Whole-hand water flow stimulation increases motor cortical excitability: a study of transcranial magnetic stimulation and movement-related cortical potentials

Shaping corticospinal pathways in virtual reality: effects of task complexity and sensory feedback during mirror therapy in neurologically intact individuals

BACKGROUND

Restoration of limb function for individuals with unilateral weakness typically requires volitional muscle control, which is often not present for individuals with severe impairment. Mirror therapy-interventions using a mirror box to reflect the less-impaired limb onto the more-impaired limb-can facilitate corticospinal excitability, leading to enhanced recovery in severely impaired clinical populations. However, the mirror box applies limitations on mirror therapy, namely that all movements appear bilateral and are confined to a small area, impeding integration of complex activities and multisensory feedback (e.g., visuo-tactile stimulation). These limitations can be addressed with virtual reality, but the resulting effect on corticospinal excitability is unclear.

OBJECTIVE

Examine how virtual reality-based unilateral mirroring, complex activities during mirroring, and visuo-tactile stimulation prior to mirroring affect corticospinal excitability.

MATERIALS AND METHODS

Participants with no known neurological conditions (n = 17) donned a virtual reality system (NeuRRoVR) that displayed a first-person perspective of a virtual avatar that matched their motions. Transcranial magnetic stimulation-induced motor evoked potentials in the nondominant hand muscles were used to evaluate corticospinal excitability in four conditions: resting, mirroring, mirroring with prior visuo-tactile stimulation (mirroring + TACT), and control. During mirroring, the movements of each participant's dominant limb were reflected onto the nondominant limb of the virtual avatar, and the avatar's dominant limb was kept immobile (i.e., unilateral mirroring). The mirroring + TACT condition was the same as the mirroring condition, except that mirroring was preceded by visuo-tactile stimulation of the nondominant limb. During the control condition, unilateral mirroring was disabled. During all conditions, participants performed simple (flex/extend fingers) and complex (stack virtual blocks) activities.

RESULTS

We found that unilateral mirroring increased corticospinal excitability compared to no mirroring (p < 0.001), complex activities increased excitability compared to simple activities during mirroring (p < 0.001), and visuo-tactile stimulation prior to mirroring decreased excitability (p = 0.032). We also found that these features did not interact with each other.

DISCUSSIONS

The findings of this study shed light onto the neurological mechanisms of mirror therapy and demonstrate the unique ways in which virtual reality can augment mirror therapy. The findings have important implications for rehabilitation for design of virtual reality systems for clinical populations.

The Effect of Caffeine on Movement-Related Cortical Potential Morphology and Detection

Movement-related cortical potential (MRCP) is observed in EEG recordings prior to a voluntary movement. It has been used for e.g., quantifying motor learning and for brain-computer interfacing (BCIs). The MRCP amplitude is affected by various factors, but the effect of caffeine is underexplored. The aim of this study was to investigate if a cup of coffee with 85 mg caffeine modulated the MRCP amplitude and the classification of MRCPs versus idle activity, which estimates BCI performance. Twenty-six healthy participants performed 2 × 100 ankle dorsiflexion separated by a 10-min break before a cup of coffee was consumed, followed by another 100 movements. EEG was recorded during the movements and divided into epochs, which were averaged to extract three average MRCPs that were compared. Also, idle activity epochs were extracted. Features were extracted from the epochs and classified using random forest analysis. The MRCP amplitude did not change after consuming caffeine. There was a slight increase of two percentage points in the classification accuracy after consuming caffeine. In conclusion, a cup of coffee with 85 mg caffeine does not affect the MRCP amplitude, and improves MRCP-based BCI performance slightly. The findings suggest that drinking coffee is only a minor confounder in MRCP-related studies.

No effect of whole-hand water flow stimulation on skill acquisition and retention during sensorimotor adaptation

Introduction

Repetitive somatosensory stimulation (RSS) is a conventional approach to modulate the neural states of both the primary somatosensory cortex (S1) and the primary motor cortex (M1). However, the impact of RSS on skill acquisition and retention in sensorimotor adaptation remains debated. This study aimed to investigate whether whole-hand water flow (WF), a unique RSS-induced M1 disinhibition, influences sensorimotor adaptation by examining the hypothesis that whole-hand WF leads to M1 disinhibition; thereby, enhancing motor memory retention.

Methods

Sixty-eight young healthy participants were randomly allocated to three groups based on the preconditioning received before motor learning: control, whole-hand water immersion (WI), and whole-hand WF. The experimental protocol for all the participants spanned two consecutive days. On the initial day (day 1), baseline transcranial magnetic stimulation (TMS) assessments (T0) were executed before any preconditioning. Subsequently, each group underwent their respective 30 min preconditioning protocol. To ascertain the influence of each preconditioning on the excitability of the M1, subsequent TMS assessments were conducted (T1). Following this, all participants engaged in the motor learning (ML) of a visuomotor tracking task, wherein they were instructed to align a cursor with a target trajectory by modulating the pinch force. Upon completion of the ML session, final TMS assessments (T2) were conducted. All participants were required to perform the same motor learning 24 h later on day 2.

Results

The results revealed that whole-hand WF did not significantly influence skill acquisition during sensorimotor adaptation, although it did reduce intracortical inhibition. This phenomenon is consistent with the idea that S1, rather than M1, is involved in skill acquisition during the early stages of sensorimotor adaptation. Moreover, memory retention 24 h after skill acquisition did not differ significantly across the three groups, challenging our initial hypothesis that whole-hand WF enhances memory retention throughout sensorimotor adaptation. This could be due to the inability of whole-hand WF to alter sensorimotor connectivity and integration, as well as the nature of the plastic response elicited by the preconditioning.

Discussion

In conclusion, these findings suggest that although whole-hand WF attenuates intracortical inhibition, it does not modulate skill acquisition or motor memory retention during sensorimotor adaptation.

Energetic responses of head-out water immersion at different temperatures during post-exercise recovery and its consequence on anaerobic mechanical power

PURPOSE

While exercise recovery may be beneficial from a physiological point of view, it may be detrimental to subsequent anaerobic performance. To investigate the energetic responses of water immersion at different temperatures during post-exercise recovery and its consequences on subsequent anaerobic performance, a randomized and controlled crossover experimental design was performed with 21 trained cyclists.

METHOD

Participants were assigned to receive three passive recovery strategies during 10 min after a Wingate Anaerobic Test (WAnT): control (CON: non-immersed condition), cold water immersion (CWI: 20 ℃), and hot water immersion (HWI: 40 ℃). Blood lactate, cardiorespiratory, and mechanical outcomes were measured during the WAnT and its recovery. Time constant (τ), asymptotic value, and area under the curve (AUC) were quantified for each physiologic parameter during recovery. After that, a second WAnT test and 10-min recovery were realized in the same session.

RESULTS

Regardless the water immersion temperature, water immersion increased [Formula: see text] (+ 18%), asymptote ([Formula: see text]+ 16%, [Formula: see text] + 13%, [Formula: see text] + 17%, HR + 16%) and AUC ([Formula: see text]+ 27%, [Formula: see text] + 18%, [Formula: see text] + 20%, HR + 25%), while decreased [Formula: see text] (- 33%). There was no influence of water immersion on blood lactate parameters. HWI improved the mean power output during the second WAnT (2.2%), while the CWI decreased 2.4% (P < 0.01).

CONCLUSION

Independent of temperature, water immersion enhanced aerobic energy recovery without modifying blood lactate recovery. However, subsequent anaerobic performance was increased only during HWI and decreased during CWI. Despite higher than in other studies, 20 °C effectively triggered physiological and performance responses. Water immersion-induced physiological changes did not predict subsequent anaerobic performance.

Effect of whole-hand water flow stimulation on the neural balance between excitation and inhibition in the primary somatosensory cortex

Sustained peripheral somatosensory stimulations, such as high-frequency repetitive somatosensory stimulation (HF-RSS) and vibrated stimulation, are effective in altering the balance between excitation and inhibition in the somatosensory cortex (S1) and motor cortex (M1). A recent study reported that whole-hand water flow (WF) stimulation induced neural disinhibition in the M1. Based on previous results, we hypothesized that whole-hand WF stimulation would lead to neural disinhibition in the S1 because there is a strong neural connection between M1 and S1 and aimed to examine whether whole-hand WF stimulation would change the neural balance between excitation and inhibition in the S1. Nineteen healthy volunteers were studied by measuring excitation and inhibition in the S1 before and after each of the four 15-min interventions. The excitation and inhibition in the S1 were assessed using somatosensory evoked potentials (SEPs) and paired-pulse inhibition (PPI) induced by single- and paired-pulse stimulations, respectively. The four interventions were as follows: control, whole-hand water immersion, whole-hand WF, and HF-RSS. The results showed no significant changes in SEPs and PPI following any intervention. However, changes in PPI with an interstimulus interval (ISI) of 30 ms were significantly correlated with the baseline value before whole-hand WF. Thus, the present findings indicated that the whole-hand WF stimulation had a greater decreased neural inhibition in participants with higher neural inhibition in the S1 at baseline. Considering previous results on M1, the present results possibly show that S1 has lower plasticity than M1 and that the duration (15 min) of each intervention may not have been enough to alter the balance of excitation and inhibition in the S1.

The intervention of mechanical tactile stimulation modulates somatosensory evoked magnetic fields and cortical oscillations

The different cortical activity evoked by a mechanical tactile stimulus depends on tactile stimulus patterns, which demonstrates that simple stimuli (i.e., global synchronous stimulation the stimulus area) activate the primary somatosensory cortex alone, whereas complex stimuli (i.e., stimulation while moving in the stimulus area) activate not only the primary somatosensory cortex but also the primary motor area. Here, we investigated whether the effects of a repetitive mechanical tactile stimulation (MS) on somatosensory evoked magnetic fields (SEFs) and cortical oscillations depend on MS patterns. This single-blinded study included 15 healthy participants. Two types interventions of MS lasting 20 min were used: a repetitive global tactile stimulation (RGS) was used to stimulate the finger by using 24 pins installed on a finger pad, whereas a sequential stepwise displacement tactile stimulation (SSDS) was used to stimulate the finger by moving a row of six pins between the left and right sides on the finger pad. Each parameter was measured pre- and post-intervention. The P50m amplitude of the SEF was increased by RGS and decreased by SSDS. The modulation of P50m was correlated with its amplitude before RGS and with the modulation of beta band oscillation at the resting state after SSDS. This study showed that the effects of a 20-min MS on SEFs and cortical oscillations depend on mechanical tactile stimulus patterns. Moreover, our results offer potential for the modulation of tactile functions and selection of stimulation patterns according to cortical states.

Elite competitive swimmers exhibit higher motor cortical inhibition and superior sensorimotor skills in a water environment

Motor skill learning leads to task-related contextual behavioral changes that are underpinned by neuroplastic cortical reorganization. Short-term training induces environment-related contextual behavioral changes and neuroplastic changes in the primary motor cortex (M1). However, it is unclear whether environment-related contextual behavioral changes persist after long-term training and how cortical plastic changes are involved in behavior. To address these issues, we examined 14 elite competitive swimmers and 14 novices. We hypothesized that the sensorimotor skills of swimmers would be higher in a water environment than those of novices, and the recruitment of corticospinal and intracortical projections would be different between swimmers and novices. We assessed joint angle modulation performance as a behavioral measure and motor cortical excitation and inhibition using transcranial magnetic stimulation (TMS) at rest and during the tasks that were performed before, during, and after water immersion (WI). Motor cortical inhibition was measured with short-interval intracortical inhibition and long-interval intracortical inhibition by a paired-pulse TMS paradigm. We found that 1) the sensorimotor skills of swimmers who underwent long-term training in a water environment were superior and robustly unchanged compared with those of novices with respect to baseline on land, during WI, on land post-WI and 2) intracortical inhibition in water environments was increased in swimmers but was decreased in non-swimmers at rest compared to that on land; however, the latter alterations in intracortical inhibition in water environment were insufficient to account for the superior sensorimotor skills of swimmers. In conclusion, we demonstrate that environment-related contextual behavioral and neural changes occur even with long-term training experience.

Priming Effects of Water Immersion on Paired Associative Stimulation-Induced Neural Plasticity in the Primary Motor Cortex

We aimed to verify whether indirect-wave (I-wave) recruitment and cortical inhibition can regulate or predict the plastic response to paired associative stimulation with an inter-stimulus interval of 25 ms (PAS25), and also whether water immersion (WI) can facilitate the subsequent PAS25-induced plasticity. To address the first question, we applied transcranial magnetic stimulation (TMS) to the M1 hand area, while alternating the direction of the induced current between posterior-to-anterior and anterior-to-posterior to activate two independent synaptic inputs to the corticospinal neurons. Moreover, we used a paired stimulation paradigm to evaluate the short-latency afferent inhibition (SAI) and short-interval intracortical inhibition (SICI). To address the second question, we examined the motor evoked potential (MEP) amplitudes before and after PAS25, with and without WI, and used the SAI, SICI, and MEP recruitment curves to determine the mechanism underlying priming by WI on PAS25. We demonstrated that SAI, with an inter-stimulus interval of 25 ms, might serve as a predictor of the response to PAS25, whereas I-wave recruitment evaluated by the MEP latency difference was not predictive of the PAS25 response, and found that 15 min WI prior to PAS25 facilitated long-term potentiation (LTP)-like plasticity due to a homeostatic increase in cholinergic activity.

The effects of mechanical tactile stimulation on corticospinal excitability and motor function depend on pin protrusion patterns

Somatosensory stimulation modulates corticospinal excitability. Mechanical tactile stimulation (MS) activates cortical activity depending on tactile stimulation patterns. In this study, we examined whether the effects of mechanical tactile stimulation on corticospinal excitability and motor function depend on different pin protrusions patterns. This single-blind study included 18 healthy subjects. Two types of MS interventions were used: repetitive global stimulus (RGS) intervention was used to stimulate the finger by using 24 pins installed on a finger pad, and sequential stepwise displacement stimulus (SSDS) intervention was used to stimulate the finger by moving a row of 6 pins between the left and right sides on the finger pad. MS interventions were applied to the right index finger for 20 min (stim on/stim off, 1 s/5 s) at a frequency of 20 Hz. After RGS intervention, motor evoked potentials (MEPs) by transcranial magnetic stimulation were observed to be significantly smaller than pre-intervention MEPs; however, motor function using the grooved pegboard task remained unchanged. After SSDS intervention, MEPs were significantly larger and motor function significantly improved compared with pre-intervention values. Our results demonstrated that MS intervention can modulate corticospinal excitability and motor function and that the effects of MS intervention depend on MS intervention patterns.

Repetitive Passive Finger Movement Modulates Primary Somatosensory Cortex Excitability

Somatosensory inputs induced by repetitive passive movement (RPM) modulate primary motor cortex (M1) excitability; however, it is unclear whether RPM affects primary somatosensory cortex (S1) excitability. In this study, we investigated whether RPM affects somatosensory evoked potentials (SEPs) and resting state brain oscillation, including alpha and beta bands, depend on RPM frequency. Nineteen healthy subjects participated in this study, and SEPs elicited by peripheral nerve electrical stimulation were recorded from the C3’ area in order to assess S1 excitability (Exp. 1: n = 15). We focused on prominent SEP components such as N20, P25 and P45-reflecting S1 activities. In addition, resting electroencephalograms (EEGs) were recorded from C3’ area to assess the internal state of the brain network at rest (Exp. 2: n = 15). Passive abduction/adduction of the right index finger was applied for 10 min at frequencies of 0.5, 1.0, 3.0, and 5.0 Hz in Exp. 1, and 1.0, 3.0, and 5.0 Hz in Exp. 2. No changes in N20 or P25 components were observed following RPM. The 3.0 Hz-RPM decreased the P45 component for 20 min (p < 0.05), but otherwise did not affect the P45 component. There was no difference in the alpha and beta bands before and after any RPM; however, a negative correlation was observed between the rate of change of beta power and P45 component at 3.0 Hz-RPM. Our findings indicated that the P45 component changes depending on the RPM frequency, suggesting that somatosensory inputs induced by RPM influences S1 excitability. Additionally, beta power enhancement appears to contribute to the P45 component depression in 3.0 Hz-RPM.

Modulation of Corticospinal Excitability Depends on the Pattern of Mechanical Tactile Stimulation

We investigated the effects of different patterns of mechanical tactile stimulation (MS) on corticospinal excitability by measuring the motor-evoked potential (MEP). This was a single-blind study that included nineteen healthy subjects. MS was applied for 20 min to the right index finger. MS intervention was defined as simple, lateral, rubbing, vertical, or random. Simple intervention stimulated the entire finger pad at the same time. Lateral intervention stimulated with moving between left and right on the finger pad. Rubbing intervention stimulated with moving the stimulus probe, fixed by protrusion pins. Vertical intervention stimulated with moving in the forward and backward directions on the finger pad. Random intervention stimulated to finger pad with either row protrudes. MEPs were measured in the first dorsal interosseous muscle to transcranial magnetic stimulation of the left motor cortex before, immediately after, and 5–20 min after intervention. Following simple intervention, MEP amplitudes were significantly smaller than preintervention, indicating depression of corticospinal excitability. Following lateral, rubbing, and vertical intervention, MEP amplitudes were significantly larger than preintervention, indicating facilitation of corticospinal excitability. The modulation of corticospinal excitability depends on MS patterns. These results contribute to knowledge regarding the use of MS as a neurorehabilitation tool to neurological disorder.

Quantification of Movement-Related EEG Correlates Associated with Motor Training: A Study on Movement-Related Cortical Potentials and Sensorimotor Rhythms

The ability to learn motor tasks is important in both healthy and pathological conditions. Measurement tools commonly used to quantify the neurophysiological changes associated with motor training such as transcranial magnetic stimulation and functional magnetic resonance imaging pose some challenges, including safety concerns, utility, and cost. EEG offers an attractive alternative as a quantification tool. Different EEG phenomena, movement-related cortical potentials (MRCPs) and sensorimotor rhythms (event-related desynchronization—ERD, and event-related synchronization—ERS), have been shown to change with motor training, but conflicting results have been reported. The aim of this study was to investigate how the EEG correlates (MRCP and ERD/ERS) from the motor cortex are modulated by short (single session in 14 subjects) and long (six sessions in 18 subjects) motor training. Ninety palmar grasps were performed before and after 1 × 45 (or 6 × 45) min of motor training with the non-dominant hand (laparoscopic surgery simulation). Four channels of EEG were recorded continuously during the experiments. The MRCP and ERD/ERS from the alpha/mu and beta bands were calculated and compared before and after the training. An increase in the MRCP amplitude was observed after a single session of training, and a decrease was observed after six sessions. For the ERD/ERS analysis, a significant change was observed only after the single training session in the beta ERD. In conclusion, the MRCP and ERD change as a result of motor training, but they are subject to a marked intra- and inter-subject variability.

Water Sensation During Passive Propulsion for Expert and Nonexpert Swimmers

This study determined whether expert swimmers, compared with nonexperts, have superior movement perception and physical sensations of propulsion in water. Expert (national level competitors, n = 10) and nonexpert (able to swim 50 m in > 3 styles, n = 10) swimmers estimated distance traveled in water with their eyes closed. Both groups indicated their subjective physical sensations in the water. For each of two trials, two-dimensional coordinates were obtained from video recordings using the two-dimensional direct linear transformation method for calculating changes in speed. The mean absolute error of the difference between the actual and estimated distance traveled in the water was significantly lower for expert swimmers (0.90 ± 0.71 meters) compared with nonexpert swimmers (3.85 ± 0.84 m). Expert swimmers described the sensation of propulsion in water in cutaneous terms as the "sense of flow" and sensation of "skin resistance." Therefore, expert swimmers appear to have a superior sense of distance during their movement in the water compared with that of nonexpert swimmers. In addition, expert swimmers may have a better perception of movement in water. We propose that expert swimmers integrate sensations and proprioceptive senses, enabling them to better perceive and estimate distance moved through water.

Nonpainful wide-area compression inhibits experimental pain

Compression therapy, a well-recognized treatment for lymphoedema and venous disorders, pressurizes limbs and generates massive non-noxious afferent sensory barrages. The aim of this study was to study whether such afferent activity has an analgesic effect when applied on the lower limbs, hypothesizing that larger compression areas will induce stronger analgesic effects, and whether this effect correlates with conditioned pain modulation (CPM). Thirty young healthy subjects received painful heat and pressure stimuli (47°C for 30 seconds, forearm; 300 kPa for 15 seconds, wrist) before and during 3 compression protocols of either SMALL (up to ankles), MEDIUM (up to knees), or LARGE (up to hips) compression areas. Conditioned pain modulation (heat pain conditioned by noxious cold water) was tested before and after each compression protocol. The LARGE protocol induced more analgesia for heat than the SMALL protocol (P < 0.001). The analgesic effect interacted with gender (P = 0.015). The LARGE protocol was more efficient for females, whereas the MEDIUM protocol was more efficient for males. Pressure pain was reduced by all protocols (P < 0.001) with no differences between protocols and no gender effect. Conditioned pain modulation was more efficient than the compression-induced analgesia. For the LARGE protocol, precompression CPM efficiency positively correlated with compression-induced analgesia. Large body area compression exerts an area-dependent analgesic effect on experimental pain stimuli. The observed correlation with pain inhibition in response to robust non-noxious sensory stimulation may suggest that compression therapy shares similar mechanisms with inhibitory pain modulation assessed through CPM.