Voluntary breathing influences corticospinal excitability of nonrespiratory finger muscles

Motor-Respiratory Coupling Improves Endurance Performance during Rhythmic Isometric Handgrip Exercise

PURPOSE

This study aimed to evaluate whether motor-respiratory coupling exists in rhythmic isometric handgrip exercises and its effect on endurance performance. In addition, the mechanism underlying observed effects was to be investigated if higher motor-respiratory coupling rate could enhance endurance performance.

METHODS

Eleven subjects completed three rhythmic isometric handgrip trials to task failure in a randomized manner. After one pretraining session to determine personal grip frequency, one trial was performed without respiration requirement (CON), and two trials were performed with inspiration-motor coupling (IMC) or expiration-motor coupling. Changes in maximal voluntary contraction (MVC) and EMG were used to measure neuromuscular fatigue. Force data during test were used to assess exercise intensity. Another 10 subjects completed electrical stimulation-induced finger flexion and extension during normal inspiration, normal expiration, fast inspiration, fast expiration, and breath holding. Force changes of different breathing conditions were compared.

RESULTS

Normalized exercise time to exhaustion was significantly longer in IMC (1.27 ± 0.23) compared with expiration-motor coupling (0.82 ± 0.18) and CON (0.91 ± 0.18, P < 0.001). ΔMVC, grip frequency, force, and EMG indices were not different among conditions (all P > 0.05). Electrical stimulation-induced finger extensor force was significant higher during fast inspiration (1.11 ± 0.09) than normal respiration (1.00 ± 0.05) and fast expiration (0.94 ± 0.08, P < 0.05).

CONCLUSIONS

IMC is an effective way to improve endurance performance of rhythmic handgrip exercise. This is likely due to a reduction in the energy consumption of motion control, as evidenced by similar peripheral fatigue in different conditions and modulation of corticospinal excitability by respiration.

Infra-slow fluctuations in cortical potentials and respiration drive fast cortical EEG rhythms in sleeping and waking states

OBJECTIVE

Infra-slow fluctuations (ISF, 0.008-0.1 Hz) characterize hemodynamic and electric potential signals of human brain. ISFs correlate with the amplitude dynamics of fast (>1 Hz) neuronal oscillations, and may arise from permeability fluctuations of the blood-brain barrier (BBB). It is unclear if physiological rhythms like respiration drive or track fast cortical oscillations, and the role of sleep in this coupling is unknown.

METHODS

We used high-density full-band electroencephalography (EEG) in healthy human volunteers (N = 21) to measure concurrently the ISFs, respiratory pulsations, and fast neuronal oscillations during periods of wakefulness and sleep, and to assess the strength and direction of their phase-amplitude coupling.

RESULTS

The phases of ISFs and respiration were both coupled with the amplitude of fast neuronal oscillations, with stronger ISF coupling being evident during sleep. Phases of ISF and respiration drove the amplitude dynamics of fast oscillations in sleeping and waking states, with different contributions.

CONCLUSIONS

ISFs in slow cortical potentials and respiration together significantly determine the dynamics of fast cortical oscillations.

SIGNIFICANCE

We propose that these slow physiological phases play a significant role in coordinating cortical excitability, which is a fundamental aspect of brain function.

High ventilation breathwork practices: An overview of their effects, mechanisms, and considerations for clinical applications

High Ventilation Breathwork (HVB) refers to practices employing specific volitional manipulation of breathing, with a long history of use to relieve various forms of psychological distress. This paper seeks to offer a consolidative insight into potential clinical application of HVB as a treatment of psychiatric disorders. We thus review the characteristic phenomenological and neurophysiological effects of these practices to inform their mechanism of therapeutic action, safety profiles and future clinical applications. Clinical observations and data from neurophysiological studies indicate that HVB is associated with extraordinary changes in subjective experience, as well as with profound effects on central and autonomic nervous systems functions through modulation of neurometabolic parameters and interoceptive sensory systems. This growing evidence base may guide how the phenomenological effects of HVB can be understood, and potentially harnessed in the context of such volitional perturbation of psychophysiological state. Reports of putative beneficial effects for trauma-related, affective, and somatic disorders invite further research to obtain detailed mechanistic knowledge, and rigorous clinical testing of these potential therapeutic uses.

Interoceptive rhythms in the brain

Sensing internal bodily signals, or interoception, is fundamental to maintain life. However, interoception should not be viewed as an isolated domain, as it interacts with exteroception, cognition and action to ensure the integrity of the organism. Focusing on cardiac, respiratory and gastric rhythms, we review evidence that interoception is anatomically and functionally intertwined with the processing of signals from the external environment. Interactions arise at all stages, from the peripheral transduction of interoceptive signals to sensory processing and cortical integration, in a network that extends beyond core interoceptive regions. Interoceptive rhythms contribute to functions ranging from perceptual detection up to sense of self, or conversely compete with external inputs. Renewed interest in interoception revives long-standing issues on how the brain integrates and coordinates information in distributed regions, by means of oscillatory synchrony, predictive coding or multisensory integration. Considering interoception and exteroception in the same framework paves the way for biological modes of information processing specific to living organisms.

Relationship between disturbances of CO2 homeostasis and force output characteristics during isometric knee extension

To determine whether disturbances of CO₂ homeostasis alter force output characteristics of lower limb muscles, participants performed four isometric knee extension trials (MVC_30%, 10s each with 20-s rest intervals) in three CO₂ conditions (normocapnia [NORM], hypercapnia [HYPER], and hypocapnia [HYPO]). Respiratory frequency and tidal volume were matched between CO₂ conditions. In each MVC_30%, the participants exerted a constant force (30% of maximum voluntary contraction [MVC]). The force coefficient of variation (Fcv) during each MVC_30% and MVC before and after the four MVC_30% trials were measured. For the means of the four trials, Fcv was significantly lower in HYPER than in HYPO. However, within HYPER, a significant positive correlation was found between the increase in end-tidal CO₂ partial pressure and the increase in Fcv. MVCs in NORM and HYPO decreased significantly over the four trials, while no such reduction was observed in HYPER. These results suggest that perturbed CO₂ homeostasis influences the force output characteristics independently of breathing pattern variables.

A cognitive task, deep breathing, and static stretching reduce variability of motor evoked potentials during subsequent transcranial magnetic stimulation

BACKGROUND

Motor evoked potentials (MEPs) induced via transcranial magnetic stimulation (TMS) demonstrate trial-to-trial variability limiting detection and interpretation of changes in corticomotor excitability. This study examined whether performing a cognitive task, voluntary breathing, or static stretching before TMS could reduce MEP variability.

METHODS

20 healthy young adults performed no-task, a cognitive task (Stroop test), deep breathing, and static stretching before TMS in a randomized order. MEPs were collected in the non-dominant tibialis anterior muscle at 130% active motor threshold. Variability of MEP amplitude was quantified as coefficient of variation (CV).

RESULTS

MEP CV was greater after no-task (25.4 ± 7.0) than after cognitive task (23.3 ± 7.2; p < 0.05), deep breathing (20.1 ± 6.3; p < 0.001), and static stretching (20.9 ± 6.0; p = 0.004). MEP CV was greater after cognitive task than after deep breathing (p = 0.007) and static stretching (p = 0.01). There was no effect of condition on MEP amplitude.

CONCLUSIONS

Performing brief cognitive, voluntary breathing, and stretching tasks before TMS can reduce MEP variability with no effect on MEP amplitude in the tibialis anterior of healthy, young adults. Similar tasks could be incorporated into research and clinical settings to improve detection of changes, normative data, and clinical predictions.

The effects of slow breathing on postural muscles during standing perturbations in young adults

Maintaining standing balance is vital to completing activities in daily living. Recent findings suggest an interaction between cardiovascular and postural control systems. Volitional slow breathing can modulate the cardiovascular response and affect postural control during quiet standing. However, the effects of slow breathing during threats to standing balance have not been studied. The study examined the effect of slow breathing on the latency and amplitude of postural muscle responses to perturbations of the base of support in healthy, young adults. Twenty-seven participants completed two balance perturbation tasks in standing on an instrumented split-belt treadmill while breathing spontaneously and breathing at 6 breaths per minute. Each perturbation task consisted of 25 posteriorly directed translations of the treadmill belts every 8-12 s. Muscle latency and muscle burst amplitude were measured using surface electromyography from the right limb for the quadriceps (QUADS), medial hamstring (MH), gastrocnemii (GASTROC), soleus (SOL), and tibialis anterior (TA) muscle groups, while a respiratory belt was used to record respiratory rate. Results indicated that during the slow breathing task both muscle latency (p = 0.022) and muscle burst amplitude (p = 0.011) decreased compared to spontaneous breathing. The EMG pre-perturbation activation was not significantly different in any muscle group between conditions (p > 0.167). The study found that reducing respiratory rate to approximately 6 breaths per minute affects the neuromuscular responses in the lower limb muscles to perturbations.

Locomotor-respiratory coupling in ambulatory adults with incomplete spinal cord injury

STUDY DESIGN

Observational, analytical cohort study.

OBJECTIVES

After incomplete spinal cord injury (iSCI), propriospinal pathways may remain intact enabling coupling between respiration and locomotion. This locomotor-respiratory coupling (LRC) may enable coordination between these two important behaviors and have implications for rehabilitation after iSCI. However, coordination between these behaviors is not well understood and it is unknown if iSCI disrupts LRC. The objective of this study was to compare LRC in ambulatory adults with iSCI to able-bodied controls.

SETTING

Rehabilitation Research Center, Jacksonville, Florida, United States of America.

METHODS

Adults with iSCI (4 males, 1 female) and able-bodied controls (2 males, 3 females) walked at their fastest comfortable speed for 6 min over ground, and on a treadmill with bodyweight support (10-20%) and as-needed assistance at a standardized fast speed (controls) or their fastest speed (iSCI) for 6 min. LRC was quantified as the percent of breaths that were coupled with steps at a consistent ratio during the last 4 min of each walking condition.

RESULTS

Over ground, participants with iSCI demonstrated significantly more LRC than able-bodied controls (72.4 ± 6.4% vs. 59.1% ± 7.5, p = 0.016). During treadmill walking, LRC did not differ between groups (iSCI 67.5 ± 15.8% vs. controls 66.3 ± 4.0%, p > 0.05).

CONCLUSIONS

Adults with iSCI demonstrated similar or greater LRC compared to able-bodied controls. This suggests that pathways subserving coordination between these behaviors remain intact in this group of individuals who walk independently after iSCI.

Recent insights into respiratory modulation of brain activity offer new perspectives on cognition and emotion

Over the past six years, a rapidly growing number of studies have shown that respiration exerts a significant influence on sensory, affective, and cognitive processes. At the same time, an increasing amount of experimental evidence indicates that this influence occurs via modulation of neural oscillations and their synchronization between brain areas. In this article, we review the relevant findings and discuss whether they might inform our understanding of a variety of disorders that have been associated with abnormal patterns of respiration. We review literature on the role of respiration in chronic obstructive pulmonary disease (COPD), anxiety (panic attacks), and autism spectrum disorder (ASD), and we conclude that the new insights into respiratory modulation of neuronal activity may help understand the relationship between respiratory abnormalities and cognitive and affective deficits.

The influence of the respiratory cycle on reaction times in sensory-cognitive paradigms

Behavioural and electrophysiological studies point to an apparent influence of the state of respiration, i.e., whether we inhale or exhale, on brain activity and cognitive performance. Still, the prevalence and relevance of such respiratory-behavioural relations in typical sensory-cognitive tasks remain unclear. We here used a battery of six tasks probing sensory detection, discrimination and short-term memory to address the questions of whether and by how much behaviour covaries with the respiratory cycle. Our results show that participants tend to align their respiratory cycle to the experimental paradigm, in that they tend to inhale around stimulus presentation and exhale when submitting their responses. Furthermore, their reaction times, but not so much their response accuracy, consistently and significantly covary with the respiratory cycle, differing between inhalation and exhalation. This effect is strongest when analysed contingent on the respiratory state around participants' responses. The respective effect sizes of these respiration-behaviour relations are comparable to those seen in other typical experimental manipulations in sensory-cognitive tasks, highlighting the relevance of these effects. Overall, our results support a prominent relation between respiration and sensory-cognitive function and show that sensation is intricately linked to rhythmic bodily or interoceptive functions.

Keeping the Breath in Mind: Respiration, Neural Oscillations, and the Free Energy Principle

Scientific interest in the brain and body interactions has been surging in recent years. One fundamental yet underexplored aspect of brain and body interactions is the link between the respiratory and the nervous systems. In this article, we give an overview of the emerging literature on how respiration modulates neural, cognitive and emotional processes. Moreover, we present a perspective linking respiration to the free-energy principle. We frame volitional modulation of the breath as an active inference mechanism in which sensory evidence is recontextualized to alter interoceptive models. We further propose that respiration-entrained gamma oscillations may reflect the propagation of prediction errors from the sensory level up to cortical regions in order to alter higher level predictions. Accordingly, controlled breathing emerges as an easily accessible tool for emotional, cognitive, and physiological regulation.

Depth and phase of respiration modulate cortico-muscular communication

Recent studies in animals have convincingly demonstrated that respiration cyclically modulates oscillatory neural activity across diverse brain areas. To what extent this generalises to humans in a way that is relevant for behaviour is yet unclear. We used magnetoencephalography (MEG) to assess the potential influence of respiration depth and respiration phase on the human motor system. We obtained simultaneous recordings of brain activity, muscle activity, and respiration while participants performed a steady contraction task. We used corticomuscular coherence as a measure of efficient long-range cortico-peripheral communication. We found coherence within the beta range over sensorimotor cortex to be reduced during voluntary deep compared to involuntary normal breathing. Moreover, beta coherence was found to be cyclically modulated by respiration phase in both conditions. Overall, these results demonstrate how respiratory rhythms influence the synchrony of brain oscillations, conceivably regulating computational efficiency through neural excitability. Intriguing questions remain with regard to the shape of these modulatory processes and how they influence perception, cognition, and behaviour.

Depth and phase of respiration modulate cortico-muscular communication

Recent studies in animals have convincingly demonstrated that respiration cyclically modulates oscillatory neural activity across diverse brain areas. To what extent this generalises to humans in a way that is relevant for behaviour is yet unclear. We used magnetoencephalography (MEG) to assess the potential influence of respiration depth and respiration phase on the human motor system. We obtained simultaneous recordings of brain activity, muscle activity, and respiration while participants performed a steady contraction task. We used corticomuscular coherence as a measure of efficient long-range cortico-peripheral communication. We found coherence within the beta range over sensorimotor cortex to be reduced during voluntary deep compared to involuntary normal breathing. Moreover, beta coherence was found to be cyclically modulated by respiration phase in both conditions. Overall, these results demonstrate how respiratory rhythms influence the synchrony of brain oscillations, conceivably regulating computational efficiency through neural excitability. Intriguing questions remain with regard to the shape of these modulatory processes and how they influence perception, cognition, and behaviour.

Voluntary control of breathing affects center of pressure complexity during static standing in healthy older adults

Background Physiological/biomechanical systems display high degrees of complexity in their corresponding physiological and/or biomechanical outputs, indicative of normal healthy physiological functioning, though little attention has been paid to potential mechanisms which may affect complexity. Center of pressure (CoP) dynamics also display high degrees of complexity and may be affected via altered respiratory-motor interactions such as during voluntary control of breathing. Purpose The purpose of this study was to investigate the differences in the complexity of CoP dynamics during autonomous vs. voluntary control of breathing and between different voluntarily controlled breathing conditions. Methods Center of pressure recordings were taken from 18 older adults during static standing under three different breathing conditions: 1) neutral breathing, 2) abdominal breathing, and 3) thoracic breathing, the first constituting the autonomous breathing condition and the latter two constituting voluntarily controlled breathing conditions. CoP dynamics were quantified using sample entropy, standard deviation, 95% sway area, and average radial velocity. Repeated measure MANOVAs were used to assess the effect of breathing on CoP dynamics, with top-down application of ANOVAs and pairwise comparison as needed. Results Voluntary control of breathing during both conditions resulted in significantly higher CoP variability and lower sample entropy than during autonomous control of breathing in the mediolateral direction, indicating less complex dynamics and loss of system control. No significant differences between voluntary breathing conditions were observed. Conclusion Voluntary control of breathing significantly affected on CoP dynamics during static standing. The complexity of the postural control system may be affected via alterations in respiratory-motor interactions.

Detecting Perfusion Pattern Based on the Background Low-Frequency Fluctuation in Resting-State Functional Magnetic Resonance Imaging Data and Its Influence on Resting-State Networks: An Iterative Postprocessing Approach

Resting-state functional magnetic resonance imaging (RS-fMRI) is based on the assumption that the vascular response and the blood oxygenation level-dependent response are homogenous across the entire brain. However, this a priori hypothesis is not consistent with the well-known variability of cerebral vascular territories. To explore whether the RS networks are influenced by varied vascular speed in different vascular territories, we assessed the time-shift maps that give an estimate of the local timing of the vascular response and checked whether local differences in this timing have an impact on the estimates of RS networks. Two hundred seventeen elderly (≥60 years), healthy participants (73.74 ± 4.41 years, 143 females, 203 right handed) underwent one MRI examination, including an RS-fMRI session. After preprocessing, statistical analyses included time-shift analyses and RS-fMRI analyses using as regressor the delay maps obtained from the time-shift analyses. The functional connectivity map of default mode network (DMN) of each participant was then calculated by using the seed-to-voxel analysis in the REST toolbox. Faster cerebrovascular responses were notably present in the primary motor and somatosensory and peri-insular cortex, while slower responses were present in various regions, including notably the posterior cingulate cortex (PCC). Moreover, significant changes notably in the DMN, including medial prefrontal cortex (t = 11.95), PCC (t = 11.52), right middle temporal lobe (t = 10.72), and right angular gyrus (t = 10.88), were observed also taking into account the cerebrovascular delayed maps. As the most prominent example of the RS networks, DMN activation patterns change as a function of the cerebrovascular delay. These data suggest that a group correction for vascular maps in RS-fMRI measurements is essential to correctly depict functional differences and exclude potential confounding effects, notably in the elderly with increasing prevalence of vascular comorbidity.

Rhythms of the body, rhythms of the brain: Respiration, neural oscillations, and embodied cognition

In spite of its importance as a life-defining rhythmic movement and its constant rhythmic contraction and relaxation of the body, respiration has not received attention in Embodied Cognition (EC) literature. Our paper aims to show that (1) respiration exerts significant and unexpected influence on cognitive processes, and (2) it does so by modulating neural synchronization that underlies specific cognitive processes. Then, (3) we suggest that the particular example of respiration may function as a model for a general mechanism through which the body influences cognitive functioning. Finally, (4) we work out the implications for EC, draw a parallel to the role of gesture, and argue that respiration sometimes plays a double, pragmatic and epistemic, role, which reduces the cognitive load. In such cases, consistent with EC, the overall cognitive activity includes a loop-like interaction between neural and non-neural elements.

The Reticulospinal Pathway Does Not Increase Its Contribution to the Strength of Contralesional Muscles in Stroke Survivors as Compared to Ipsilesional Side or Healthy Controls

Objective

Startling acoustic stimulation (SAS), via activation of reticulospinal (RS) pathways, has shown to increase muscle strength in healthy subjects. We hypothesized that, given RS hyperexcitability in stroke survivors, SAS could increase muscle strength in stroke survivors. The objective was to quantify the effect of SAS on maximal and sub-maximal voluntary elbow flexion on the contralesional (impaired) side in stroke survivors as compared to ipsilesional (non-impaired) side and healthy controls.

Design

Thirteen hemiparetic stroke survivors and 12 healthy subjects volunteered for this investigation. Acoustic stimulation was given at rest, during ballistic maximal and sustained sub-maximal isometric elbow contractions using low (80 dB) and high intensity sound (105 dB). The effect of acoustic stimuli was evaluated from EMG and force recordings.

Results

Prevalence of acoustic startle reflex with shorter latency in the impaired biceps was greater as compared to the response in the non-impaired side of stroke subjects and in healthy subjects. Delivery of SAS resulted in earlier initiation of elbow flexion and greater peak torque in healthy subjects and in stroke subjects with spastic hemiplegia during maximal voluntary elbow flexion tasks. During sub-maximal elbow flexion tasks, SAS-induced force responses were slightly greater on the impaired side than the non-impaired side. However, no statistically significant difference was found in SAS-induced responses between impaired and non-impaired sides at maximal and sub-maximal elbow flexion tasks.

Conclusion

The findings suggest RS hyperexcitability in stroke survivors with spastic hemiplegia. The results of similar SAS-induced responses between healthy and stroke subjects indicate that RS projections via acoustic stimulation are not likely to contribute to muscle strength for stroke survivors to a significant extent.

Activity of Lower Limb Muscles During Squat With and Without Abdominal Drawing-in and Pilates Breathing

Barbosa, AC, Martins, FM, Silva, AF, Coelho, AC, Intelangelo, L, and Vieira, ER. Activity of lower limb muscles during squat with and without abdominal drawing-in and Pilates breathing. J Strength Cond Res 31(11): 3018-3023, 2017-The purpose of this study was to assess the effects of abdominal drawing-in and Pilates breathing on the activity of lower limb muscles during squats. Adults (n = 13, 22 ± 3 years old) with some Pilates experience performed three 60° squats under each of the following conditions in a random order: (I) normal breathing, (II) drawing-in maneuver with normal breathing, and (III) drawing-in maneuver with Pilates breathing. Peak-normalized surface electromyography of the rectus femoris, biceps femoris, gastrocnemius medialis, and tibialis anterior during the knee flexion and extension phases of squat exercises was analyzed. There were significant differences among the conditions during the knee flexion phase for the rectus femoris (p = 0.001), biceps femoris (p = 0.038), and tibialis anterior (p = 0.001), with increasing activation from conditions I to III. For the gastrocnemius medialis, there were significant differences among the conditions during the knee extension phase (p = 0.023), with increased activity under condition I. The rectus and biceps femoris activity was higher during the extension vs. flexion phase under conditions I and II. The tibialis anterior activity was higher during the flexion compared with the extension phase under all conditions, and the medial gastrocnemius activity was higher during the extension phase under condition I. Doing squats with abdominal drawing-in and Pilates breathing resulted in increased rectus, biceps femoris, and tibialis anterior activity during the flexion phase, increasing movement stability during squat exercises.

Breathing as a Fundamental Rhythm of Brain Function

Ongoing fluctuations of neuronal activity have long been considered intrinsic noise that introduces unavoidable and unwanted variability into neuronal processing, which the brain eliminates by averaging across population activity (Georgopoulos et al., 1986; Lee et al., 1988; Shadlen and Newsome, 1994; Maynard et al., 1999). It is now understood, that the seemingly random fluctuations of cortical activity form highly structured patterns, including oscillations at various frequencies, that modulate evoked neuronal responses (Arieli et al., 1996; Poulet and Petersen, 2008; He, 2013) and affect sensory perception (Linkenkaer-Hansen et al., 2004; Boly et al., 2007; Sadaghiani et al., 2009; Vinnik et al., 2012; Palva et al., 2013). Ongoing cortical activity is driven by proprioceptive and interoceptive inputs. In addition, it is partially intrinsically generated in which case it may be related to mental processes (Fox and Raichle, 2007; Deco et al., 2011). Here we argue that respiration, via multiple sensory pathways, contributes a rhythmic component to the ongoing cortical activity. We suggest that this rhythmic activity modulates the temporal organization of cortical neurodynamics, thereby linking higher cortical functions to the process of breathing.

Relationship between motor corticospinal excitability and ventilatory response during intense exercise

PURPOSE

Effort sense has been suggested to be involved in the hyperventilatory response during intense exercise (IE). However, the mechanism by which effort sense induces an increase in ventilation during IE has not been fully elucidated. The aim of this study was to determine the relationship between effort-mediated ventilatory response and corticospinal excitability of lower limb muscle during IE.

METHODS

Eight subjects performed 3 min of cycling exercise at 75-85 % of maximum workload twice (IE1st and IE2nd). IE2nd was performed after 60 min of resting recovery following 45 min of submaximal cycling exercise at the workload corresponding to ventilatory threshold. Vastus lateralis muscle response to transcranial magnetic stimulation of the motor cortex (motor evoked potentials, MEPs), effort sense of legs (ESL, Borg 0-10 scale), and ventilatory response were measured during the two IEs.

RESULTS

The slope of ventilation (l/min) against CO2 output (l/min) during IE2nd (28.0 ± 5.6) was significantly greater than that (25.1 ± 5.5) during IE1st. Mean ESL during IE was significantly higher in IE2nd (5.25 ± 0.89) than in IE1st (4.67 ± 0.62). Mean MEP (normalized to maximal M-wave) during IE was significantly lower in IE2nd (66 ± 22 %) than in IE1st (77 ± 24 %). The difference in mean ESL between the two IEs was significantly (p < 0.05, r = -0.82) correlated with the difference in mean MEP between the two IEs.

CONCLUSIONS

The findings suggest that effort-mediated hyperventilatory response to IE may be associated with a decrease in corticospinal excitability of exercising muscle.

Pain modulation effect of breathing-controlled electrical stimulation (BreEStim) is not likely to be mediated by deep and fast voluntary breathing

Voluntary breathing-controlled electrical stimulation (BreEStim), a novel non-invasive and non-pharmacological treatment protocol for neuropathic pain management, was reported to selectively reduce the affective component of pain possibly by increasing pain threshold. The underlying mechanisms involved in the analgesic effect of BreEStim were considered to result from combination of multiple internal pain coping mechanisms triggered during BreEStim. Findings from our recent studies have excluded possible roles of acupuncture and aversiveness and habituation of painful electrical stimulation in mediating the analgesia effect of BreEStim. To further investigate the possible role of voluntary breathing during BreEStim, the effectiveness of fast and deep voluntary breathing-only and BreEStim on experimentally induced pain was compared in healthy human subjects. Results showed no change in electrical pain threshold after Breathing-only, but a significant increase in electrical pain threshold after BreEStim. There was no statistically significant change in other thresholds after Breathing-only and BreEStim. The findings suggest that the analgesic effect of BreEStim is not likely attributed to fast and deep voluntary breathing. Possible mechanisms are discussed.

Single-motor-unit discharge characteristics in human lumbar multifidus muscle

The underlying neurophysiology of postural control of the lower back in humans is poorly understood. We have characterized motor unit (MU) discharge activity in the deep lumbar multifidus (LM) muscle in nine healthy subjects (20-40 yr, 3 females). Bilateral fine wire electrodes were implanted at L4 spinal level using ultrasound guidance. EMG was recorded during spontaneous sitting and standing and during voluntary force production. Individual MUs were analyzed with regard to instantaneous discharge rate, interspike interval variability, alternation of activity between MUs, and cross correlation between concurrently active MUs quantified by the common drive coefficient (CDC). Significant effects of sitting vs. standing were seen on median discharge rate and interspike interval variability. Median discharge rate in 71 units was 5.4 and 6.9 pulses/s during spontaneous sitting and standing and 7.4 pulses/s during voluntary force production. Several MUs fired doublets. CDC analysis of 87 MU pairs showed a significantly higher common drive in spontaneous than in voluntary activity and significant differences between unilateral and bilateral pairs, although not when spontaneously active in standing. In spite of common drive, MUs were recruited from inactivity to tonic discharge lasting for several minutes without changes in discharge rate in already active MUs, and several instances were documented where activity was rotated between MUs. We argue that this behavior is indicative of self-sustained discharge in LM motoneurons, establishing intrinsic motoneuron properties as a central mechanism for postural control of deep back muscles.

Spinal interneurons and forelimb plasticity after incomplete cervical spinal cord injury in adult rats

Cervical spinal cord injury (cSCI) disrupts bulbospinal projections to motoneurons controlling the upper limbs, resulting in significant functional impairments. Ongoing clinical and experimental research has revealed several lines of evidence for functional neuroplasticity and recovery of upper extremity function after SCI. The underlying neural substrates, however, have not been thoroughly characterized. The goals of the present study were to map the intraspinal motor circuitry associated with a defined upper extremity muscle, and evaluate chronic changes in the distribution of this circuit following incomplete cSCI. Injured animals received a high cervical (C2) lateral hemisection (Hx), which compromises supraspinal input to ipsilateral spinal motoneurons controlling the upper extremities (forelimb) in the adult rat. A battery of behavioral tests was used to characterize the time course and extent of forelimb motor recovery over a 16 week period post-injury. A retrograde transneuronal tracer - pseudorabies virus - was used to define the motor and pre-motor circuitry controlling the extensor carpi radialis longus (ECRL) muscle in spinal intact and injured animals. In the spinal intact rat, labeling was observed unilaterally within the ECRL motoneuron pool and within spinal interneurons bilaterally distributed within the dorsal horn and intermediate gray matter. No changes in labeling were observed 16 weeks post-injury, despite a moderate degree of recovery of forelimb motor function. These results suggest that recovery of the forelimb function assessed following C2Hx injury does not involve recruitment of new interneurons into the ipsilateral ECRL motor pathway. However, the functional significance of these existing interneurons to motor recovery requires further exploration.

The effects of voluntary control of respiration on the excitability of the primary motor hand area, evaluated by end-tidal CO2 monitoring

OBJECTIVE

To investigate the effects of voluntary deep breathing on the excitability of the hand area in the primary motor cortex (M1).

METHODS

We applied near-threshold transcranial magnetic stimulation (TMS) over M1 during the early phase of inspiration or expiration in both normal automatic and voluntary deep, but not "forced", breathing in eight healthy participants at rest. We monitored exhaled CO2 levels continuously, and recorded motor-evoked potentials (MEPs) simultaneously from the abductor pollicis brevis, first dorsal interosseous, abductor digiti minimi, flexor digitorum superficialis, and extensor incidis muscles.

RESULTS

We observed that, during voluntary deep breathing, MEP amplitude increased by up to 50% for all recorded muscles and the latency of MEPs decreased by approximately 1ms, compared with normal automatic breathing. We found no difference in the amplitude or latency of MEPs between inspiratory and expiratory phases in either normal automatic or voluntary deep breathing.

CONCLUSIONS

Voluntary deep breathing at rest facilitates MEPs following TMS over the hand area of M1, and MEP enhancement occurs throughout the full respiratory cycle.

SIGNIFICANCE

The M1 hand region is continuously driven by top-down neural signals over the entire respiratory cycle of voluntary deep breathing.

Acoustic startle reflex in patients with chronic stroke at different stages of motor recovery: a pilot study

BACKGROUND

Acoustic startle reflex (ASR) can be used as a tool to examine reticulospinal excitability. The potential role of reticulospinal mechanisms in the development of spasticity has been suggested but not tested.

OBJECTIVE

To examine reticulospinal excitability at different stages of motor recovery in patients with chronic stroke using the ASR.

METHODS

Sixteen subjects with hemiplegic stroke participated in the study. We examined ASR responses at rest and contralateral motor overflow during voluntary elbow flexion.

RESULTS

ASR responses in impaired biceps muscles showed different patterns at different stages. In subjects without spasticity, ASR responses were less frequent (10% on impaired side) and had normal duration (<200 ms). In subjects with spasticity, the responses were more frequent (58.3% on impaired side) and longer lasting (up to 1 minute). However, no correlation between exaggerated reflex responses and Modified Ashworth Scale (MAS) scores was observed. During voluntary elbow flexion on the impaired side, similar positive linear force-electromyogram (EMG) relationships were found in subjects with and without spasticity. Electromyographic activity of the resting nonimpaired limb increased proportionally in subjects with spasticity (r = 0.6313, P = .0004), but no such correlation was found in subjects without spasticity (r = 0.0191, P = .9612).

CONCLUSIONS

Preliminary findings of exaggerated ASR responses and associated contralateral overflow only in spastic biceps muscles in patients with chronic stroke suggest the important role of reticulospinal mechanisms in the development of spasticity.

Habituation to experimentally induced electrical pain during voluntary-breathing controlled electrical stimulation (BreEStim)

Objective

Painful peripheral electrical stimulation to acupuncture points was found to cause sensitization if delivered randomly (EStim), but induced habituation if triggered by voluntary breathing (BreEStim). The objective was to systematically compare the effectiveness of BreEStim and EStim and to investigate the possible mechanisms mediating the habituation effect of BreEStim.

Methods

Eleven pain-free, healthy subjects (6 males, 5 females) participated in the study. Each subject received the BreEStim and EStim treatments in a random order at least three days apart. Both treatments consisted of 120 painful but tolerable stimuli to the ulnar nerve at the elbow on the dominant arm. BreEStim was triggered by voluntary breathing while EStim was delivered randomly. Electrical sensation threshold (EST) and electrical pain threshold (EPT) were measured from the thenar and hypothenar eminences on both hands at pre-intervention and 10-minutes post-intervention.

Results

There was no difference in the pre-intervention baseline measurement of EST and EPT between BreEStim and EStim. BreEStim increased EPT in all tested sites on both hands, while EStim increased EPT in the dominant hypothenar eminence distal to the stimulating site and had no effect on EPT in other sites. There was no difference in the intensity of electrical stimulation between EStim and BreEStim.

Conclusion

Our findings support the important role human voluntary breathing plays in the systemic habituation effect of BreEStim to peripheral painful electrical stimulation.

Does the supplementary motor area keep patients with Ondine's curse syndrome breathing while awake?

BACKGROUND

Congenital central hypoventilation syndrome (CCHS) is a rare neuro-respiratory disorder associated with mutations of the PHOX2B gene. Patients with this disease experience severe hypoventilation during sleep and are consequently ventilator-dependent. However, they breathe almost normally while awake, indicating the existence of cortical mechanisms compensating for the deficient brainstem generation of automatic breathing. Current evidence indicates that the supplementary motor area plays an important role in modulating ventilation in awake normal humans. We hypothesized that the wake-related maintenance of spontaneous breathing in patients with CCHS could involve supplementary motor area.

METHODS

We studied 7 CCHS patients (5 women; age: 20-30; BMI: 22.1 ± 4 kg.m(-2)) during resting breathing and during exposure to carbon dioxide and inspiratory mechanical constraints. They were compared with 8 healthy individuals. Segments of electroencephalographic tracings were selected according to ventilatory flow signal, from 2.5 seconds to 1.5 seconds after the onset of inspiration. After artefact rejection, 80 or more such segments were ensemble averaged. A slow upward shift of the EEG signal starting between 2 and 0.5 s before inspiration (pre-inspiratory potential) was considered suggestive of supplementary motor area activation.

RESULTS

In the control group, pre-inspiratory potentials were generally absent during resting breathing and carbon dioxide stimulation, and consistently identified in the presence of inspiratory constraints (expected). In CCHS patients, pre-inspiratory potentials were systematically identified in all study conditions, including resting breathing. They were therefore significantly more frequent than in controls.

CONCLUSIONS

This study provides a neurophysiological substrate to the wakefulness drive to breathe that is characteristic of CCHS and suggests that the supplementary motor area contributes to this phenomenon. Whether or not this "cortical breathing" can be taken advantage of therapeutically, or has clinical consequences (like competition with attentional resources) remains to be determined.

Modification of electrical pain threshold by voluntary breathing-controlled electrical stimulation (BreEStim) in healthy subjects

BACKGROUND

Pain has a distinct sensory and affective (i.e., unpleasantness) component. BreEStim, during which electrical stimulation is delivered during voluntary breathing, has been shown to selectively reduce the affective component of post-amputation phantom pain. The objective was to examine whether BreEStim increases pain threshold such that subjects could have improved tolerance of sensation of painful stimuli.

METHODS

Eleven pain-free healthy subjects (7 males, 4 females) participated in the study. All subjects received BreEStim (100 stimuli) and conventional electrical stimulation (EStim, 100 stimuli) to two acupuncture points (Neiguan and Weiguan) of the dominant hand in a random order. The two different treatments were provided at least three days apart. Painful, but tolerable electrical stimuli were delivered randomly during EStim, but were triggered by effortful inhalation during BreEStim. Measurements of tactile sensation threshold, electrical sensation and electrical pain thresholds, thermal (cold sensation, warm sensation, cold pain and heat pain) thresholds were recorded from the thenar eminence of both hands. These measurements were taken pre-intervention and 10-min post-intervention.

RESULTS

There was no difference in the pre-intervention baseline measurement of all thresholds between BreEStim and EStim. The electrical pain threshold significantly increased after BreEStim (27.5±6.7% for the dominant hand and 28.5±10.8% for the non-dominant hand, respectively). The electrical pain threshold significantly decreased after EStim (9.1±2.8% for the dominant hand and 10.2±4.6% for the non-dominant hand, respectively) (F[1, 10] = 30.992, p = .00024). There was no statistically significant change in other thresholds after BreEStim and EStim. The intensity of electrical stimuli was progressively increased, but no difference was found between BreEStim and EStim.

CONCLUSION

Voluntary breathing controlled electrical stimulation selectively increases electrical pain threshold, while conventional electrical stimulation selectively decreases electrical pain threshold. This may translate into improved pain control.

Breathing-controlled Electrical Stimulation (BreEStim) for management of neuropathic pain and spasticity

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

Breathing-controlled electrical stimulation could modify the affective component of neuropathic pain after amputation: a case report

In this case, a 31-year-old male suffered phantom neuropathic pain for more than 3 years after an above-the-knee amputation. His shooting phantom pain disappeared after the first session of breathing-controlled electrical stimulation, and reappeared or was triggered 28 days after an experimental error during which he received sustained electrical stimulation. In other words, painful shooting stimuli may not have been “cured” but forgotten and retriggered by a fearful event due to the experimental error. Therefore, this accidental finding provides a unique opportunity to understand sensory and affective components of neuropathic pain, and a novel intervention could modify the affective component of it.