Physiological changes underlying bilateral isometric arm voluntary contractions in healthy humans

Abnormal changes in motor cortical maps in humans with spinal cord injury

KEY POINTS

The functional role of motor cortical reorganization following spinal cord injury (SCI) remains largely unknown. Here, we tested motor maps in a hand muscle at rest and during voluntary contraction of the hand with and without voluntary contraction of a proximal arm muscle. Motor map area in participants with SCI decreased during hand voluntary contraction and further decreased during additional contraction of a proximal arm muscle compared with rest. In contrast, motor map area in controls increased during the same motor tasks. Participants with SCI with more severe sensory deficits in the hand showed larger decreases in motor map area. Ten minutes of hand muscle-tendon vibration increased the motor map area during voluntary contraction in SCI participants. These novel findings suggest that abnormal changes in motor cortical maps during voluntary contraction after SCI can be reshaped by sensory input, knowledge that can have implications for rehabilitation.

ABSTRACT

Motor cortical representations reorganize following cervical spinal cord injury (SCI). The functional role of this reorganization remains largely unknown. Using neuronavigated transcranial magnetic stimulation, we examined motor cortical maps during voluntary contraction in humans with chronic cervical SCI and age-matched controls. We constructed motor maps in the first dorsal interosseous (FDI) muscle at rest and during voluntary contraction of the FDI with and without voluntary contraction of the biceps brachi (BB). The role of sensory input into this reorganization was examined by muscle-tendon vibration. We found that, at rest, motor maps were larger in SCI (22.3 cm2 ) compared with control (12.6 cm2 , P < 0.001) participants. Motor map area increased during voluntary contraction of the FDI (120.7%) and further increased during contraction of the BB (143.9%) compared with rest in control subjects; however, motor map area decreased during voluntary contraction of the FDI (69.5%) and further decreased during contraction of the BB (55.5%) in individuals with SCI. SCI participants with larger decreases in map area during voluntary contraction of the FDI were those with larger sensory deficits in the hand and 10 min of hand muscle-tendon vibration increased motor map area. These results provide the first evidence of abnormal changes in motor cortical maps in humans with chronic SCI during voluntary contraction, suggesting that sensory input can help to reshape this reorganization.

The modulation of short and long-latency interhemispheric inhibition during bimanually coordinated movements

Bimanual coordination is essential for the performance of many everyday tasks. There are several types of bimanually coordinated movements, classified according to whether the arms are acting to achieve a single goal (cooperative) or separate goals (independent), and whether the arms are moving symmetrically or asymmetrically. Symmetric bimanual movements are thought to facilitate corticomotor excitability (CME), while asymmetric bimanual movements are thought to recruit interhemispheric inhibition to reduce functional coupling between the motor cortices. The influences of movement symmetry and goal conceptualisation on interhemispheric interactions have not been studied together, and not during bimanually active dynamic tasks. The present study used transcranial magnetic stimulation (TMS) to investigate the modulation of CME and short- and long-latency interhemispheric inhibition (SIHI and LIHI, respectively) during bimanually active dynamic tasks requiring different types of bimanual coordination. Twenty healthy right-handed adults performed four bimanual tasks in which they held a dumbbell in each hand (independent) or a custom device between both hands (cooperative) while rhythmically flexing and extending their wrists symmetrically or asymmetrically. Motor-evoked potentials were recorded from the right extensor carpi ulnaris. We found CME was greater during asymmetric tasks than symmetric tasks, and movement symmetry did not modulate SIHI or LIHI. There was no effect of goal conceptualisation nor any interaction with movement symmetry for CME, SIHI or LIHI. Based on these results, movement symmetry and goal conceptualisation may not modulate interhemispheric inhibition during dynamic bimanual tasks. These findings contradict prevailing thinking about the roles of CME and interhemispheric inhibition in bimanual coordination.

Participation of ipsilateral cortical descending influences in bimanual wrist movements in humans

There are contralateral and less studied ipsilateral (i), indirect cortical descending projections to motoneurons (MNs). We compared ipsilateral cortical descending influences on MNs of wrist flexors by applying transcranial magnetic stimulation (TMS) over the right primary motor cortex at actively maintained flexion and extension wrist positions in uni- and bimanual tasks in right-handed participants (n = 23). The iTMS response includes a short latency (~ 25 ms) motor evoked potential (iMEP), a silent period (iSP) and a long latency (~ 60 ms) facilitation called rebound (iRB). We also investigated whether the interaction between the two hands while holding an object in a bimanual task involves ipsilateral cortical descending influences. In the unimanual task, iTMS responses in the right wrist flexors were unaffected by changes in wrist position. In the bimanual task with an object, iMEPs in the right wrist flexors were larger when the ipsilateral wrist was in flexion compared to extension. Without the object, only iRB were larger when the ipsilateral wrist was extended. Thus, ipsilateral cortical descending influences on MNs were modulated only in bimanual tasks and depended on how the two hands interacted. It is concluded that the left and right cortices cooperate in bimanual tasks involving holding an object with both hands, with possible involvement of oligo- and poly-synaptic, as well as transcallosal projections to MNs. The possible involvement of spinal and transcortical stretch and cutaneous reflexes in bimanual tasks when holding an object is discussed in the context of the well-established notion that indirect, referent control underlies motor actions.

Neurophysiological basis of manual force asymmetries in young and senior adults

In this study, we investigated age differences in manual force production to explore their neurophysiological basis. Manual pinching and gripping forces were first measured during unilateral and bilateral efforts in two groups of right-handed adults (young, n = 12, senior, n = 11). Then, transcranial magnetic stimulation (TMS) was applied to each hemisphere to assess central motor inhibition via the contralateral and ipsilateral silent period (cSP, iSP). Laterality quotients (LQs) were computed to determine asymmetries for unimanual strength tests and hemispheric asymmetries in TMS measures. Bilateral indices (BLI) were computed to assess the bilateral force deficit (BFD). During unilateral efforts, both young and senior participants exhibited similar degrees of asymmetry. Similarly, no age difference was detected when comparing LQs derived from TMS measures. During bilateral efforts, although BLI tended to be lower in seniors, no age difference was detected. Asymmetry in strength and BLI showed no association with hemispheric asymmetry in TMS measures, except for the asymmetry in pinch strength, which was associated with asymmetry in the iSP duration. These observations confirm that asymmetries in manual strength and BFD are little affected by age. Also, our results show that hemispheric asymmetries in transcallosal inhibition are associated with pinch strength asymmetry.

The Averaged EMGs Recorded from the Arm Muscles During Bimanual "Rowing" Movements

The main purpose was to analyze quantitatively the the average surface EMGs of the muscles that function around the elbow and shoulder joints of both arms in bimanual “rowing” movements, which were produced under identical elastic loads applied to the levers (“oars”). The muscles of PM group (“pulling” muscles: elbow flexors, shoulder extensors) generated noticeable velocity-dependent dynamic EMG components during the pulling and returning phases of movement and supported a steady-state activity during the hold phase. The muscles of RM group (“returning” muscles: elbow extensors, shoulder flexors) co-contracted with PM group during the movement phases and decreased activity during the hold phase. The dynamic components of the EMGs strongly depended on the velocity factor in both muscle groups, whereas the side and load factors and combinations of various factors acted only in PM group. Various subjects demonstrated diverse patterns of activity redistribution among muscles. We assume that central commands to the same muscles in two arms may be essentially different during execution of similar movement programs. Extent of the diversity in the EMG patterns of such muscles may reflect the subject's skilling in motor performance; on the other hand, the diversity can be connected with redistribution of activity between synergic muscles, thus providing a mechanism directed against development of the muscle fatigue.

Interhemispheric connectivity during bimanual isometric force generation

Interhemispheric interactions through the corpus callosum play an important role in the control of bimanual forces. However, the extent to which physiological connections between primary motor cortices are modulated during increasing levels of bimanual force generation in intact humans remains poorly understood. Here we studied coherence between electroencephalographic (EEG) signals and the ipsilateral cortical silent period (iSP), two well-known measures of interhemispheric connectivity between motor cortices, during unilateral and bilateral 10%, 40%, and 70% of maximal isometric voluntary contraction (MVC) into index finger abduction. We found that EEG-EEG coherence in the alpha frequency band decreased while the iSP area increased during bilateral compared with unilateral 40% and 70% but not 10% of MVC. Decreases in coherence in the alpha frequency band correlated with increases in the iSP area, and subjects who showed this inverse relation were able to maintain more steady bilateral muscle contractions. To further examine the relationship between the iSP and coherence we electrically stimulated the ulnar nerve at the wrist at the alpha frequency. Electrical stimulation increased coherence in the alpha frequency band and decreased the iSP area during bilateral 70% of MVC. Altogether, our findings demonstrate an inverse relation between alpha oscillations and the iSP during strong levels of bimanual force generation. We suggest that interactions between neural pathways mediating alpha oscillatory activity and transcallosal inhibition between motor cortices might contribute to the steadiness of strong bilateral isometric muscle contractions in intact humans.

Bilateral reach-to-grasp movement asymmetries after human spinal cord injury

Cervical spinal cord injury (SCI) in humans typically damages both sides of the spinal cord, resulting in asymmetric functional impairments in the arms. Despite this well-accepted notion and the growing emphasis on the use of bimanual training strategies, how movement of one arm affects the motion of the contralateral arm after SCI remains unknown. Using kinematics and multichannel electromyographic (EMG) recordings we studied unilateral and bilateral reach-to-grasp movements to a small and a large cylinder in individuals with asymmetric arm impairments due to cervical SCI and age-matched control subjects. We found that the stronger arm of SCI subjects showed movement durations longer than control subjects during bilateral compared with unilateral trials. Specifically, movement duration was prolonged when opening and closing the hand when reaching for a large and a small object, respectively, accompanied by deficient activation of finger flexor and extensor muscles. In subjects with SCI interlimb coordination was reduced compared with control subjects, and individuals with lesser coordination between hands were those who showed prolonged times to open the hand. Although the weaker arm showed movement durations during bilateral compared with unilateral trials that were proportional to controls, the stronger arm was excessively delayed during bilateral reaching. Altogether, our findings demonstrate that during bilateral reach-to-grasp movements the more impaired arm has detrimental effects on hand opening and closing of the less impaired arm and that they are related, at least in part, to deficient control of EMG activity of hand muscles. We suggest that hand opening might provide a time to drive bimanual coordination adjustments after human SCI.

Bimanual coordination of force enhances interhemispheric inhibition between the primary motor cortices

The purpose of this study was to elucidate whether bimanual coordination of force affects interhemispheric inhibition (IHI) between the primary motor cortices (M1s). IHI with the index fingers isometrically abducted against a fixed plate (AAP task) was compared with IHI with the index fingers isometrically abducted against each other (AAF task). The index fingers were held stationary at the midline and activity levels of the first dorsal interosseous muscles were equalized between the tasks. The abduction force of each index finger was individually controlled during the AAP task, and bimanually coordinated during the AAF task. IHI during the AAF task was significantly higher than that during the AAP task. IHI between the M1s is related not only to the suppression of unwanted activity of the M1 contralateral to the active M1 but also to bimanual coordination of force.

Speed-dependent contribution of callosal pathways to ipsilateral movements

Transcallosal inhibitory interactions between primary motor cortices are important to suppress unintended movements in a resting limb during voluntary activation of the contralateral limb. The functional contribution of transcallosal inhibition targeting the voluntary active limb remains unknown. Using transcranial magnetic stimulation, we examined transcallosal inhibition [by measuring interhemispheric inhibition (IHI) and the ipsilateral silent period (iSP)] in the preparatory and execution phases of isotonic slower self-paced and ballistic movements performed by the ipsilateral index finger into abduction and the elbow into flexion in intact humans. We demonstrate decreased IHI in the preparatory phase of self-paced and ballistic index finger and elbow movements compared to rest; the decrease in IHI was larger during ballistic than self-paced movements. In contrast, in the execution phase, IHI and the iSP increased during ballistic compared to self-paced movements. Transcallosal inhibition was negatively correlated with reaction times in the preparatory phase and positively correlated with movement amplitude in the execution phase. Together, our results demonstrate a widespread contribution of transcallosal inhibition to ipsilateral movements of different speeds with a functional role during rapid movements; at faster speeds, decreased transcallosal inhibition in the preparatory phase may contribute to start movements rapidly, while the increase in the execution phase may contribute to stop the movement. We argue that transcallosal pathways enable signaling of the time of discrete behavioral events during ipsilateral movements, which is amplified by the speed of a movement.

Modulation of transcallosal inhibition by bilateral activation of agonist and antagonist proximal arm muscles

Transcallosal inhibitory interactions between proximal representations in the primary motor cortex remain poorly understood. In this study, we used transcranial magnetic stimulation to examine the ipsilateral silent period (iSP; a measure of transcallosal inhibition) in the biceps and triceps brachii during unilateral and bilateral isometric voluntary contractions. Healthy volunteers performed 10% of maximal isometric voluntary elbow flexion or extension with one arm while the contralateral arm remained at rest or performed 30% of maximal isometric voluntary elbow flexion or extension. The iSP was measured in the arm performing 10% contractions, and electromyographic (EMG) recordings were comparable across conditions. The iSP onset and duration in the biceps and triceps brachii were comparable. In both muscles, the iSP depth and area were increased during bilateral contractions of homologous agonist muscles (extension-extension and flexion-flexion) compared with a unilateral contraction, whereas during bilateral contractions of nonhomologous antagonist muscles (extension-flexion and flexion-extension), the iSP depth and area were decreased compared with a unilateral contraction, and sometimes facilitation of EMG was seen. This effect was never observed during bilateral activation of homologous muscles. The size of responses evoked by cervicomedullary electrical stimulation in the arm that made 10% contractions remained unchanged across conditions. Thus transcallosal inhibition targeting triceps and biceps brachii is upregulated by voluntary contraction of the contralateral agonist muscle and downregulated by voluntary contraction of the contralateral antagonist muscle. We speculate that these reciprocal task-dependent interactions between bilateral flexor and extensor arm regions of the motor cortex may contribute to coupling between the arms during motor behavior.

Interlimb interactions during bilateral voluntary elbow flexion tasks in chronic hemiparetic stroke

The purpose was to systematically investigate interlimb interactions in chronic hemiparetic stroke. Fourteen poststroke hemiparetic subjects (>1 year) performed maximum voluntary contraction (MVC) elbow flexion tasks without visual feedback with one (unilateral) and two limbs simultaneously (bilateral). At submaximal levels, subjects produced force to a visual target reflecting 20%, 40%, 60%, and 80% of corresponding MVC in unilateral tasks, and of summated unilateral MVCs in bilateral tasks. Elbow flexion force and biceps surface electromyogram (EMG) were measured bilaterally. Proportionally increased EMG activity on the contralateral limb (motor overflow) was observed during unilateral tasks of the nonimpaired limb but not of the impaired limb. During bilateral tasks at submaximal levels, the impaired limb produced less force (i.e., force deficit [FD]) as compared to expected forces based upon its unilateral MVC. Force deficit on the impaired limb was compensated by greater force production on the nonimpaired limb such that the visual target was reached. However, force contribution to the total force progressively decreased from the nonimpaired side, when the level of submaximal contractions increased. During bilateral MVC tasks, there was no FD on the impaired limb, but FD was observed on the nonimpaired limb. A net result of a small bilateral deficit in force with parallel changes in EMG was observed. These novel findings of activation level–dependent interactions and asymmetrical contralateral motor overflow provide new insights that, among other compensatory mechanisms, ipsilateral corticospinal projections from the nonlesioned hemisphere play an important role in interlimb interactions in chronic stroke, in addition to unbalanced interhemispheric inhibition.

Impaired crossed facilitation of the corticospinal pathway after cervical spinal cord injury

In uninjured humans, it is well established that voluntary contraction of muscles on one side of the body can facilitate transmission in the contralateral corticospinal pathway. This crossed facilitatory effect may favor interlimb coordination and motor performance. Whether this aspect of corticospinal function is preserved after chronic spinal cord injury (SCI) is unknown. Here, using transcranial magnetic stimulation, we show in patients with chronic cervical SCI (C(5)-C(8)) that the size of motor evoked potentials (MEPs) in a resting intrinsic hand muscle remained unchanged during increasing levels of voluntary contraction with a contralateral distal or proximal arm muscle. In contrast, MEP size in a resting hand muscle was increased during the same motor tasks in healthy control subjects. The magnitude of voluntary electromyography was negatively correlated with MEP size after chronic cervical SCI and positively correlated in healthy control subjects. To examine the mechanisms contributing to MEP crossed facilitation we examined short-interval intracortical inhibition (SICI), interhemispheric inhibition (IHI), and motoneuronal behavior by testing F waves and cervicomedullary MEPs (CMEPs). During strong voluntary contractions SICI was unchanged after cervical SCI and decreased in healthy control subjects compared with rest. F-wave amplitude and persistence and CMEP size remained unchanged after cervical SCI and increased in healthy control subjects compared with rest. In addition, during strong voluntary contractions IHI was unchanged in cervical SCI compared with rest. Our results indicate that GABAergic intracortical circuits, interhemispheric glutamatergic projections between motor cortices, and excitability of index finger motoneurons are neural mechanisms underlying, at least in part, the lack of crossed corticospinal facilitation observed after SCI. Our data point to the spinal motoneurons as a critical site for modulating corticospinal transmission after chronic cervical SCI.

Corticomuscular coherence during bilateral isometric arm voluntary activity in healthy humans

Bilateral voluntary contractions involve functional changes in both primary motor cortices. We investigated whether a voluntary contraction controlled by one hemisphere can influence oscillatory processes contralaterally. Corticomuscular coherence was calculated between EEG recorded over the motor cortex hand representation and electromyogram from the first dorsal interosseous muscle when the nondominant hand performed a precision grip task. The dominant arm remained at rest or performed a finger abduction or an elbow flexion task at 10, 40, and 70% of maximal isometric voluntary contraction (MVC). Mean coherence in the 15- to 30-Hz range in the hand performing a precision grip increased during 40% (by 72%) and 70% (by 73%) but not during 10% of MVC in the finger abduction task. Similarly, in the elbow flexion task, mean coherence increased during 40% (by 40%) and 70% (by 48%) but not during 10% of MVC. No differences were observed between the increments in coherence between the finger abduction and elbow flexion tasks at a given force level. We speculate that these results reflect the increased complexity of controlling a fine motor task with one hand while performing a strong contraction with the contralateral hand and suggest that increased oscillatory corticomuscular coupling may contribute to successful task performance.