Corticospinal Excitability Is Lower During Rhythmic Arm Movement Than During Tonic Contraction

Motor cortex excitability is reduced during freezing of upper limb movement in Parkinson's disease

Whilst involvement of the motor cortex in the phenomenon of freezing in Parkinson's disease has been previously suggested, few empiric studies have been conducted to date. We investigated motor cortex (M1) excitability in eleven right-handed Parkinson's disease patients (aged 69.7 ± 9.6 years, disease duration 11.2 ± 3.9 years, akinesia-rigidity type) with verified gait freezing using a single-pulse transcranial magnetic stimulation (TMS) repetitive finger tapping paradigm. We delivered single TMS pulses at 120% of the active motor threshold at the 'ascending (contraction)' and 'descending (relaxation)' slope of the tap cycle during i) regular tapping, ii) the transition period of the three taps prior to a freeze and iii) during freezing of upper limb movement. M1 excitability was modulated along the tap cycle with greater motor evoked potentials (MEPs) during 'ascending' than 'descending'. Furthermore, MEPs during the 'ascending' phase of regular tapping, but not during the transition period, were greater compared to the MEPs recorded throughout a freeze. Neither force nor EMG activity 10-110 s before the stimulus predicted MEP size. This piloting study suggests that M1 excitability is reduced during freezing and the transition period preceding a freeze. This supports that M1 excitability is critical to freezing in Parkinson's disease.

Robot-assisted training with functional electrical stimulation enhances lower extremity function after spinal cord injury

INTRODUCTION

Functional Electrical Stimulation (FES) synchronized with robot-assisted lower extremity training is used in spinal cord injury (SCI) rehabilitation to promote residual function.

METHODS

Data of SCI inpatients who trained lower limb mobilization on a stationary robotic system were retrospectively analyzed. The primary outcome was the improvement of muscle strength from the first through to the last training session during FES-induced as well as voluntarily induced flexion and extension. The secondary outcome was the sum score of voluntary muscle function in the lower limbs before and after the training period.

RESULTS

Data from 72 patients with SCI (AIS A-D) were analyzed. For extension, FES-assisted strength increased (p<0.001) from 25.2 to 44.0 N, voluntary force (p<0.001) from 24.4 to 39.9 N. For flexion, FES-assisted flexion (p<0.006) increased from 14.1 to 19.0 N, voluntary flexion (p<0.005) from 12.6 to 17.1 N. There was a significant correlation between the increase in FES-assisted force and voluntary flexion (r=0.730, p=0.001) as well as between the increase in FES-assisted force and voluntary extension (r=0.881, p<0.001). The sum score in muscle test increased from 15 to 24 points.

CONCLUSION

Robot-assisted training with FES seems to support the regeneration of residual functions after SCI. This is evidenced by an improvement in motor function and strength in the lower limbs.

Moving forward: methodological considerations for assessing corticospinal excitability during rhythmic motor output in humans

The use of transcranial magnetic stimulation to assess the excitability of the central nervous system to further understand the neural control of human movement is expansive. The majority of the work performed to-date has assessed corticospinal excitability either at rest or during relatively simple isometric contractions. The results from this work are not easily extrapolated to rhythmic, dynamic motor outputs, given that corticospinal excitability is task-, phase-, intensity-, direction-, and muscle-dependent (Power KE, Lockyer EJ, Forman DA, Button DC. Appl Physiol Nutr Metab 43: 1176-1185, 2018). Assessing corticospinal excitability during rhythmic motor output, however, involves technical challenges that are to be overcome, or at the minimum considered, when attempting to design experiments and interpret the physiological relevance of the results. The purpose of this narrative review is to highlight the research examining corticospinal excitability during a rhythmic motor output and, importantly, to provide recommendations regarding the many factors that must be considered when designing and interpreting findings from studies that involve limb movement. To do so, the majority of work described herein refers to work performed using arm cycling (arm pedaling or arm cranking) as a model of a rhythmic motor output used to examine the neural control of human locomotion.

Changes in muscle activity during the flexion and extension phases of arm cycling as an effect of power output are muscle-specific

Arm cycling is commonly used in rehabilitation settings for individuals with motor impairments in an attempt to facilitate neural plasticity, potentially leading to enhanced motor function in the affected limb(s). Studies examining the neural control of arm cycling, however, typically cycle using a set cadence and power output. Given the importance of motor output intensity, typically represented by the amplitude of electromyographic (EMG) activity, on neural excitability, surprisingly little is known about how arm muscle activity is modulated using relative workloads. Thus, the objective of this study was to characterize arm muscle activity during arm cycling at different relative workloads. Participants (n = 11) first completed a 10-second maximal arm ergometry sprint to determine peak power output (PPO) followed by 11 randomized trials of 20-second arm cycling bouts ranging from 5–50% of PPO (5% increments) and a standard 25 W workload. All submaximal trials were completed at 60 rpm. Integrated EMG amplitude (iEMG) was assessed from the biceps brachii, brachioradialis, triceps brachii, flexor carpi radialis, extensor carpi radialis and anterior deltoid of the dominant arm. Arm cycling was separated into two phases, flexion and extension, relative to the elbow joint for all comparisons. As expected, iEMG amplitude increased during both phases of cycling for all muscles examined. With the exception of the triceps brachii and extensor carpi radialis, iEMG amplitudes differed between the flexion and extension phases. Finally, there was a linear relationship between iEMG amplitude and the %PPO for all muscles during both elbow flexion and extension.

Freely Chosen Cadence During Cycling Attenuates Intracortical Inhibition and Increases Intracortical Facilitation Compared to a Similar Fixed Cadence

In contrast to other rhythmic tasks such as running, the preferred movement rate in cycling does not minimize energy consumption. It is possible that neurophysiological mechanisms contribute to the choice of cadence, however this phenomenon is not well understood. Eleven participants cycled at a fixed workload of 125 W and different cadences including a freely chosen cadence (FCC, ∼72), and fixed cadences of 70, 80, 90 and 100 revolutions per minute (rpm) during which transcranial magnetic stimulation (TMS) was used to measure short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). There was a significant increase in SICI at 70 (P = 0.004), 80 (P = 0.008) and 100 rpm (P = 0.041) compared to FCC. ICF was significantly reduced at 70 rpm compared to FCC (P = 0.04). Inhibition-excitation ratio (SICI divided by ICF) declined (P = 0.014) with an increase in cadence. The results demonstrate that SICI is attenuated during FCC compared to fixed cadences. The outcomes suggest that the attenuation of intracortical inhibition and augmentation of ICF may be a contributing factor for FCC.

Corticospinal excitability to the biceps and triceps brachii during forward and backward arm cycling is direction- and phase-dependent

The purpose of this study was to evaluate corticospinal excitability to the biceps and triceps brachii during forward (FWD) and backward (BWD) arm cycling. Corticospinal and spinal excitability were assessed using transcranial magnetic stimulation and transmastoid electrical stimulation to elicit motor evoked potentials (MEPs) and cervicomedullary evoked potentials (CMEPs), respectively. MEPs and CMEPs were recorded from the biceps and triceps brachii during FWD and BWD arm cycling at 2 positions, 6 and 12 o’clock. The 6 o’clock position corresponded to mid-elbow flexion and extension during FWD and BWD cycling, respectively, while 12 o’clock corresponded to mid-elbow extension and flexion during FWD and BWD cycling, respectively. During the flexion phase, MEP and CMEP amplitudes of the biceps brachii were higher during FWD cycling. However, during the extension phase, MEP and CMEP amplitudes were higher during BWD cycling. For the triceps brachii, MEP amplitudes were higher during FWD cycling regardless of phase. However, CMEP amplitudes were phase-dependent. During the flexion phase, CMEPs of the triceps brachii were higher during FWD cycling compared with BWD, but during the extension phase CMEPs were higher during BWD cycling compared with FWD. The data suggest that corticospinal and spinal excitability to the biceps brachii is phase- and direction-dependent. In the triceps brachii, spinal, but not corticospinal, excitability is phase-dependent when comparing FWD and BWD cycling.

Novelty This is the first study to assess corticospinal excitability during FWD and BWD locomotor output. Corticospinal excitability during arm cycling depends on the direction, phase, and muscle being assessed.

Global Corticospinal Excitability as Assessed in A Non-Exercised Upper Limb Muscle Compared Between Concentric and Eccentric Modes of Leg Cycling

This study investigated the effects of eccentric (ECC) and concentric (CON) semi-recumbent leg cycling on global corticospinal excitability (CSE), assessed through the activity of a non-exercised hand muscle. Thirteen healthy male adults completed two 30-min bouts of moderate intensity ECC and CON recumbent cycling on separate days. Power output (POutput), heart rate (HR) and cadence were monitored during cycling. Global CSE was assessed using transcranial magnetic stimulation to elicit motor-evoked potentials (MEP) in the right first dorsal interosseous muscle before (‘Pre’), interleaved (at 10 and 20 mins, t10 and t20, respectively), immediately after (post, P0), and 30-min post exercise (P30). Participants briefly stopped pedalling (no more than 60 s) while stimulation was applied at the t10 and t20 time-points of cycling. Mean POutput, and rate of perceived exertion (RPE) did not differ between ECC and CON cycling and HR was significantly lower during ECC cycling (P = 0.01). Group mean MEP amplitudes were not significantly different between ECC and CON cycling at P0, t10, t20, and P30 and CON (at P > 0.05). Individual participant ratios of POutput and MEP amplitude showed large variability across the two modes of cycling, as did changes in slope of stimulus-response curves. These results suggest that compared to ‘Pre’ values, group mean CSE is not significantly affected by low-moderate intensity leg cycling in both modes. However, POutput and CSE show wide inter-participant variability which has implications for individual neural responses to CON and ECC cycling and rates of adaptation to a novel (ECC) mode. The study of CSE should therefore be analysed for each participant individually in relation to relevant physiological variables and account for familiarisation to semi-recumbent ECC leg cycling.

Walking and finger tapping can be done with independent rhythms

Rhythmic movements occur in many aspects of daily life. Examples include clapping the hands and walking. The production of two independent rhythms with multiple limbs is considered to be extremely difficult. In the present study we evaluated whether two different, independent rhythms that involved finger tapping and walking could be produced. In Experiment I, twenty subjects that had no experience of musical instrument training performed rhythmic finger tapping with the right index finger and one of four different lower limb movements; (1) self-paced walking, (2) given-paced walking, (3) alternative bilateral heel tapping from a sitting position, and (4) unilateral heel tapping with the leg ipsilateral to the tapping finger from a sitting position. The target intervals of finger tapping and heel strikes for walking step/heel tapping were set at 375 ms and 600 ms, respectively. The even distribution of relative phases between instantaneous finger tapping and heel strike was taken as the criteria of independency for the two rhythms. In the self-paced walking and given-paced walking tasks, 16 out of 20 subjects successfully performed finger tapping and walking with independent rhythms without any special practice. On the other hand, in the bipedal heels striking and unipedal heel striking tasks 19 subjects failed to perform the two movements independently, falling into interrelated rhythms with the ratio mostly being 2:1. In Experiment II, a similar independency of finger tapping and walking at a given pace was observed for heel strike intervals of 400, 600, and 800 ms, as well as at the constant 375 ms for finger tapping. These results suggest that finger tapping and walking are controlled by separate neural control mechanisms, presumably with a supra-spinal locus for finger tapping, and a spinal location for walking.

Understanding exercise-dependent plasticity of motoneurons using intracellular and intramuscular approaches

Spinal motoneurons (MN) exhibit exercise-dependent adaptations to increased activity, such as exercise and locomotion, as well as decreased activity associated with disuse, spinal cord injury, and aging. The development of several experimental approaches, in both human and animal models, has contributed significantly to our understanding of this plasticity. The purpose of this review is to summarize how intracellular recordings in an animal model and motor unit recordings in a human model have, together, contributed to our current understanding of exercise-dependent MN plasticity. These approaches and techniques will allow neuroscientists to continue to advance our understanding of MN physiology and the plasticity of the "final common path" of the motor system, and to design experiments to answer the critical questions that are emerging in this field.

Neuromuscular fatigue during repeated sprint exercise: underlying physiology and methodological considerations

Neuromuscular fatigue occurs when an individual’s capacity to produce force or power is impaired. Repeated sprint exercise requires an individual to physically exert themselves at near-maximal to maximal capacity for multiple short-duration bouts, is extremely taxing on the neuromuscular system, and consequently leads to the rapid development of neuromuscular fatigue. During repeated sprint exercise the development of neuromuscular fatigue is underlined by a combination of central and peripheral fatigue. However, there are a number of methodological considerations that complicate the quantification of the development of neuromuscular fatigue. The main goal of this review is to synthesize the results from recent investigations on the development of neuromuscular fatigue during repeated sprint exercise. Hence, we summarize the overall development of neuromuscular fatigue, explain how recovery time may alter the development of neuromuscular fatigue, outline the contributions of peripheral and central fatigue to neuromuscular fatigue, and provide some methodological considerations for quantifying neuromuscular fatigue during repeated sprint exercise.

Modulation of motoneurone excitability during rhythmic motor outputs

In quadrupeds, special circuity located within the spinal cord, referred to as central pattern generators (CPGs), is capable of producing complex patterns of activity such as locomotion in the absence of descending input. During these motor outputs, the electrical properties of spinal motoneurones are modulated such that the motoneurone is more easily activated. Indirect evidence suggests that like quadrupeds, humans also have spinally located CPGs capable of producing locomotor outputs, albeit descending input is considered to be of greater importance. Whether motoneurone properties are reconfigured in a similar manner to those of quadrupeds is unclear. The purpose of this review is to summarize our current state of knowledge regarding the modulation of motoneurone excitability during CPG-mediated motor outputs using animal models. This will be followed by more recent work initially aimed at understanding changes in motoneurone excitability during CPG-mediated motor outputs in humans, which quickly expanded to also include supraspinal excitability.

Intensity matters: effects of cadence and power output on corticospinal excitability during arm cycling are phase and muscle dependent

The present study investigated the effects of cadence and power output on corticospinal excitability to the biceps (BB) and triceps brachii (TB) during arm cycling. Supraspinal and spinal excitability were assessed using transcranial magnetic stimulation (TMS) of the motor cortex and transmastoid electrical stimulation (TMES) of the corticospinal tract, respectively. Motor-evoked potentials (MEPs) elicited by TMS and cervicomedullary motor-evoked potentials (CMEPs) elicited by TMES were recorded at two positions during arm cycling corresponding to mid-elbow flexion and mid-elbow extension (i.e., 6 and 12 o'clock made relative to a clock face, respectively). Arm cycling was performed at combinations of two cadences (60 and 90 rpm) at three relative power outputs (20, 40, and 60% peak power output). At the 6 o'clock position, BB MEPs increased ~11.5% as cadence increased and up to ~57.2% as power output increased ( P < 0.05). In the TB, MEPs increased ~15.2% with cadence ( P = 0.013) but were not affected by power output, while CMEPs increased with cadence (~16.3%) and power output (up to ~19.1%, P < 0.05). At the 12 o'clock position, BB MEPs increased ~26.8% as cadence increased and up to ~96.1% as power output increased ( P < 0.05), while CMEPs decreased ~29.7% with cadence ( P = 0.013) and did not change with power output ( P = 0.851). In contrast, TB MEPs were not different with cadence or power output, while CMEPs increased ~12.8% with cadence and up to ~23.1% with power output ( P < 0.05). These data suggest that the "type" of intensity differentially modulates supraspinal and spinal excitability in a manner that is phase- and muscle dependent. NEW & NOTEWORTHY There is currently little information available on how changes in locomotor intensity influence excitability within the corticospinal pathway. This study investigated the effects of arm cycling intensity (i.e., alterations in cadence and power output) on corticospinal excitability projecting to the biceps and triceps brachii during arm cycling. We demonstrate that corticospinal excitability is modulated differentially by cadence and power output and that these modulations are dependent on the phase and the muscle examined.

Sherlock Holmes and the curious case of the human locomotor central pattern generator

Evidence first described in reduced animal models over 100 years ago led to deductions about the control of locomotion through spinal locomotor central pattern-generating (CPG) networks. These discoveries in nature were contemporaneous with another form of deductive reasoning found in popular culture, that of Arthur Conan Doyle's detective, Sherlock Holmes. Because the invasive methods used in reduced nonhuman animal preparations are not amenable to study in humans, we are left instead with deducing from other measures and observations. Using the deductive reasoning approach of Sherlock Holmes as a metaphor for framing research into human CPGs, we speculate and weigh the evidence that should be observable in humans based on knowledge from other species. This review summarizes indirect inference to assess "observable evidence" of pattern-generating activity that leads to the logical deduction of CPG contributions to arm and leg activity during locomotion in humans. The question of where a CPG may be housed in the human nervous system remains incompletely resolved at this time. Ongoing understanding, elaboration, and application of functioning locomotor CPGs in humans is important for gait rehabilitation strategies in those with neurological injuries.

Modulation of corticospinal input to the legs by arm and leg cycling in people with incomplete spinal cord injury

The spinal cervico-lumbar interaction during rhythmic movements in humans has recently been studied; however, the role of arm movements in modulating the corticospinal drive to the legs is not well understood. The goals of this study were to investigate the effect of active rhythmic arm movements on the corticospinal drive to the legs (study 1) and assess the effect of simultaneous arm and leg training on the corticospinal pathway after incomplete spinal cord injury (iSCI) (study 2). In study 1, neurologically intact (NI) participants or participants with iSCI performed combinations of stationary and rhythmic cycling of the arms and legs while motor evoked potentials (MEPs) were recorded from the vastus lateralis (VL) muscle. In the NI group, arm cycling alone could facilitate the VL MEP amplitude, suggesting that dynamic arm movements strongly modulate the corticospinal pathway to the legs. No significant difference in VL MEP between conditions was found in participants with iSCI. In study 2, participants with iSCI underwent 12 wk of electrical stimulation-assisted cycling training: one group performed simultaneous arm and leg (A&L) cycling and the other legs-only cycling. MEPs in the tibialis anterior (TA) muscle were compared before and after training. After training, only the A&L group had a significantly larger TA MEP, suggesting increased excitability in the corticospinal pathway. The findings demonstrate the importance of arm movements in modulating the corticospinal drive to the legs and suggest that active engagement of the arms in lower limb rehabilitation may produce better neural regulation and restoration of function.NEW & NOTEWORTHY This study aimed to demonstrate the importance of arm movements in modulating the corticospinal drive to the legs. It provides direct evidence in humans that active movement of the arms could facilitate corticospinal transmission to the legs and, for the first time, shows that facilitation is absent after spinal cord injury. Active engagement of the arms in lower limb rehabilitation increased the excitability of the corticospinal pathway and may produce more effective improvement in leg function.

Phase- and Workload-Dependent Changes in Corticospinal Excitability to the Biceps and Triceps Brachii during Arm Cycling

This is the first study to examine corticospinal excitability (CSE) to antagonistic muscle groups during arm cycling. Transcranial magnetic stimulation (TMS) of the motor cortex and transmastoid electrical stimulation (TMES) of the corticospinal tract were used to assess changes in supraspinal and spinal excitability, respectively. TMS induced motor evoked potentials (MEPs) and TMES induced cervicomedullary evoked potentials (CMEPs) were recorded from the biceps and triceps brachii at two positions, mid-elbow flexion and extension, while cycling at 5% and 15% of peak power output. While phase-dependent modulation of MEP and CMEP amplitudes occurred in the biceps brachii, there was no difference between flexion and extension for MEP amplitudes in the triceps brachii and CMEP amplitudes were higher during flexion than extension. Furthermore, MEP amplitudes in both biceps and triceps brachii increased with increased workload. CMEP amplitudes increased with higher workloads in the triceps brachii, but not biceps brachii, though the pattern of change in CMEPs was similar to MEPs. Differences between changes in CSE between the biceps and triceps brachii suggest that these antagonistic muscles may be under different neural control during arm cycling. Putative mechanisms are discussed.

Arm-cycling sprints induce neuromuscular fatigue of the elbow flexors and alter corticospinal excitability of the biceps brachii

We examined the effects of arm-cycling sprints on maximal voluntary elbow flexion and corticospinal excitability of the biceps brachii. Recreationally trained athletes performed ten 10-s arm-cycling sprints interspersed with 150 s of rest in 2 separate experiments. In experiment A (n = 12), maximal voluntary contraction (MVC) force of the elbow flexors was measured at pre-sprint 1, post-sprint 5, and post-sprint 10. Participants received electrical motor point stimulation during and following the elbow flexor MVCs to estimate voluntary activation (VA). In experiment B (n = 7 participants from experiment A), supraspinal and spinal excitability of the biceps brachii were measured via transcranial magnetic and transmastoid electrical stimulation that produced motor evoked potentials (MEPs) and cervicomedullary motor evoked potentials (CMEPs), respectively, during a 5% isometric MVC at pre-sprint 1, post-sprint 1, post-sprint 5, and post-sprint 10. In experiment A, mean power output, MVC force, potentiated twitch force, and VA decreased 13.1% (p < 0.001), 8.7% (p = 0.036), 27.6% (p = 0.003), and 5.6% (p = 0.037), respectively, from pre-sprint 1 to post-sprint 10. In experiment B, (i) MEPs decreased 42.1% (p = 0.002) from pre-sprint 1 to post-sprint 5 and increased 40.1% (p = 0.038) from post-sprint 5 to post-sprint 10 and (ii) CMEPs increased 28.5% (p = 0.045) from post-sprint 1 to post-sprint 10. Overall, arm-cycling sprints caused neuromuscular fatigue of the elbow flexors, which corresponded with decreased supraspinal and increased spinal excitability of the biceps brachii. The different post-sprint effects on supraspinal and spinal excitability may illustrate an inhibitory effect on supraspinal drive that reduces motor output and, therefore, decreases arm-cycling sprint performance.

Cadence-dependent changes in corticospinal excitability of the biceps brachii during arm cycling

This is the first study to report the influence of different cadences on the modulation of supraspinal and spinal excitability during arm cycling. Supraspinal and spinal excitability were assessed using transcranial magnetic stimulation of the motor cortex and transmastoid electrical stimulation of the corticospinal tract, respectively. Transcranial magnetic stimulation-induced motor evoked potentials and transmastoid electrical stimulation-induced cervicomedullary evoked potentials (CMEPs) were recorded from the biceps brachii at two separate positions corresponding to elbow flexion and extension (6 and 12 o'clock relative to a clock face, respectively) while arm cycling at 30, 60 and 90 rpm. Motor evoked potential amplitudes increased significantly as cadence increased during both elbow flexion (P < 0.001) and extension (P = 0.027). CMEP amplitudes also increased with cadence during elbow flexion (P < 0.01); however, the opposite occurred during elbow extension (i.e., decreased CMEP amplitude; P = 0.01). The data indicate an overall increase in the excitability of corticospinal neurons which ultimately project to biceps brachii throughout arm cycling as cadence increased. Conversely, changes in spinal excitability as cadence increased were phase dependent (i.e., increased during elbow flexion and decreased during elbow extension). Phase- and cadence-dependent changes in spinal excitability are suggested to be mediated via changes in the balance of excitatory and inhibitory synaptic input to the motor pool, as opposed to changes in the intrinsic properties of spinal motoneurons.

Intensity-dependent alterations in the excitability of cortical and spinal projections to the knee extensors during isometric and locomotor exercise

We investigated the role of exercise intensity and associated central motor drive in determining corticomotoneuronal excitability. Ten participants performed a series of nonfatiguing (3 s) isometric single-leg knee extensions (ISO; 10-100% of maximal voluntary contractions, MVC) and cycling bouts (30-160% peak aerobic capacity, W peak). At various exercise intensities, electrical potentials were evoked in the vastus lateralis (VL) and rectus femoris (RF) via transcranial magnetic stimulation (motor-evoked potentials, MEP), and electrical stimulation of both the cervicomedullary junction (cervicomedullary evoked potentials, CMEP) and the femoral nerve (maximal M-waves, M max). Whereas M max remained unchanged in both muscles (P > 0.40), voluntary electromyographic activity (EMG) increased in an exercise intensity-dependent manner for ISO and cycling exercise in VL and RF (both P < 0.001). During ISO exercise, MEPs and CMEPs progressively increased in VL and RF until a plateau was reached at ∼ 75% MVC; further increases in contraction intensity did not cause additional changes (P > 0.35). During cycling exercise, VL-MEPs and CMEPs progressively increased by ∼ 65% until a plateau was reached at W peak. In contrast, RF MEPs and CMEPs progressively increased by ∼ 110% throughout the tested cycling intensities without the occurrence of a plateau. Furthermore, alterations in EMG below the plateau influenced corticomotoneuronal excitability similarly between exercise modalities. In both exercise modalities, the MEP-to-CMEP ratio did not change with exercise intensity (P > 0.22). In conclusion, increases in exercise intensity and EMG facilitates the corticomotoneuronal pathway similarly in isometric knee extension and locomotor exercise until a plateau occurs at a submaximal exercise intensity. This facilitation appears to be primarily mediated by increases in excitability of the motoneuron pool.

Preservation of common rhythmic locomotor control despite weakened supraspinal regulation after stroke

The basic pattern of arm and leg movement during rhythmic locomotor tasks is supported by common central neural control from spinal and supraspinal centers in neurologically intact participants. The purpose of this study was to test the hypothesis that following a cerebrovascular accident, shared systems from interlimb cutaneous networks facilitating arm and leg coordination persist across locomotor tasks. Twelve stroke participants (>6 months post CVA) performed arm and leg (A&L) cycling using a stationary ergometer and walking on a motorized treadmill. In both tasks cutaneous reflexes were evoked via surface stimulation of the nerves innervating the dorsum of the hand (superficial radial; SR) and foot (superficial peroneal; SP) of the less affected limbs. Electromyographic (EMG) activity from the tibialis anterior, soleus, flexor carpi radialis, and posterior deltoid were recorded bilaterally with surface electrodes. Full-wave rectified and filtered EMG data were separated into eight equal parts or phases and aligned to begin with maximum knee extension for both walking and A&L cycling. At each phase of movement, background EMG data were quantified as the peak normalized response for each participant and cutaneous reflexes were quantified as the average cumulative reflex over 150 ms following stimulation. In general, background EMG was similar between walking and A&L cycling, seen especially in the distal leg muscles. Cutaneous reflexes were evident and modified in the less and more affected limbs during walking and A&L cycling and similar modulation patterns were observed suggesting activity in related control networks between tasks. After a stroke common neural patterning from conserved subcortical regulation is seen supporting the notion of a common core in locomotor tasks involving arm and leg movement. This has translational implications for rehabilitation where A&L cycling could be usefully applied to improve walking function.

Different corticospinal control between discrete and rhythmic movement of the ankle

We investigated differences in corticospinal and spinal control between discrete and rhythmic ankle movements. Motor evoked potentials (MEPs) in the tibialis anterior and soleus muscles and soleus H-reflex were elicited in the middle of the plantar flexion phase during discrete ankle movement or in the initial or later cycles of rhythmic ankle movement. The H-reflex was evoked at an intensity eliciting a small M-wave and MEPs were elicited at an intensity of 1.2 times the motor threshold of the soleus MEPs. Only trials in which background EMG level, ankle angle, and ankle velocity were similar among the movement conditions were included for data analysis. In addition, only trials with a similar M-wave were included for data analysis in the experiment evoking H-reflexes. Results showed that H reflex and MEP amplitudes in the soleus muscle during discrete movement were not significantly different from those during rhythmic movement. MEP amplitude in the tibialis anterior muscle during the later cycles of rhythmic movement was significantly larger than that during the initial cycle of the rhythmic movement or during discrete movement. Higher corticospinal excitability in the tibialis anterior muscle during the later cycles of rhythmic movement may reflect changes in corticospinal control from the initial cycle to the later cycles of rhythmic movement.

Corticospinal excitability of the biceps brachii is higher during arm cycling than an intensity-matched tonic contraction

Human studies have not assessed corticospinal excitability of an upper-limb prime mover during arm cycling. The purpose of the present study was to determine whether supraspinal and/or spinal motoneuron excitability of the biceps brachii was different between arm cycling and an intensity-matched tonic contraction. We hypothesized that spinal motoneuron excitability would be higher during arm cycling than an intensity-matched tonic contraction. Supraspinal and spinal motoneuron excitability were assessed using transcranial magnetic stimulation (TMS) of the motor cortex and transmastoid electrical stimulation (TMES) of the corticospinal tract, respectively. TMS-induced motor-evoked potentials (MEPs) and TMES-induced cervicomedullary-evoked potentials (CMEPs) were assessed at three separate positions (3, 6, and 12 o'clock relative to a clock face) during arm cycling and an intensity-matched tonic contraction. MEP amplitudes were 7.2 and 8.8% maximum amplitude of the compound muscle action potential (Mmax) larger during arm cycling compared with a tonic contraction at the 3 (P < 0.001) and 6 o'clock (P < 0.001) positions, respectively. There was no difference between tasks during elbow extension (12 o'clock). CMEP amplitudes were 5.2% Mmax larger during arm cycling compared with a tonic contraction at the 3 o'clock position (P < 0.001) with no differences seen at midflexion (6 o'clock) or extension (12 o'clock). The data indicate an increase in the excitability of corticospinal neurons, which ultimately project to biceps brachii during the elbow flexion portion of arm cycling, and increased spinal motoneuron excitability at the onset of elbow flexion during arm cycling. We conclude that supraspinal and spinal motoneuron excitability are phase- and task-dependent.

Increased corticospinal excitability prior to arm cycling is due to enhanced supraspinal but not spinal motoneurone excitability

Human studies have not assessed supraspinal or spinal motoneurone excitability in the quiescent state prior to a rhythmic and alternating cyclical motor output. The purpose of the current study was to determine whether supraspinal and (or) spinal motoneurone excitability was modulated in humans prior to arm cycling when compared with rest with no intention to move. We hypothesized that corticospinal excitability would be enhanced prior to arm cycling due, in part, to increased spinal motoneurone excitability. Supraspinal and spinal motoneurone excitability were assessed via transcranial magnetic stimulation (TMS) of the motor cortex and transmastoid stimulation of the corticospinal tract, respectively. Surface electromyography recordings of TMS motor evoked potentials (MEPs) and cervicomedullary MEPs (CMEPs) were made from the relaxed biceps brachii muscle prior to rhythmic arm cycling and at rest with no intention to move. The amplitude of the MEPs was greater (mean increase: +9.8% of maximal M wave; p = 0.006) and their onset latencies were shorter (mean decrease: –1.5 ms; p < 0.05) prior to cycling when compared with rest. The amplitudes of the CMEPs at any of 3 stimulation intensities were not different between conditions. We conclude that premovement enhancement of corticospinal excitability is greater prior to arm cycling than at rest because of increases in supraspinal but not spinal motoneurone excitability.

Effects of motor skill learning on reciprocal inhibition

PURPOSE

Learning a skilled movement is associated with more efficient use of subcortical motor circuits which can coordinate features of the movements such as the timing and patterns of activation of different muscles. Learning a motor skill could strengthen spinal interneuron circuits that facilitate the movement. We hypothesized that learning a simple, alternating movement would produce changes in spinal circuits that mediate reciprocal inhibition between antagonist muscles.

METHODS

Sixteen healthy adult subjects were trained to perform a wrist flexion and extension task to control the movement of a cursor between targets appearing on a computer display. The goal of the task was to hit the targets. Subjects practiced for 15 minutes daily until reaching the acquisition criterion. Surface EMG recordings from wrist flexor and extensor muscles showed reduced co-contraction during acquisition of the task.

RESULTS

Compared to the initial session, in the final session short-latency reciprocal inhibition was enhanced during the late-extension phase in the final session. This phase-dependent increase in short-latency reciprocal inhibition is likely to facilitate switching activation between wrist antagonistic muscles.

CONCLUSIONS

Learning a motor skill can produce alterations in spinal reflex circuits that facilitate the desired movement.

Short-interval intracortical inhibition in knee extensors during locomotor cycling

AIM

Short-interval intracortical inhibition (SICI) can provide information on changes in cortical responsiveness during voluntary contractions. It is, however, unknown whether the magnitude of SICI changes throughout the cycle of rhythmic movements such as leg cycling.

METHODS

The effects of four conditioning stimulus (CS) intensities, 70, 80, 90 and 95% of active motor threshold (AMT), on the magnitude of SICI were tested during three conditions: (1) activation phase of the electromyography (EMG) burst, (2) deactivation phase of the EMG burst and (3) static contractions. The three conditions were matched for EMG amplitude and test motor-evoked potential (MEP) size with reference to the vastus lateralis muscle. Responses were also recorded from rectus femoris and vastus medialis.

RESULTS

short-interval cortical inhibition was weak during static knee contractions (15% reduction in control MEP) relative to previous reports during contractions in other muscle groups. SICI was abolished during the activation phase of the knee extensor EMG burst (P > 0.05), but present (approx. 90% of control MEP size) during the deactivation phase of EMG (P < 0.05). Furthermore, inhibition was elicited at a lower CS intensity during the deactivation phase of EMG during cycling than during static contractions (70 AMT vs. 90% AMT).

CONCLUSION

The results suggest that the efficacy of intracortical inhibitory projections to knee extensor corticomotoneurons is particularly weak during muscle activation. A lower threshold of activation for inhibitory cells during deactivation phase of cycling EMG was evident, and there was a phasic modulation of intracortical inhibition affecting corticospinal projections to the working muscles.

Dissociation between neuronal activity in sensorimotor cortex and hand movement revealed as a function of movement rate

It is often assumed that similar behavior is generated by the same brain activity. However, this does not take into account the brain state or recent behavioral history and movement initiation or continuation may not be similarly generated in the brain. To study whether similar movements are generated by the same brain activity, we measured neuronal population activity during repeated movements. Three human subjects performed a motor repetition task in which they moved their hand at four different rates (0.3, 0.5, 1, and 2 Hz). From high-resolution electrocorticography arrays implanted on motor and sensory cortex, high-frequency power (65-95 Hz) was extracted as a measure of neuronal population activity. During the two faster movement rates, high-frequency power was significantly suppressed, whereas movement parameters remained highly similar. This suppression was nonlinear: after the initial movement, neuronal population activity was reduced most strongly, and the data fit a model in which a fast decline rapidly converged to saturation. The amplitude of the beta-band suppression did not change with different rates. However, at the faster rates, beta power did not return to baseline between movements but remained suppressed. We take these findings to indicate that the extended beta suppression at the faster rates, which may suggest a release of inhibition in motor cortex, facilitates movement initiation. These results show that the relationship between behavior and neuronal activity is not consistent: recent movement influences the state of motor cortex and facilitates next movements by reducing the required level of neuronal activity.

Neural control of rhythmic arm cycling after stroke

Disordered reflex activity and alterations in the neural control of walking have been observed after stroke. In addition to impairments in leg movement that affect locomotor ability after stroke, significant impairments are also seen in the arms. Altered neural control in the upper limb can often lead to altered tone and spasticity resulting in impaired coordination and flexion contractures. We sought to address the extent to which the neural control of movement is disordered after stroke by examining the modulation pattern of cutaneous reflexes in arm muscles during arm cycling. Twenty-five stroke participants who were at least 6 mo postinfarction and clinically stable, performed rhythmic arm cycling while cutaneous reflexes were evoked with trains (5 × 1.0-ms pulses at 300 Hz) of constant-current electrical stimulation to the superficial radial (SR) nerve at the wrist. Both the more (MA) and less affected (LA) arms were stimulated in separate trials. Bilateral electromyography (EMG) activity was recorded from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on averaged reflexes in 12 equidistant phases of the movement cycle. Phase-modulated cutaneous reflexes were present, but altered, in both MA and LA arms after stroke. Notably, the pattern was "blunted" in the MA arm in stroke compared with control participants. Differences between stroke and control were progressively more evident moving from shoulder to wrist. The results suggest that a reduced pattern of cutaneous reflex modulation persists during rhythmic arm movement after stroke. The overall implication of this result is that the putative spinal contributions to rhythmic human arm movement remain accessible after stroke, which has translational implications for rehabilitation.

Spinal and cortical activity-dependent plasticity following learning of complex arm movements in humans

Activity-dependent plasticity is a fundamental requirement for human motor learning, which takes place at several stages of the motor system and involves various mechanisms in neuronal circuitry. Here, we investigate parameters of cortical and spinal excitability before and immediately after a single session of locomotion-like arm training (LMT) or sequential visuo-motor learning (VMT). Both training paradigms focused especially on mainly activating the flexor carpi radialis muscle (FCR). The activity-dependent change in the excitability of FCR-associated neurons was investigated using standard transcranial magnetic stimulation, including analysis of motor-evoked potentials (MEP) amplitude, short-interval intracortical inhibition and intracortical facilitation (ICF). Furthermore, spinal plasticity was also assessed by means of homosynaptic FCR H-reflex depression (HD). LMT decreased HD and ICF. In contrast, VMT had no significant effect on cortical and spinal parameters. There was a nonsignificant tendency of an increase in MEP amplitudes after both interventions. This implies that human locomotor-related learning involves spinal mechanisms. Despite the decreasing importance of quadrupedal coordination in the course of evolution, these changes in transsynaptic plasticity may reflect a persisting locomotor memory-encoding function in the spinal circuitry of the human upper extremities. Evaluating FCR HD might be helpful for the evaluation and development of locomotor rehabilitation strategies.

Corticospinal contributions to lower limb muscle activity during cycling in humans

The purpose of the current study was to investigate corticospinal contributions to locomotor drive to leg muscles involved in cycling. We studied 1) if activation of inhibitory interneurons in the cortex via subthreshold transcranial magnetic stimulation (TMS) caused a suppression of EMG and 2) how the responses to stimulation of the motor cortex via TMS and cervicomedullary stimulation (CMS) were modulated across the locomotor cycle. TMS at intensities subthreshold for activation of the corticospinal tract elicited suppression of EMG for approximately one-half of the subjects and muscles during cycling, and in matched static contractions in vastus lateralis. There was also significant modulation in the size of motor-evoked potentials (MEPs) elicited by TMS across the locomotor cycle ( P < 0.001) that was strongly related to variation in background EMG in all muscles ( r > 0.86; P < 0.05). When MEP and CMEP amplitudes were normalized to background EMG, they were relatively larger prior to the main EMG burst and smaller when background EMG was maximum. Since the pattern of modulation of normalized MEP and CMEP responses was similar, the data suggest that phase-dependent modulation of corticospinal responses during cycling in humans is driven mainly by spinal mechanisms. However, there were subtle differences in the degree to which normalized MEP and CMEP responses were facilitated prior to EMG burst, which might reflect small increases in cortical excitability prior to maximum muscle activation. The data demonstrate that the motor cortex contributes actively to locomotor drive, and that spinal factors dominate phase-dependent modulation of corticospinal excitability during cycling in humans.

Upper limb effort does not increase maximal voluntary muscle activation in individuals with incomplete spinal cord injury

OBJECTIVE

To determine the effect of upper limb effort on maximal lower limb muscle activation in individuals with incomplete spinal cord injury.

METHODS

Fifteen individuals with incomplete spinal cord injury performed recumbent stepping using different combinations of upper and lower limb efforts.

RESULTS

There was no significant difference in active lower limb electromyography amplitudes regardless of whether the upper limbs were resting or exerting maximal effort. Upper limb effort increased passive lower limb muscle activation and likewise, lower limb effort increased passive upper limb muscle activation.

CONCLUSIONS

Upper limb effort did not increase lower limb muscle activation during active lower limb effort in individuals with incomplete spinal cord injury during recumbent stepping. This suggests that individuals with incomplete spinal cord injury cannot recruit additional lower limb motor units using maximal volitional effort of their upper limbs.

SIGNIFICANCE

Understanding how upper limb effort and movement influences lower limb muscle activation patterns in incomplete spinal cord injury patients has implications for prescribing therapies for lower limb rehabilitation.

Chronotype influences diurnal variations in the excitability of the human motor cortex and the ability to generate torque during a maximum voluntary contraction

The ability to generate torque during a maximum voluntary contraction (MVC) changes over the day. The present experiments were designed to determine the influence of an individual's chronotype on this diurnal rhythm and on cortical, spinal, and peripheral mechanisms that may be related to torque production. After completing a questionnaire to determine chronotype, 18 subjects (9 morning people, 9 evening people) participated in 4 data collection sessions (at 09:00, 13:00, 17:00, and 21:00) over 1 day. We used magnetic stimulation of the cortex, electrical stimulation of the tibial nerve, electromyographic (EMG) recordings of muscle activity, and isometric torque measurements to evaluate the excitability of the motor cortex, the spinal cord, and the torque-generating capacity of the triceps surae (TS) muscles. We found that for morning people, cortical excitability was highest at 09:00, spinal excitability was highest at 21:00, and there were no significant differences in TS EMG or torque produced during MVCs over the day. In contrast, evening people showed parallel increases in cortical and spinal excitability over the day, and these were associated with increased TS EMG and MVC torque. There were no differences at the level of the muscle over the day between morning and evening people. We propose that the simultaneous increases in cortical and spinal excitability increased central nervous system drive to the muscles of evening people, thus increasing torque production over the day. These differences in cortical excitability and performance of a motor task between morning and evening people have implications for maximizing human performance and highlight the influence of chronotype on an individual's diurnal rhythms.

Physiological basis of limb-impedance modulation during free and constrained movements

Arm stiffness is a critical factor underlying stable interactions with the environment. When the hand moves freely through space, a stiff limb would most effectively maintain the hand on the desired path in the face of external perturbations. Conversely, when constrained by a rigid surface, a compliant limb would allow the surface to guide the hand while minimizing variations in contact forces. We aimed to identify the physiological basis of stiffness adaptation for these two classes of movement. Stiffness can be regulated by two mechanisms: coactivation of antagonistic muscles and modulation of reflex gains. We hypothesized that subjects would select high stiffness (high coactivation and/or reflex gains) in free space and high compliance (low coactivation and reflex gains) for constrained movements. We measured EMG and the H-reflex during constrained and unconstrained movement of the wrist. As predicted, subjects coactivated antagonist muscles more when performing the unconstrained movement. Contrary to our hypothesis, however, H-reflex amplitude was higher for the constrained movement despite the a priori preference for lower reflex gains in this situation. In addition, the H-reflex depended on the task and the net force exerted by the limb on the environment, rather than showing a simple dependence on the level of muscle activation. Thus stiffness seems to increase in free space compared with constrained motion through the use of coactivation, whereas spinal loop gains are adjusted to better regulate the influence of afferences on the ongoing movement. These observations support the hypothesis of movement programming in terms of impedance.

Walking performance and its recovery in chronic stroke in relation to extent of lesion overlap with the descending motor tract

We investigated the association between the degree of lesion overlap with the corticospinal tract and walking performance before and after 4-weeks of partial body weight support (PBWS) treadmill training in 18 individuals (ten male, eight female) with a mean age 59 +/- 13 years (mean +/- SD), range 32-74 years, who were ambulant and 6 months from a subcortical ischaemic stroke. Lesion volumes were manually defined on high resolution T1-weighted 3T-MRI scans and a probabilistic map of the corticospinal tract created using diffusion tensor imaging data collected previously in healthy subjects. The percentage overlap between the lesion and the corticospinal tract was calculated for each patient. Walking performance was determined by measures of 10 m speed, spatiotemporal parameters, percentage recovery of centre of mass (CoM), walking symmetry and 2-min endurance walk prior to and following 4 weeks of treadmill training with PBWS that emphasised normal fast walking. Lesion overlap measures weakly correlated with walking performance measures. Spatiotemporal and performance measures changed in response to training, but spatial symmetry and mechanical energy recovery did not. Walking speed at entry to the study predicted change in response to training of 10 m walk time and swing time asymmetry. Age and lesion overlap did not add to prediction of outcome models. The extent of lesion overlap with the corticospinal tract was not strongly associated with either walking performance or response to gait retraining, despite the correlation of these parameters with upper limb recovery.

Rhythmic leg cycling modulates forearm muscle H-reflex amplitude and corticospinal tract excitability

Rhythmic arm cycling leads to suppression of H-reflexes in both leg and arm muscles, and a reduction in the excitability of corticospinal projections to the forearm flexors. It is unknown, however, whether leg cycling modulates excitability in neural projections to the arms. Here we studied the extent to which rhythmic movement of the legs alters reflex (Experiment 1) and corticospinal (Experiment 2) transmission to arm muscles. In experiment 1, flexor carpi radialis (FCR) H-reflex recruitment curves were recorded with the legs static, and during rhythmic leg movement, while the FCR was both contracted and relaxed. The results indicate that rhythmic leg movement suppresses reflex transmission, both when FCR is at rest and during tonic contraction, but that the effect is not phase-dependent. In experiment 2, we used transcranial magnetic stimulation (TMS) to elicit motor-evoked potentials in the contracted and relaxed FCR during static leg, and leg cycling conditions. Sub-threshold TMS was also used to condition H-reflexes in order to provide specific information about cortical excitability during leg cycling. Both resting and tonically contracting arm muscles showed a greater corticospinal excitability during leg cycling than during the static leg condition. The magnitude of TMS facilitation of H-reflexes was similar during leg cycling and rest, suggesting a considerable sub-cortical component to the increased corticospinal excitability. The results suggest a differential regulation of afferent and descending projections to the arms during leg cycling, and are consistent with the idea that there is a loose, but significant, neural coupling between the arms and legs during rhythmic movement.

Resonance tuning in a neuro-musculo-skeletal model of the forearm

In rhythmic movements, humans activate their muscles in a robust and energy efficient way. These activation patterns are oscillatory and seem to originate from neural networks in the spinal cord, called central pattern generators (CPGs). Evidence for the existence of CPGs was found for instance in lampreys, cats and rats. There are indications that CPGs exist in humans as well, but this is not proven yet. Energy efficiency is achieved by resonance tuning: the central nervous system is able to tune into the resonance frequency of the limb, which is determined by the local reflex gains. The goal of this study is to investigate if the existence of a CPG in the human spine can explain the resonance tuning behavior, observed in human rhythmic limb movement. A neuro-musculo-skeletal model of the forearm is proposed, in which a CPG is organized in parallel to the local reflexloop. The afferent and efferent connections to the CPG are based on clues about the organization of the CPG, found in literature. The model is kept as simple as possible (i.e., lumped muscle models, groups of neurons are lumped into half-centers, simple reflex model), but incorporates enough of the essential dynamics to explain behavior-such as resonance tuning-in a qualitative way. Resonance tuning is achieved above, at and below the endogenous frequency of the CPG in a highly non-linear neuro- musculo-skeletal model. Afferent feedback of muscle lengthening to the CPG is necessary to accomplish resonance tuning above the endogenous frequency of the CPG, while feedback of muscle velocity is necessary to compensate for the phase lag, caused by the time delay in the loop coupling the limb to the CPG. This afferent feedback of muscle lengthening and velocity represents the Ia and II fibers, which-according to literature-is the input to the CPG. An internal process of the CPG, which integrates the delayed muscle lengthening and feeds it to the half-center model, provides resonance tuning below the endogenous frequency. Increased co-contraction makes higher movement frequencies possible. This agrees with studies of rhythmic forearm movements, which have shown that co-contraction increases with movement frequency. Robustness against force perturbations originates mainly from the CPG and the local reflex loop. The CPG delivers an increasing part of the necessary muscle activation for increasing perturbation size. As far as we know, the proposed neuro-musculo-skeletal model is the first that explains the observed resonance tuning in human rhythmic limb movement.

Two Types of TMS-Induced Movement Variability After Stimulation of the Primary Motor Cortex

Using transcranial magnetic stimulation, we studied the role of the primary motor cortex (M1) in repetitive movements, examining whether the functional contribution of this region is associated with controlling response timing, response implementation, or both. In two experiments, participants performed a rhythmic tapping task, attempting to produce isochronous intervals (range of 350–550 ms) while stimulation was applied over M1 or a control site. M1 stimulation was associated with increased variability of the inter-tap intervals (ITI), and, by manipulating stimulation intensity, we identified two distinct changes in performance: a generalized increase in ITI variability and a delay in the subsequent response when the pulse fell within a restricted window prior to movement onset. Using a series of simulations, we demonstrate that the general increase in variability and the temporally specific delay reflect disruption of response implementation processes rather than an increase in noise associated with response timing.