perturbations caused by artificially generated movements.Approach.We performed a BCI session with ten participants who carried out motor imagery of three limbs. In some of the trials, one of the arms was moved by neuromuscular stimulation. We analysed 2-class motor imagery classifications with and without movement perturbations. We investigated the performance decrease produced by these disturbances and designed different computational strategies to attenuate the observed classification accuracy drop.Main results.When the movement was induced in a limb not coincident with the motor imagery classes, extracting oscillatory sources of the movement imagination tasks resulted in BCI performance being similar to the control (undisturbed) condition; when the movement was induced in a limb also involved in the motor imagery tasks, the performance drop was significantly alleviated by spatially filtering out the neural noise caused by the stimulation. We also show that the loss of BCI accuracy was accompanied by weaker power of the sensorimotor rhythm. Importantly, this residual power could be used to predict whether a BCI user will perform with sufficient accuracy under the movement disturbances.Significance.We provide methods to ameliorate and even eliminate motor related afferent disturbances during the performance of motor imagery tasks. This can help improving the reliability of current motor imagery based BCI systems.
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Affiliation(s)
- C Vidaurre
- Department of Statistics, Computer Science and Mathematics, Public University of Navarre, Pamplona, Spain.,Machine Learning Group, Computer Science Faculty, Berlin Institute of Technology, Berlin, Germany.,Both authors contributed equally
| | - T Jorajuría
- Department of Statistics, Computer Science and Mathematics, Public University of Navarre, Pamplona, Spain.,Both authors contributed equally
| | - A Ramos-Murguialday
- Institute for Medical Psychology and Behavioral Neurobiology (IMP), University of Tübingen, 72076 Tübingen, Germany.,Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | - K-R Müller
- Machine Learning Group, Computer Science Faculty, Berlin Institute of Technology, Berlin, Germany.,BIFOLD Berlin Institute for the Foundations of Learning and Data, Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.,Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea.,Max Planck Institute for Informatics, Saarbrücken, Germany
| | - M Gómez
- Department of Statistics, Computer Science and Mathematics, Public University of Navarre, Pamplona, Spain
| | - V V Nikulin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
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14
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Bastos JAI, Martins W, Junior GC, Collins DF, Durigan JLQ. CONTRACTION FATIGUE, STRENGTH ADAPTATIONS, AND DISCOMFORT DURING CONVENTIONAL VERSUS WIDE-PULSE, HIGH-FREQUENCY, NEUROMUSCULAR ELECTRICAL STIMULATION: A SYSTEMATIC REVIEW. Appl Physiol Nutr Metab 2021; 46:1314-1321. [PMID: 34260861 DOI: 10.1139/apnm-2021-0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neuromuscular electrical stimulation (NMES) can be delivered in a conventional form (CONVNMES) and using relatively wide-pulses and high-frequencies (WPHFNMES). WPHFNMES is proposed to reduce contraction fatigability and generate larger contractions with less discomfort than CONVNMES, however, there are no systematic reviews to guide the selection of NMES types. This systematic review compared the effects of CONVNMES versus WPHFNMES on contraction fatigability, strength adaptations, and perceived discomfort in clinical and non-clinical populations. Eight studies were included. When averaged across all non-clinical participants in individual short- and long-term studies, there was either no difference between CONVNMES and WPHFNMES for all outcomes or WPHFNMES produced more fatigability. In a subset of non-clinical participants ("responders"), however, WPHFNMES reduced contraction fatigability during a single session. Long-term studies found no differences between protocols for strength adaptations in non-clinical participants and those with multiple sclerosis. We concluded that WPHFNMES reduces contraction fatigability only in the short-term and in non-clinical responder participants and may exacerbate fatigability in non-responders. This review was registered in the prospective international registry of systematic reviews/PROSPERO (Registration Number: CRD42020153907, accessed at https://www.crd.york.ac.uk/PROSPERO/). Novelty bullets: • WPHF NMES may reduce fatigue in some participants and exacerbate fatigue in others. • There were no differences in long-term between WPHF and CONV NMES on strength adaptations. • Future high-quality research is needed to optimize outcomes of NMES-based programs.
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Affiliation(s)
| | - Wagner Martins
- Universidade de Brasilia, 28127, Faculdade de Fisioterapia, Ceilândia , Distrito Federal, Brazil;
| | | | - David F Collins
- University of Alberta, 3158, Kinesiology, Sport, and Recreation, Edmonton, Alberta, Canada, T6G 2R3;
| | - Joao Luiz Quaglioti Durigan
- UnB, Physical Therapy, D- Graduate program of Science and Technology of Health and Graduate program of Physical Education, University of Brasília, Distrito Federal, Brazil, Brasiia, Select a State / Province, Brazil, 13560210;
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15
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Zhao Y, Yao J, Wu X, Chen L, Wang X, Zhang X, Hou W. Event-Related Beta EEG Changes Induced by Various Neuromuscular Electrical Stimulation: A Pilot Study. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1206-1212. [PMID: 34129499 DOI: 10.1109/tnsre.2021.3089478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Previous results demonstrated that neuromuscular electrical stimulation (NMES) with various configurations could induce different activity at both the central and peripheral levels. Although NMES generating different peripheral movements have been studied, it is still unclear whether the difference in NMES-induced cortical activity is due to movement- or stimulation- related differences. Because NMES-induced cortical activity impacts motor function recovery, it is essential to know when NMES with various configurations evoke the same movement, whether the induced cortical activity is still different. Four NMES configurations: 1) Eight-let Frequency Trains, 2) Doublet frequency trains (DFT), 3) Constant-frequency trains with narrow-pulse, and 4) wide-pulse, were delivered to the right biceps brachii muscle in nine healthy young adults. We adjusted the intensities of these NMES to evoke the same elbow flexion and compared the cortical activities over sensorimotor regions. Our results showed that the four NMES patterns induced different beta-band Event-Related Desynchronization (ERD), with the DFT providing the strongest ERD value given the same NMES-induced elbow flexion (p < 0.05). This difference is possibly due to NMES with different configuration activated in the amount of afferent proprioceptive fibers. Our pilot study suggests that the NMES-induced beta-band ERD may be an additional factor to consider when selecting the NMES configuration for a better motor function recovery.
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16
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Espeit L, Rozand V, Millet GY, Gondin J, Maffiuletti NA, Lapole T. Influence of wide-pulse neuromuscular electrical stimulation frequency and superimposed tendon vibration on occurrence and magnitude of extra torque. J Appl Physiol (1985) 2021; 131:302-312. [PMID: 34080917 DOI: 10.1152/japplphysiol.00968.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Low-frequency and high-frequency wide-pulse neuromuscular electrical stimulation (NMES) can generate extra torque (ET) via afferent pathways. Superimposing tendon vibration (TV) to NMES can increase the activation of these afferent pathways and favor ET generation. Knowledge of the characteristics of ET is essential to implement these stimulation paradigms in clinical practice. Thus, we aimed to investigate the effects of frequency and TV superimposition on the occurrence and magnitude of ET in response to wide-pulse NMES. NMES-induced isometric plantar flexion torque was recorded in 30 healthy individuals who performed five NMES protocols: wide-pulse low-frequency (1 ms; 20 Hz; WPLF) and wide-pulse high-frequency (1 ms; 100 Hz; WPHF) without and with superimposed TV (1 mm; 100 Hz) and conventional NMES (50 µs; 20 Hz; reference protocol). Each NMES protocol consisted of three 20-s trains interspersed by 90 s of rest, with NMES intensity being adjusted to reach 10% of maximal voluntary contraction. The ET occurrence was similar for WPLF and WPHF (P = 0.822). In the responders, the ET magnitude was greater for WPHF than WPLF (P < 0.001). There was no effect of superimposed TV on ET characteristics. This study reported an effect of NMES frequency on ET magnitude, whereas TV superimposition did not affect this parameter. In the context of our experimental design decisions, the present findings question the clinical use of wide-pulse NMES and its combination with superimposed TV. Yet, further research is needed to maximize force production through the occurrence and magnitude of ET.NEW & NOTEWORTHY This study is the first to assess the effect of stimulation frequency and superimposed tendon vibration on extra torque characteristics generated by wide-pulse neuromuscular electrical stimulation. The percentage of subjects showing extra torque (i.e., considered as responders) was similar for low-frequency and high-frequency wide-pulse neuromuscular electrical stimulation. In the responders, the extra torque was greater for high-frequency than for low-frequency wide-pulse neuromuscular electrical stimulation. The superimposition of tendon vibration had no effect on extra torque occurrence or magnitude.
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Affiliation(s)
- Loïc Espeit
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
| | - Vianney Rozand
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
| | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France.,Institut Universitaire de France, Paris, France
| | - Julien Gondin
- Institut NeuroMyoGène, Université Claude Bernard Lyon 1, CNRS UMR-5310, INSERM U-1217, Lyon, France
| | | | - Thomas Lapole
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
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17
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Tsai SY, Schreiber JA, Adamczyk NS, Wu JY, Ton ST, Hofler RC, Walter JS, O'Brien TE, Kartje GL, Nockels RP. Improved Functional Outcome After Peripheral Nerve Stimulation of the Impaired Forelimb Post-stroke. Front Neurol 2021; 12:610434. [PMID: 33959086 PMCID: PMC8093517 DOI: 10.3389/fneur.2021.610434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Lack of blood flow to the brain, i.e., ischemic stroke, results in loss of nerve cells and therefore loss of function in the effected brain regions. There is no effective treatment to improve lost function except restoring blood flow within the first several hours. Rehabilitation strategies are widely used with limited success. The purpose of this study was to examine the effect of electrical stimulation on the impaired upper extremity to improve functional recovery after stroke. We developed a rodent model using an electrode cuff implant onto a single peripheral nerve (median nerve) of the paretic forelimb and applied daily electrical stimulation. The skilled forelimb reaching test was used to evaluate functional outcome after stroke and electrical stimulation. Anterograde axonal tracing from layer V pyramidal neurons with biotinylated dextran amine was done to evaluate the formation of new neuronal connections from the contralesional cortex to the deafferented spinal cord. Rats receiving electrical stimulation on the median nerve showed significant improvement in the skilled forelimb reaching test in comparison with stroke only and stroke with sham stimulation. Rats that received electrical stimulation also exhibited significant improvement in the latency to initiate adhesive removal from the impaired forelimb, indicating better sensory recovery. Furthermore, axonal tracing analysis showed a significant higher midline fiber crossing index in the cervical spinal cord of rats receiving electrical stimulation. Our results indicate that direct peripheral nerve stimulation leads to improved sensorimotor recovery in the stroke-impaired forelimb, and may be a useful approach to improve post-stroke deficits in human patients.
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Affiliation(s)
- Shih-Yen Tsai
- Edward Hines Jr. Veteran Affairs Hospital, Hines, IL, United States
| | - Jennifer A Schreiber
- Edward Hines Jr. Veteran Affairs Hospital, Hines, IL, United States.,Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States
| | | | - Joanna Y Wu
- Edward Hines Jr. Veteran Affairs Hospital, Hines, IL, United States
| | - Son T Ton
- Edward Hines Jr. Veteran Affairs Hospital, Hines, IL, United States
| | - Ryan C Hofler
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States
| | - James S Walter
- Edward Hines Jr. Veteran Affairs Hospital, Hines, IL, United States
| | - Timothy E O'Brien
- Department of Mathematics and Statistics and Institute of Environmental Sustainability, Loyola University Chicago, Chicago, IL, United States
| | - Gwendolyn L Kartje
- Edward Hines Jr. Veteran Affairs Hospital, Hines, IL, United States.,Department of Molecular Pharmacology and Neuroscience, Loyola University Chicago Health Science Division, Chicago, IL, United States
| | - Russ P Nockels
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States
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18
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Insausti-Delgado A, López-Larraz E, Omedes J, Ramos-Murguialday A. Intensity and Dose of Neuromuscular Electrical Stimulation Influence Sensorimotor Cortical Excitability. Front Neurosci 2021; 14:593360. [PMID: 33519355 PMCID: PMC7845652 DOI: 10.3389/fnins.2020.593360] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES) of the nervous system has been extensively used in neurorehabilitation due to its capacity to engage the muscle fibers, improving muscle tone, and the neural pathways, sending afferent volleys toward the brain. Although different neuroimaging tools suggested the capability of NMES to regulate the excitability of sensorimotor cortex and corticospinal circuits, how the intensity and dose of NMES can neuromodulate the brain oscillatory activity measured with electroencephalography (EEG) is still unknown to date. We quantified the effect of NMES parameters on brain oscillatory activity of 12 healthy participants who underwent stimulation of wrist extensors during rest. Three different NMES intensities were included, two below and one above the individual motor threshold, fixing the stimulation frequency to 35 Hz and the pulse width to 300 μs. Firstly, we efficiently removed stimulation artifacts from the EEG recordings. Secondly, we analyzed the effect of amplitude and dose on the sensorimotor oscillatory activity. On the one hand, we observed a significant NMES intensity-dependent modulation of brain activity, demonstrating the direct effect of afferent receptor recruitment. On the other hand, we described a significant NMES intensity-dependent dose-effect on sensorimotor activity modulation over time, with below-motor-threshold intensities causing cortical inhibition and above-motor-threshold intensities causing cortical facilitation. Our results highlight the relevance of intensity and dose of NMES, and show that these parameters can influence the recruitment of the sensorimotor pathways from the muscle to the brain, which should be carefully considered for the design of novel neuromodulation interventions based on NMES.
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Affiliation(s)
- Ainhoa Insausti-Delgado
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- International Max Planck Research School (IMPRS) for Cognitive and Systems Neuroscience, Tübingen, Germany
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | - Jason Omedes
- Instituto de Investigación en Ingeniería de Aragón (I3A), Zaragoza, Spain
- Departamento de Informática e Ingeniería de Sistemas (DIIS), University of Zaragoza, Zaragoza, Spain
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Neurotechnology Laboratory, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
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19
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Milosevic M, Marquez-Chin C, Masani K, Hirata M, Nomura T, Popovic MR, Nakazawa K. Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation. Biomed Eng Online 2020; 19:81. [PMID: 33148270 PMCID: PMC7641791 DOI: 10.1186/s12938-020-00824-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
Delivering short trains of electric pulses to the muscles and nerves can elicit action potentials resulting in muscle contractions. When the stimulations are sequenced to generate functional movements, such as grasping or walking, the application is referred to as functional electrical stimulation (FES). Implications of the motor and sensory recruitment of muscles using FES go beyond simple contraction of muscles. Evidence suggests that FES can induce short- and long-term neurophysiological changes in the central nervous system by varying the stimulation parameters and delivery methods. By taking advantage of this, FES has been used to restore voluntary movement in individuals with neurological injuries with a technique called FES therapy (FEST). However, long-lasting cortical re-organization (neuroplasticity) depends on the ability to synchronize the descending (voluntary) commands and the successful execution of the intended task using a FES. Brain-computer interface (BCI) technologies offer a way to synchronize cortical commands and movements generated by FES, which can be advantageous for inducing neuroplasticity. Therefore, the aim of this review paper is to discuss the neurophysiological mechanisms of electrical stimulation of muscles and nerves and how BCI-controlled FES can be used in rehabilitation to improve motor function.
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Affiliation(s)
- Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan.
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro, Tokyo, 153-8902, Japan
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20
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Bao SC, Khan A, Song R, Kai-yu Tong R. Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration. J Stroke 2020; 22:47-63. [PMID: 32027791 PMCID: PMC7005350 DOI: 10.5853/jos.2019.03027] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.
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Affiliation(s)
- Shi-chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Ahsan Khan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong Song
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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21
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Bao SC, Leung WC, K Cheung VC, Zhou P, Tong KY. Pathway-specific modulatory effects of neuromuscular electrical stimulation during pedaling in chronic stroke survivors. J Neuroeng Rehabil 2019; 16:143. [PMID: 31744520 PMCID: PMC6862792 DOI: 10.1186/s12984-019-0614-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/24/2019] [Indexed: 12/25/2022] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is extensively used in stroke motor rehabilitation. How it promotes motor recovery remains only partially understood. NMES could change muscular properties, produce altered sensory inputs, and modulate fluctuations of cortical activities; but the potential contribution from cortico-muscular couplings during NMES synchronized with dynamic movement has rarely been discussed. Method We investigated cortico-muscular interactions during passive, active, and NMES rhythmic pedaling in healthy subjects and chronic stroke survivors. EEG (128 channels), EMG (4 unilateral lower limb muscles) and movement parameters were measured during 3 sessions of constant-speed pedaling. Sensory-level NMES (20 mA) was applied to the muscles, and cyclic stimulation patterns were synchronized with the EMG during pedaling cycles. Adaptive mixture independent component analysis was utilized to determine the movement-related electro-cortical sources and the source dipole clusters. A directed cortico-muscular coupling analysis was conducted between representative source clusters and the EMGs using generalized partial directed coherence (GPDC). The bidirectional GPDC was compared across muscles and pedaling sessions for post-stroke and healthy subjects. Results Directed cortico-muscular coupling of NMES cycling was more similar to that of active pedaling than to that of passive pedaling for the tested muscles. For healthy subjects, sensory-level NMES could modulate GPDC of both ascending and descending pathways. Whereas for stroke survivors, NMES could modulate GPDC of only the ascending pathways. Conclusions By clarifying how NMES influences neuromuscular control during pedaling in healthy and post-stroke subjects, our results indicate the potential limitation of sensory-level NMES in promoting sensorimotor recovery in chronic stroke survivors.
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Affiliation(s)
- Shi-Chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Cheong Leung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C K Cheung
- School of Biomedical Sciences, and The Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong, Hong Kong, China.,The KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research of Common Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, 77030, TX, USA.,TIRR Memorial Hermann Research Center, Houston, 77030, TX, USA
| | - Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China. .,Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.
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22
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Carson RG, Buick AR. Neuromuscular electrical stimulation-promoted plasticity of the human brain. J Physiol 2019; 599:2375-2399. [PMID: 31495924 DOI: 10.1113/jp278298] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
Abstract
The application of neuromuscular electrical stimulation (NMES) to paretic limbs has demonstrated utility for motor rehabilitation following brain injury. When NMES is delivered to a mixed peripheral nerve, typically both efferent and afferent fibres are recruited. Muscle contractions brought about by the excitation of motor neurons are often used to compensate for disability by assisting actions such as the formation of hand aperture, or by preventing others including foot drop. In this context, exogenous stimulation provides a direct substitute for endogenous neural drive. The goal of the present narrative review is to describe the means through which NMES may also promote sustained adaptations within central motor pathways, leading ultimately to increases in (intrinsic) functional capacity. There is an obvious practical motivation, in that detailed knowledge concerning the mechanisms of adaptation has the potential to inform neurorehabilitation practice. In addition, responses to NMES provide a means of studying CNS plasticity at a systems level in humans. We summarize the fundamental aspects of NMES, focusing on the forms that are employed most commonly in clinical and experimental practice. Specific attention is devoted to adjuvant techniques that further promote adaptive responses to NMES thereby offering the prospect of increased therapeutic potential. The emergent theme is that an association with centrally initiated neural activity, whether this is generated in the context of NMES triggered by efferent drive or via indirect methods such as mental imagery, may in some circumstances promote the physiological changes that can be induced through peripheral electrical stimulation.
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Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland.,School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, UK.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Alison R Buick
- School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, UK
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23
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Jiang SL, Wang Z, Yi W, He F, Qi H, Ming D. Current Change Rate Influences Sensorimotor Cortical Excitability During Neuromuscular Electrical Stimulation. Front Hum Neurosci 2019; 13:152. [PMID: 31156411 PMCID: PMC6529745 DOI: 10.3389/fnhum.2019.00152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES) is frequently used in rehabilitation therapy to improve motor recovery. To optimize the stimulatory effect of NMES, the parameters of NMES, including stimulation mode, location, current intensity, and duration, among others have been investigated; however, these studies mainly focused on the effects of changing parameters in the current plateau stage of the NMES cycle, while the impacts on other stages, such as the current rising stage, have yet to be investigated. In this article, we studied the electroencephalograph (EEG) effects during NMES, with different rates of current change in the rising stage, and stable current intensity in the plateau stage. EEG signals (64-channel) were collected from 28 healthy subjects, who were administered with high, medium, or low current change rate (CCR) NMES through a right-hand wrist extensor. Time-frequency analysis and brain source analysis, using the LORETA method, were used to investigate neural activity in sensorimotor cortical areas. The strengths of cortical activity induced by different CCR conditions were compared. NMES with a high CCR activated the sensorimotor cortex, despite the NMES current intensity in the plateau stage lower than the motor threshold. Reduction of the Alpha 2 band (10–13 Hz) event related spectral power (ERSP) during NMES stimulation was significantly enhanced by increasing CCR (p < 0.05). LORETA-based source analysis demonstrated that, in addition to typical sensory areas, such as primary somatosensory cortex (S1), sensorimotor areas including primary motor cortex (M1), premotor cortex (PMC), and somatosensory association cortex (SAC) were all activated by within threshold NMES. Furthermore, compared with the low CCR condition, cortical activity was significantly enhanced in the S1, M1, and PMC areas under high CCR conditions. This study shows CCR in the NMES rising stage can affect EEG responses in the sensorimotor cortex and suggests that CCR is an important parameter applicable to the optimization of NMES treatment.
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Affiliation(s)
- Sheng-Long Jiang
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Zhongpeng Wang
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Weibo Yi
- Beijing Machine and Equipment Institute, Beijing, China
| | - Feng He
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Hongzhi Qi
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- *Correspondence: Hongzhi Qi Dong Ming
| | - Dong Ming
- Biomedical Engineering Department, School of Precision Instrument & Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- *Correspondence: Hongzhi Qi Dong Ming
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24
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Rodgers MM, Alon G, Pai VM, Conroy RS. Wearable technologies for active living and rehabilitation: Current research challenges and future opportunities. J Rehabil Assist Technol Eng 2019; 6:2055668319839607. [PMID: 31245033 PMCID: PMC6582279 DOI: 10.1177/2055668319839607] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 02/20/2019] [Indexed: 12/28/2022] Open
Abstract
This paper presents some recent developments in the field of wearable sensors and systems that are relevant to rehabilitation and provides examples of systems with evidence supporting their effectiveness for rehabilitation. A discussion of current challenges and future developments for selected systems is followed by suggestions for future directions needed to advance towards wider deployment of wearable sensors and systems for rehabilitation.
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Affiliation(s)
- Mary M Rodgers
- Department of Physical Therapy & Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gad Alon
- Department of Physical Therapy & Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Richard S Conroy
- Office of Strategic Coordination, National Institutes of Health, Bethesda, MD, USA
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25
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Neyroud D, Gonzalez M, Mueller S, Agostino D, Grosprêtre S, Maffiuletti NA, Kayser B, Place N. Neuromuscular adaptations to wide-pulse high-frequency neuromuscular electrical stimulation training. Eur J Appl Physiol 2019; 119:1105-1116. [DOI: 10.1007/s00421-019-04100-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
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26
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Neurophysiological Evidence of Motor Network Reorganization in Myotonic Dystrophy Type 1. J Clin Neurophysiol 2019; 36:74-81. [DOI: 10.1097/wnp.0000000000000508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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Gad* A. Functional Electrical Stimulation (FES): Clinical successes and failures to date. ACTA ACUST UNITED AC 2018. [DOI: 10.29328/journal.jnpr.1001022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Maffiuletti NA, Gondin J, Place N, Stevens-Lapsley J, Vivodtzev I, Minetto MA. Clinical Use of Neuromuscular Electrical Stimulation for Neuromuscular Rehabilitation: What Are We Overlooking? Arch Phys Med Rehabil 2017; 99:806-812. [PMID: 29233625 DOI: 10.1016/j.apmr.2017.10.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/18/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022]
Abstract
The clinical success of neuromuscular electrical stimulation (NMES) for neuromuscular rehabilitation is greatly compromised by the poor consideration of different physiological and methodological issues that are not always obvious to the clinicians. Therefore, the aim of this narrative review is to reexamine some of these fundamental aspects of NMES using a tripartite model perspective. First, we contend that NMES does not actually bypass the central nervous system but results in a multitude of neurally mediated responses that contribute substantially to force generation and may engender neural adaptations. Second, we argue that too much emphasis is generally placed on externally controllable stimulation parameters while the major determinant of NMES effectiveness is the intrinsically determined muscle tension generated by the current (ie, evoked force). Third, we believe that a more systematic approach to NMES therapy is required in the clinic and this implies a better identification of the patient-specific impairment and of the potential "responders" to NMES therapy. On the basis of these considerations, we suggest that the crucial steps to ensure the clinical effectiveness of NMES treatment should consist of (1) identifying the neuromuscular impairment with clinical assessment and (2) implementing algorithm-based NMES therapy while (3) properly dosing the treatment with tension-controlled NMES and eventually amplifying its neural effects.
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Affiliation(s)
| | - Julien Gondin
- NeuroMyoGene Institute, University Claude Bernard Lyon 1, INSERM U1217, CNRS UMR 5310, Villeurbanne, France
| | - Nicolas Place
- Institute of Sport Sciences, Faculty of Biology Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Isabelle Vivodtzev
- INSERM U1042, HP2 Laboratory (Hypoxia: Pathophysiology), University Grenoble Alps, Grenoble, France
| | - Marco A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
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