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Capozio A, Chakrabarty S, Astill S. Acute Effects of Strength and Skill Training on the Cortical and Spinal Circuits of Contralateral Limb. J Mot Behav 2023; 56:119-131. [PMID: 37788807 DOI: 10.1080/00222895.2023.2265316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
Unilateral strength and skill training increase strength and performance in the contralateral untrained limb, a phenomenon known as cross-education. Recent evidence suggests that similar neural mechanisms might be responsible for the increase in strength and skill observed in the untrained hand after unimanual training. The aims of this study were to: investigate whether a single session of unimanual strength and skill (force-tracking) training increased strength and skill in the opposite hand; measure ipsilateral (untrained) brain (via transcranial magnetic stimulation, TMS) and spinal (via the monosynaptic reflex) changes in excitability occurring after training; measure ipsilateral (untrained) pathway-specific changes in neural excitability (via TMS-conditioning of the monosynaptic reflex) occurring after training. Participants (N = 13) completed a session of unimanual strength (ballistic isometric wrist flexions) and skill (force-tracking wrist flexions) training on two separate days. Strength increased after training in the untrained hand (p = 0.025) but not in the trained hand (p = 0.611). Force-tracking performance increased in both the trained (p = 0.007) and untrained (p = 0.010) hand. Corticospinal excitability increased after force-tracking and strength training (p = 0.027), while spinal excitability was not affected (p = 0.214). TMS-conditioned monosynaptic reflex increased after force-tracking (p = 0.001) but not strength training (p = 0.689), suggesting a possible role of polysynaptic pathways in the increase of cortical excitability observed after training. The results suggest that cross-education of strength and skill at the acute stage is supported by increased excitability of the untrained motor cortex.New & Noteworthy: A single session of isometric wrist flexion strength and skill straining increased strength and skill in the untrained limb. The excitability of the untrained motor cortex increased after strength and skill training. TMS-conditioned H-reflexes increased after skill but not strength training in the untrained hand, indicating that polysynaptic pathways in the increase of cortical excitability observed after skill training.
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Affiliation(s)
- Antonio Capozio
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Astill
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Voskuil CC, Andrushko JW, Huddleston BS, Farthing JP, Carr JC. Exercise prescription and strategies to promote the cross-education of strength: a scoping review. Appl Physiol Nutr Metab 2023; 48:569-582. [PMID: 37156010 DOI: 10.1139/apnm-2023-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The cross-education of strength is moderated by exercise design and prescription in clinical and non-clinical populations. This review synthesizes the available evidence regarding exercise design strategies for unilateral resistance training and provides evidence-based recommendations for the prescription of unilateral training to maximize the cross-education of strength. Greater insights regarding the timing and effectiveness of cross-education interventions in clinical scenarios will strengthen the use of unilateral resistance training for individuals who may benefit from its use.
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Affiliation(s)
- Caleb C Voskuil
- Department of Kinesiology, Texas Christian University, Fort Worth TX, USA
| | - Justin W Andrushko
- Faculty of Medicine, Department of Physical Therapy, The University of British Columbia, Vancouver BC, Canada
| | - Boglarka S Huddleston
- Health Sciences Librarian, Mary C. Burnett Library, Texas Christian University, Fort Worth TX, USA
| | | | - Joshua C Carr
- Department of Kinesiology, Texas Christian University, Fort Worth TX, USA
- Department of Medical Education, Texas Christian University School of Medicine, Fort Worth TX, USA
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Ye X, Vala D, Walker H, Gaza V, Umali V, Brodoff P, Gockel N, Nakamura M. Effects of Unilateral Neuromuscular Electrical Stimulation with Illusionary Mirror Visual Feedback on the Contralateral Muscle: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3755. [PMID: 36834447 PMCID: PMC9962941 DOI: 10.3390/ijerph20043755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
We aim to examine the cross-education effects of unilateral muscle neuromuscular electrical stimulation (NMES) training combined with illusionary mirror visual feedback (MVF). Fifteen adults (NMES + MVF: 5; NMES: 5, Control: 5) completed this study. The experimental groups completed a 3-week NMES training on their dominant elbow flexor muscle. The NMES + MVF group had a mirror placed in the midsagittal plane between their upper arms, so a visual illusion was created in which their non-dominant arms appeared to be stimulated. Baseline and post-training measurements included both arms' isometric strength, voluntary activation level, and resting twitch. Cross-education effects were not observed from all dependent variables. For the unilateral muscle, both experimental groups showed greater strength increases when compared to the control (isometric strength % changes: NMES + MVF vs. NMES vs. Control = 6.31 ± 4.56% vs. 4.72 ± 8.97% vs. -4.04 ± 3.85%, p < 0.05). Throughout the training, even with the maximally tolerated NMES, the NMES + MVF group had greater perceived exertion and discomfort than the NMES. Additionally, the NMES-evoked force increased throughout the training for both groups. Our data does not support that NMES combined with or without MVF induces cross-education. However, the stimulated muscle becomes more responsive to the NMES and can become stronger following the training.
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Affiliation(s)
- Xin Ye
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT 06117, USA
| | - Daniel Vala
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT 06117, USA
| | - Hayden Walker
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT 06117, USA
| | - Victor Gaza
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT 06117, USA
| | - Vinz Umali
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT 06117, USA
| | - Patrick Brodoff
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT 06117, USA
| | - Nathan Gockel
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT 06117, USA
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
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DENİZOĞLU KÜLLİ H, ALPAY K, DURGUT E, TEMİZEL A. Acute Effect of Unilateral Muscle Training Supported with Visual Feedback on Contralateral Muscle Strength and Joint Position Sense. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1131359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aim: Unilateral exercise training is an effective and useful technique, especially in immobilization and neurological conditions, but the effect of unilateral muscle exercise training on muscle strength is modest. Therefore, the aim of this study is to detect the acute concomitant effect of mirror therapy and unilateral exercise training on muscle strength and joint position sense in healthy adults.Method: Thirty-one participants were randomly enrolled in two groups the mirror (n=16) and control groups (n=15). Hand grip (HG), pinch grip (PG) strengths, and joint position sense (JPS) of the wrist were assessed in both hands before and after a single exercise session which include 300 repetitive ball squeezing exercises by right (exercised) hand for all groups. The participants in the mirror group were asked to watch the mirror to see the reflection of their exercised hands, the control group only watched their exercised and unexercised hands without any visual feedback support during the exercise session. Repeated Measure ANOVA and Mixed ANOVA tests were performed to analyze in- and between-group differences.Results: The statistically significant differences were determined in unexercised hand HG and PG strength in the mirror group (F=10,105; p=0,006, ηp2=0,403; F=5,341; p=0,035; ηp2=0,263, respectively). However, any group×time interaction was found in JPS, HG, or PG tests (p<0;05). Additionally, no difference was shown in JPS in-group comparisons (p<0;05).Conclusion: The result of the study suggested that unilateral exercise training should apply concomitant with visual feedback. Further studies are needed to compare the effect of different sensory feedbacks on unilateral exercise training.
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Bilateral Sensorimotor Cortical Communication Modulated by Multiple Hand Training in Stroke Participants: A Single Training Session Pilot Study. Bioengineering (Basel) 2022; 9:bioengineering9120727. [PMID: 36550934 PMCID: PMC9774770 DOI: 10.3390/bioengineering9120727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Bi-manual therapy (BT), mirror therapy (MT), and robot-assisted rehabilitation have been conducted in hand training in a wide range of stages in stroke patients; however, the mechanisms of action during training remain unclear. In the present study, participants performed hand tasks under different intervention conditions to study bilateral sensorimotor cortical communication, and EEG was recorded. A multifactorial design of the experiment was used with the factors of manipulating objects (O), robot-assisted bimanual training (RT), and MT. The sum of spectral coherence was applied to analyze the C3 and C4 signals to measure the level of bilateral corticocortical communication. We included stroke patients with onset <6 months (n = 6), between 6 months and 1 year (n = 14), and onset >1 year (n = 20), and their Brunnstrom recovery stage ranged from 2 to 4. The results showed that stroke duration might influence the effects of hand rehabilitation in bilateral cortical corticocortical communication with significant main effects under different conditions in the alpha and beta bands. Therefore, stroke duration may influence the effects of hand rehabilitation on interhemispheric coherence.
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Lim H, Madhavan S. Effects of Cross-Education on Neural Adaptations Following Non-Paretic Limb Training in Stroke: A Scoping Review with Implications for Neurorehabilitation. J Mot Behav 2022; 55:111-124. [PMID: 35940590 DOI: 10.1080/00222895.2022.2106935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Current stroke rehabilitation interventions focus on intensive task specific training of the paretic limb, which may not be feasible for individuals with higher levels of impairment or in the early phase of stroke. Cross-education, a mechanism that improves strength or skill of the untrained limb following unilateral motor training, has high clinical relevance for stroke rehabilitation. Despite its potential benefits, our knowledge on the application and efficacy of cross-education in stroke is limited. We performed a scoping review to synthesize the current evidence regarding neurophysiological and motor effects of cross-education training in stroke. Low to strong evidence from five studies demonstrated strength gains ranging from 31-200% in the untrained paretic limb following non-paretic muscle training. Neurophysiological mechanisms underlying cross-education were unclear as the three studies that used transcranial magnetic stimulation to probe functional connectivity demonstrated mixed results in low sample size. Our review suggests that cross-education is a promising clinical approach in stroke, however high quality studies focusing on neurophysiological mechanisms are required to establish the efficacy and underlying mechanisms of cross-education in stroke. Recommendations regarding future directions and clinical utility are provided.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.,Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
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Coratella G, Galas A, Campa F, Pedrinolla A, Schena F, Venturelli M. The Eccentric Phase in Unilateral Resistance Training Enhances and Preserves the Contralateral Knee Extensors Strength Gains After Detraining in Women: A Randomized Controlled Trial. Front Physiol 2022; 13:788473. [PMID: 35309062 PMCID: PMC8928196 DOI: 10.3389/fphys.2022.788473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022] Open
Abstract
The current randomized controlled study investigated whether or not the inclusion of the eccentric phase in resistance training favors the contralateral strength gains after different unilateral protocols, and whether such gains are retained after detraining. Sixty healthy women were randomly assigned to a unilateral concentric-only (CONC), eccentric-only (ECC), concentric–eccentric (TRAD) volume-equated knee extension training or control group (CON). The participants trained 2 days/week for 8 weeks and then did not train for further 8 weeks. Knee extensors isokinetic concentric, eccentric, and isometric peak torque and vastus lateralis muscle thickness were assessed in the contralateral limb at baseline, post-training, and post-detraining. At post-training, concentric peak torque increased in CONC [+9.2%, 95%CI (+6.2/+12.3), p < 0.001, ES: 0.70, 95%CI (0.01/1.39)], ECC [+11.0% (+7.7/+14.2), p < 0.001: ES: 0.66(0.09/1.23)] and TRAD [+8.5%(+5.7/+11.6), p < 0.001, ES: 0.50(0.02/0.98)]. Eccentric peak torque increased in ECC in ECC [+15.0%(+11.4/+20.7), p < 0.001, ES: 0.91(0.14/1.63)] and TRAD [+5.5%(+0.3/10.7), p = 0.013, ES: 0.50(0.05/0.95)]. Isometric peak torque increased in ECC [+11.3(+5.8/16.8), p < 0.001, ES: 0.52(0.10/0.94)] and TRAD [+8.6%(+3.4/+13.7), p < 0.001, ES: 0.55(0.14/0.96)]. No change in eccentric and isometric peak torque occurred in CONC (p > 0.05). Muscle thickness did not change in any group (p > 0.05). At post-detraining, all groups preserved the contralateral strength gains observed at post-training (p < 0.05). The findings showed that ECC and TRAD increased contralateral knee extensors strength in concentric, eccentric, and isometric modality, while CONC only increased concentric strength. The eccentric phase appears to amplify the cross-education effect, permitting a transfer in strength gaining toward multiple testing modalities. Both eccentric-based and traditional eccentric–concentric resistance protocols are recommended to increase the contralateral retention in strength gains after a detraining period.
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Affiliation(s)
- Giuseppe Coratella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
- *Correspondence: Giuseppe Coratella,
| | - Annalisa Galas
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Campa
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Anna Pedrinolla
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- CeRISM Research Center, University of Verona, Rovereto, Italy
| | - Massimo Venturelli
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
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Calvert GHM, Carson RG. Neural mechanisms mediating cross education: With additional considerations for the ageing brain. Neurosci Biobehav Rev 2021; 132:260-288. [PMID: 34801578 DOI: 10.1016/j.neubiorev.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
CALVERT, G.H.M., and CARSON, R.G. Neural mechanisms mediating cross education: With additional considerations for the ageing brain. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2021. - Cross education (CE) is the process whereby a regimen of unilateral limb training engenders bilateral improvements in motor function. The contralateral gains thus derived may impart therapeutic benefits for patients with unilateral deficits arising from orthopaedic injury or stroke. Despite this prospective therapeutic utility, there is little consensus concerning its mechanistic basis. The precise means through which the neuroanatomical structures and cellular processes that mediate CE may be influenced by age-related neurodegeneration are also almost entirely unknown. Notwithstanding the increased incidence of unilateral impairment in later life, age-related variations in the expression of CE have been examined only infrequently. In this narrative review, we consider several mechanisms which may mediate the expression of CE with specific reference to the ageing CNS. We focus on the adaptive potential of cellular processes that are subserved by a specific set of neuroanatomical pathways including: the corticospinal tract, corticoreticulospinal projections, transcallosal fibres, and thalamocortical radiations. This analysis may inform the development of interventions that exploit the therapeutic utility of CE training in older persons.
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Affiliation(s)
- Glenn H M Calvert
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland; School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
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Veldman MP, Maurits NM, Mantini D, Hortobágyi T. Age-dependent modulation of motor network connectivity for skill acquisition, consolidation and interlimb transfer after motor practice. Clin Neurophysiol 2021; 132:1790-1801. [PMID: 34130247 DOI: 10.1016/j.clinph.2021.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 02/19/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Age-related differences in neural strategies for motor learning are not fully understood. We determined the effects of age on the relationship between motor network connectivity and motor skill acquisition, consolidation, and interlimb transfer using dynamic imaging of coherent sources. METHODS Healthy younger (n = 24, 18-24 y) and older (n = 24, 65-87 y) adults unilaterally practiced a visuomotor task and resting-state electroencephalographic data was acquired before and after practice as well as at retention. RESULTS The results showed that right-hand skill acquisition and consolidation did not differ between age groups. However, age affected the ability to transfer the newly acquired motor skill to the non-practiced limb. Moreover, strengthened left- and right-primary motor cortex-related beta connectivity was negatively and positively associated with right-hand skill acquisition and left-hand skill consolidation in older adults, respectively. CONCLUSION Age-dependent modulations of bilateral resting-state motor network connectivity indicate age-specific strategies for the acquisition, consolidation, and interlimb transfer of novel motor tasks. SIGNIFICANCE The present results provide insights into the mechanisms underlying motor learning that are important for the development of interventions for patients with unilateral injuries.
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Affiliation(s)
- M P Veldman
- KU Leuven, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Leuven, Belgium; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium.
| | - N M Maurits
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - D Mantini
- KU Leuven, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Leuven, Belgium; Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - T Hortobágyi
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
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Colomer-Poveda D, Romero-Arenas S, Hortobagyi T, Márquez G. Does ipsilateral corticospinal excitability play a decisive role in the cross-education effect caused by unilateral resistance training? A systematic review. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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11
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Zhang JJ, Fong KNK. The Modulatory Effects of Intermittent Theta Burst Stimulation in Combination With Mirror Hand Motor Training on Functional Connectivity: A Proof-of-Concept Study. Front Neural Circuits 2021; 15:548299. [PMID: 33994954 PMCID: PMC8116554 DOI: 10.3389/fncir.2021.548299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Mirror training (MT) is an observation-based motor learning strategy. Intermittent theta burst stimulation (iTBS) is an accelerated form of excitatory repetitive transcranial magnetic stimulation (rTMS) that has been used to enhance the cortical excitability of the motor cortices. This study aims to investigate the combined effects of iTBS with MT on the resting state functional connectivity at alpha frequency band in healthy adults. Eighteen healthy adults were randomized into one of three groups—Group 1: iTBS plus MT, Group 2: iTBS plus sham MT, and Group 3: sham iTBS plus MT. Participants in Groups 1 and 3 observed the mirror illusion of the moving (right) hand in a plain mirror for four consecutive sessions, one session/day, while participants in Group 2 received the same training with a covered mirror. Real or sham iTBS was applied daily over right motor cortex prior to the training. Resting state electroencephalography (EEG) at baseline and post-training was recorded when participants closed their eyes. The mixed-effects model demonstrated a significant interaction effect in the coherence between FC4 and C4 channels, favoring participants in Group 1 over Group 3 (Δβ = −0.84, p = 0.048). A similar effect was also found in the coherence between FC3 and FC4 channels favoring Group 1 over Group 3 (Δβ = −0.43, p = 0.049). In contrast to sham iTBS combined with MT, iTBS combined with MT may strengthen the functional connectivity between bilateral premotor cortices and ipsilaterally within the motor cortex of the stimulated hemisphere. In contrast to sham MT, real MT, when combined with iTBS, might diminish the connectivity among the contralateral parietal–frontal areas.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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12
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Carr JC, Bemben MG, Stock MS, DeFreitas JM. Ipsilateral and contralateral responses following unimanual fatigue with and without illusionary mirror visual feedback. J Neurophysiol 2021; 125:2084-2093. [PMID: 33909484 DOI: 10.1152/jn.00077.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Illusionary mirror visual feedback alters interhemispheric communication and influences cross-limb interactions. Combining forceful unimanual contractions with the mirror illusion is a convenient way to provoke robust alterations within ipsilateral motor networks. It is unknown, however, if the mirror illusion affects cross-limb fatigability. We examine this concept by comparing the ipsilateral and contralateral handgrip force and electromyographic (EMG) responses following unimanual fatigue with and without illusionary mirror visual feedback. Participants underwent three experimental sessions (mirror, no-mirror, and control), performing a unimanual fatigue protocol with and without illusionary mirror visual feedback. Maximal handgrip force and EMG activity were measured before and after each session for both hands during maximal unimanual and bimanual contractions. The associated EMG activity from the inactive forearm during unimanual contraction was also examined. The novel findings demonstrate greater relative fatigability during bimanual versus unimanual contraction following unimanual fatigue (-31.8% vs. -23.4%, P < 0.01) and the mirror illusion attenuates this difference (-30.3% vs. -26.3%, P = 0.169). The results show no evidence for a cross-over effect of fatigue with (+0.62%, -2.72%) or without (+0.26%, -2.49%) the mirror illusion during unimanual or bimanual contraction. The mirror illusion resulted in significantly lower levels of associated EMG activity in the contralateral forearm. There were no sex differences for any of the measures of fatigability. These results demonstrate that the mirror illusion influences contraction-dependent fatigue during maximal handgrip contractions. Alterations in facilitatory and inhibitory transcallosal drive likely explain these findings.NEW & NOTEWORTHY Illusionary mirror visual feedback is a promising clinical tool for motor rehabilitation, yet many features of its influence on motor output are unknown. We show that maximal bimanual force output is compromised to a greater extent than unimanual force output following unimanual fatigue, yet illusionary mirror visual feedback attenuates this difference. The mirror illusion also reduces the unintended EMG activity of the inactive, contralateral forearm during unimanual contraction.
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Affiliation(s)
- Joshua C Carr
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas.,Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, Texas
| | - Michael G Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - Matt S Stock
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, Florida.,Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Jason M DeFreitas
- Applied Neuromuscular Physiology Laboratory, Oklahoma State University, Stillwater, Oklahoma
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Colomer-Poveda D, Romero-Arenas S, Fariñas J, Iglesias-Soler E, Hortobágyi T, Márquez G. Training load but not fatigue affects cross-education of maximal voluntary force. Scand J Med Sci Sports 2020; 31:313-324. [PMID: 33038018 DOI: 10.1111/sms.13844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/02/2020] [Accepted: 09/25/2020] [Indexed: 01/23/2023]
Abstract
The purpose of this study was to determine the effects of training load (25% vs. 75% of one repetition maximum [1RM]) and fatigue (failure vs. non-failure) during four weeks of unilateral knee extension resistance training (RT) on maximal voluntary force in the trained and the untrained knee extensors. Healthy young adults (n = 42) were randomly assigned to control (CON, n = 9, 24 ± 4.3 years), low-load RT to failure (LLF, n = 11, 21 ± 1.3 years, three sets to failure at 25% of 1RM), high-load RT to failure (HLF, n = 11, 21 ± 1.4 years, three sets to failure at 75% of 1RM), and high-load RT without failure (HLNF, n = 11, 22 ± 1.5 years, six sets of five repetitions at 75% of 1RM) groups. Before and after the four weeks of training, 1RM, maximal voluntary isometric force, and corticospinal excitability (CSE) were measured. 1RM in the trained (20%, d = 0.70, 15%, d = 0.61) and the untrained knee extensors (5%, d = 0.27, 6%, d = 0.26) increased only in the HLF and HLNF groups, respectively. MVIC force increased only in the trained leg of the HLF (5%, d = 0.35) and HLNF groups (12%, d = 0.67). CSE decreased in the VL of both legs in the HLNF group (-19%, d = 0.44) and no changes occurred in the RF. In conclusion, high- but not low-load RT improves maximal voluntary force in the trained and the untrained knee extensors and fatigue did not further enhance these adaptations. Voluntary force improvements were unrelated to CSE changes in both legs.
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Affiliation(s)
- David Colomer-Poveda
- Department of Physical Education and Sport, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Salvador Romero-Arenas
- Department of Physical Education and Sport, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Juan Fariñas
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruna, Spain
| | - Eliseo Iglesias-Soler
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruna, Spain
| | - Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gonzalo Márquez
- Department of Physical Education and Sport, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain.,Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruna, Spain
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14
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Tai RY, Zhu JD, Cheng CH, Tseng YJ, Chen CC, Hsieh YW. Cortical neural activity evoked by bilateral and unilateral mirror therapy after stroke. Clin Neurophysiol 2020; 131:2333-2340. [PMID: 32828035 DOI: 10.1016/j.clinph.2020.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to investigate the differential effects of bilateral and unilateral mirror therapy (MT) on motor cortical activations in stroke patients by magnetoencephalography (MEG). METHODS Sixteen stroke patients and 16 right-handed healthy volunteers were recruited. All participants were required to perform 4 conditions: resting, no mirror with bilateral hand movements (Bilateral-No mirror), mirror with bilateral hand movements (Bilateral-Mirror) and mirror with unilateral hand movements (Unilateral-Mirror). Beta oscillatory activities in the primary motor cortex (M1) were collected during each condition using MEG. The percentage change of beta oscillatory activity was calculated for each condition to correct the baseline differences. RESULTS In the stroke group, the percentage change of M1 beta oscillatory activity significantly decreased more in the Bilateral-Mirror condition than in the Bilateral-No mirror and Unilateral-Mirror conditions. In the healthy group, no significant differences in the percentage change of beta oscillatory activity were found among the 3 conditions. Further, a significant difference in the percentage change of beta oscillatory activity only in the Bilateral-Mirror condition was found between the 2 groups. CONCLUSIONS This study provides new information on the differential cortical activations modulated by bilateral and unilateral MT. SIGNIFICANCE Bilateral MT led to greater M1 neural activities than unilateral MT and bilateral movements without a mirror in stroke patients.
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Affiliation(s)
- Ruei-Yi Tai
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Jun-Ding Zhu
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Jhan Tseng
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.
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15
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Wang CY, Miyoshi S, Chen CH, Lee KC, Chang LC, Chung JH, Shi HY. Walking ability and functional status after post-acute care for stroke rehabilitation in different age groups: a prospective study based on propensity score matching. Aging (Albany NY) 2020; 12:10704-10714. [PMID: 32482912 PMCID: PMC7346049 DOI: 10.18632/aging.103288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/27/2020] [Indexed: 12/26/2022]
Abstract
Few studies have compared how rehabilitative post-acute care affects recovery of walking ability and other functions after stroke in different age groups. After propensity score matching (1:1), 316 stroke patients were separated into an aged group (age ≥65 years, n=158) and a non-aged group (age <65 years, n=158). Both groups significantly improved in Barthel index, EuroQol-5 dimension, Berg balance scale, 6-minute walking distance and 5-meter walking speed (P<0.001). The non-aged group had significantly larger improvements in Berg balance scale, instrumental activities of daily living, EuroQol-5 dimension and 6-minute walking distance (P<0.001) compared to the aged group. The two groups did not significantly differ in Barthel index, 5-meter walking speed, length of stay, and cost. The aged group had poorer walking ability and poorer instrumental activities of daily living compared to the non-aged group. After intensive rehabilitative post-acute care, however, the aged group improved in walking ability, functional performance and mental health. Intensive strength training for unaffected lower limbs in the stroke patients achieved good recovery of walking ability and other functions. Overall, intensive rehabilitative post-acute care improved self-care ability and decreased informal care costs. Rehabilitative PAC under per-diem reimbursement is efficient and economical for stroke patients in an aging society.
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Affiliation(s)
- Chung-Yuan Wang
- Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital, Pingtung, Taiwan.,Department of Beauty Science, Meiho University, Pingtung, Taiwan
| | - Seido Miyoshi
- Department of Rehabilitation, Asagi Hospital, Fukuoka, Japan
| | - Chang-Hung Chen
- Department of Neurology, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Kai-Chun Lee
- Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Long-Chung Chang
- Superintendent Office, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Jo-Hsuan Chung
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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16
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Zhang JJ, Fong KNK. Enhancing mirror visual feedback with intermittent theta burst stimulation in healthy adults. Restor Neurol Neurosci 2020; 37:483-495. [PMID: 31424421 DOI: 10.3233/rnn-190927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Excitatory brain stimulation, in the form of intermittent theta burst stimulation (iTBS), combined with mirror visual feedback (MVF), is hypothesized to promote neuroplasticity and motor performance. OBJECTIVE This study aimed to investigate the combined effects of iTBS with mirror training (MT) on the MVF-induced sensorimotor event-related desynchronization (ERD) and the non-dominant hand motor performance in healthy adults. METHODS Eighteen healthy right-handed subjects were randomly assigned to one of three groups (Group 1: iTBS plus MT, Group 2: iTBS plus sham MT, or Group 3: sham iTBS plus MT). For participants in Groups 1 and 3, motor training was performed for 15 minutes for the right hand over four consecutive days, with MVF superimposing on their inactive left hand behind a mirror. Participants in Group 2 received the same right-hand motor training, but the mirror was covered without MVF. iTBS or sham iTBS was applied daily over the right primary motor cortex prior to the training. Electroencephalography at pre/post-training was recorded while participants performed right-hand movement under mirror and direct view. Motor performance was assessed at baseline and post-training. RESULTS Baseline comparisons demonstrated that a shift in sensorimotor ERD towards the right hemisphere was induced by MVF, in mu-1 (8-10 Hz) (p = 0.002), mu-2 (10-12 Hz) (p = 0.004) and beta-1 (12-16 Hz) (p = 0.049) bands. After the training, participants in Group 1 showed a stronger MVF-induced sensorimotor ERD in mu-1 (p = 0.017) and mu-2 (p = 0.009) bands than those in Group 3. No significant between-group difference in motor outcomes was observed. CONCLUSIONS iTBS appears to prime subjects' brain to be more receptive to MVF.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
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17
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Chen Y, Wang P, Bai Y, Wang Y. Effects of mirror training on motor performance in healthy individuals: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2019; 5:e000590. [PMID: 31908833 PMCID: PMC6937065 DOI: 10.1136/bmjsem-2019-000590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Mirror training (MTr) is a rehabilitation technique for patients with neurological diseases. There is no consensus on its effects on motor function in healthy individuals. This systematic review and meta-analysis considers the effects of MTr on motor function in healthy individuals. Design This is a systematic review and meta-analysis. Data sources We searched six databases for studies assessing the effects of MTr on motor function in healthy individuals, published between January 1995 and December 2018. The Cochrane risk of bias was used to assess the quality of the studies. A meta-analysis was conducted with narrative synthesis. Eligibility criteria for selecting studies English-language randomised controlled trials reporting the behavioural results in healthy individuals were included. Results Fourteen randomised controlled trials involving 538 healthy individuals were eligible. Two short-term studies showed MTr was inferior to passive vision pattern (standardised mean difference 0.57 (95% CI 0.06 to 1.08), I2=0%, p=0.03). The methods varied and there is limited evidence supporting the effectiveness of MTr compared with three alternative training patterns, with insufficient evidence to support analyses of age, skill level or hand dominance. Conclusion The limited evidence that MTr affects motor performance in healthy individuals is weak and inconsistent among studies. It is unclear whether the effects of MTr on motor performance are more pronounced than the direct vision pattern, passive vision pattern or action observation. Further studies are needed to explore the short-term and long-term benefits of MTr and its effects on motor learning in healthy individuals. PROSPERO registration number CRD42019128881.
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Affiliation(s)
- Yinglun Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Pu Wang
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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18
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Colomer-Poveda D, Hortobágyi T, Keller M, Romero-Arenas S, Márquez G. Training intensity-dependent increases in corticospinal but not intracortical excitability after acute strength training. Scand J Med Sci Sports 2019; 30:652-661. [PMID: 31785009 DOI: 10.1111/sms.13608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to determine whether the increases in corticospinal excitability (CSE) observed after one session of unilateral isometric strength training (ST) are related to changes in intracortical excitability measured by magnetic brain stimulation (TMS) in the trained and the contralateral untrained biceps brachii (BB) and whether such changes scale with training intensity. On three separate days, 15 healthy young men performed one ST session of 12 sets of eight isometric contractions of the right elbow flexors at 0% (control session), 25%, or 75% of the maximal voluntary contraction (MVC) in a random order. Before and after each session separated at least by 1 week, motor evoked potential (MEP) amplitude, short-interval intracortical inhibition (SICI), contralateral silent period (SP), and intracortical facilitation (ICF) generated by TMS were measured in the trained and the untrained BBs. Compared with baseline, MEPs recorded from the trained BB increased by ~47% after training at 75% of MVC (P < .05) but not after training at 0% (~4%) or 25% MVC (~5%, both P > .05). MEPs in the untrained BB and SICI, SP, and ICF in either BB did not change. Therefore, acute high-intensity but not low-intensity unilateral isometric ST increases CSE in the trained BB without modifications in intracortical inhibition or facilitation. Thus, increases in corticospinal neurons or α-α-motoneuron excitability could underlie the increases in CSE. Regardless of contraction intensity, acute isometric ST did not modify the excitability of the ipsilateral primary motor cortex measured by TMS.
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Affiliation(s)
- David Colomer-Poveda
- Department of Physical Education and Sport, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Keller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Salvador Romero-Arenas
- Department of Physical Education and Sport, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Gonzalo Márquez
- Department of Physical Education and Sport, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain
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19
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Effects of acute and chronic unilateral resistance training variables on ipsilateral motor cortical excitability and cross-education: A systematic review. Phys Ther Sport 2019; 40:143-152. [DOI: 10.1016/j.ptsp.2019.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 07/09/2019] [Accepted: 09/16/2019] [Indexed: 12/26/2022]
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20
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Ehrensberger M, Simpson D, Broderick P, Blake C, Horgan F, Hickey P, OʼReilly J, Monaghan K. Unilateral Strength Training and Mirror Therapy in Patients With Chronic Stroke: A Pilot Randomized Trial. Am J Phys Med Rehabil 2019; 98:657-665. [PMID: 31318745 DOI: 10.1097/phm.0000000000001162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the feasibility and potential effectiveness of mirror-aided cross-education compared with cross-education alone in poststroke upper limb recovery. DESIGN A pilot randomized controlled parallel group study was carried out. Thirty-two patients with chronic stroke followed a 4-wk isometric strength training program performed with the less-affected upper limb three times per week. Participants in the mirror and strength training group observed the reflection of the exercising arm in the mirror. Participants in the strength training only group exercised without a mirror entirely. Participant compliance, adverse effects, and suitability of outcome measures assessed feasibility. Effectiveness outcomes included maximal isometric strength measured with the Biodex Dynamometer, the Modified Ashworth Scale, and the Chedoke Arm and Hand Activity Inventory. RESULTS Compliance was high with no adverse effects. The use of the Biodex Dynamometer must be reviewed. Mirror therapy did not augment the cross-education effect (P > 0.05) in patients with chronic stroke when training isometrically. CONCLUSIONS This pilot trial established the feasibility of a randomized controlled trial comparing mirror-aided cross-education with cross-education alone for poststroke upper limb recovery. Mirror therapy did not augment cross-education when training isometrically. However, results indicate that the combination of interventions should be investigated further applying an altered training protocol.
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Affiliation(s)
- Monika Ehrensberger
- From the Clinical Health & Nutrition Centre (CHANCE), Department of Life Sciences, Institute of Technology, Sligo, Ireland (ME, DS, PB, KM); Physiotherapy & Population Science, University College Dublin, Dublin, Ireland (CB); Faculty of Medicine & Health Sciences, Royal College of Surgeons Ireland, Dublin, Ireland (FH); and University Hospital, Sligo, Ireland (PH, JO)
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21
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Simpson D, Ehrensberger M, Horgan F, Blake C, Roberts D, Broderick P, Monaghan K. Unilateral dorsiflexor strengthening with mirror therapy to improve motor function after stroke: A pilot randomized study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1792. [PMID: 31264770 DOI: 10.1002/pri.1792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/27/2019] [Accepted: 05/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting. OBJECTIVES This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke. METHODS Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining. RESULTS Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity. CONCLUSION Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.
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Affiliation(s)
- Daniel Simpson
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Monika Ehrensberger
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Frances Horgan
- School of Physiotherapy, RCSI (Royal College of Surgeons in Ireland), Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - David Roberts
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Patrick Broderick
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Kenneth Monaghan
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
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22
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Denizoglu Kulli H, Karabulut D, Saka T, Akan A, Arslan YZ. Force irradiation effect of kinesiotaping on contralateral muscle activation. Hum Mov Sci 2019; 66:310-317. [PMID: 31136904 DOI: 10.1016/j.humov.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/11/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
We aimed to determine the force irradiation effect of kinesiotaping (KT) on contralateral muscle activity during unilateral muscle contraction. Forty healthy (26 females, 14 males) subjects were divided into two groups: KT and control groups. KT was applied on the biceps brachii at the contralateral limb (non-dominant limb) in the KT group, whereas no taping was applied to the control group. All participants performed unilateral isometric, concentric, and eccentric contractions with their dominant upper limbs (exercised limb) by means of an isokinetic dynamometer, while the contralateral limb was in the resting condition, neutral position, and motionless during the testing procedure. During the exercise, contralateral biceps brachii muscle activity was recorded by surface electromyography (EMG). To quantify the muscle activation, EMG signals were expressed as a percentage of the maximal isometric voluntary contraction, which is referred to as %EMGmax. The KT group showed significantly higher %EMGmax in the biceps brachii compared to the control group at the contralateral limb during the isometric, concentric, and eccentric contractions (p = 0.035, p = 0.046, and p = 0.002, respectively) The median values of the contralateral muscle activity were 2.74 %EMGmax and 6.62 %EMGmax during the isometric contraction for the control and KT groups, respectively (p = 0.035). During the concentric contraction, the median values of the contralateral muscle activity were 1.61 %EMGmax and 9.39 %EMGmax for the control and KT groups, respectively (p = 0.046). The median values of the contralateral muscle activity were 4.49 %EMGmax and 22.89 %EMGmax for the eccentric contraction for the control and KT groups, respectively (p = 0.002). In conclusion, KT application on the contralateral limb increased the contralateral muscle activation in the biceps brachii during the unilateral isometric, concentric, and eccentric contractions.
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Affiliation(s)
- Hilal Denizoglu Kulli
- Bezmialem Vakif University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Derya Karabulut
- Istanbul University-Cerrahpasa, Faculty of Engineering, Department of Mechanical Engineering, Istanbul, Turkey.
| | - Tolga Saka
- Health Sciences University, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Department of Sports Medicine, Istanbul, Turkey
| | - Aydın Akan
- Izmir Katip Celebi University, Faculty of Engineering and Architecture, Department of Biomedical Engineering, Izmir, Turkey.
| | - Yunus Ziya Arslan
- Istanbul University-Cerrahpasa, Faculty of Engineering, Department of Mechanical Engineering, Istanbul, Turkey.
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23
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THOMAS KEVIN, BROWNSTEIN CALLUMGEORGE, DENT JACK, PARKER PAUL, GOODALL STUART, HOWATSON GLYN. Neuromuscular Fatigue and Recovery after Heavy Resistance, Jump, and Sprint Training. Med Sci Sports Exerc 2018; 50:2526-2535. [DOI: 10.1249/mss.0000000000001733] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Green LA, Gabriel DA. The effect of unilateral training on contralateral limb strength in young, older, and patient populations: a meta-analysis of cross education. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1499272] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Lara A. Green
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - David A. Gabriel
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
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25
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Frazer AK, Pearce AJ, Howatson G, Thomas K, Goodall S, Kidgell DJ. Determining the potential sites of neural adaptation to cross-education: implications for the cross-education of muscle strength. Eur J Appl Physiol 2018; 118:1751-1772. [PMID: 29995227 DOI: 10.1007/s00421-018-3937-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/05/2018] [Indexed: 12/11/2022]
Abstract
Cross-education describes the strength gain in the opposite, untrained limb following a unilateral strength training program. Since its discovery in 1894, several studies now confirm the existence of cross-education in contexts that involve voluntary dynamic contractions, eccentric contraction, electrical stimulation, whole-body vibration and, more recently, following mirror feedback training. Although many aspects of cross-education have been established, the mediating neural mechanisms remain unclear. Overall, the findings of this review show that the neural adaptations to cross-education of muscle strength most likely represent a continuum of change within the central nervous system that involves both structural and functional changes within cortical motor and non-motor regions. Such changes are likely to be the result of more subtle changes along the entire neuroaxis which include, increased corticospinal excitability, reduced cortical inhibition, reduced interhemispheric inhibition, changes in voluntary activation and new regions of cortical activation. However, there is a need to widen the breadth of research by employing several neurophysiological techniques (together) to better understand the potential mechanisms mediating cross-education. This fundamental step is required in order to better prescribe targeted and effective guidelines for the clinical practice of cross-education. There is a need to determine whether similar cortical responses also occur in clinical populations where, perhaps, the benefits of cross-education could be best observed.
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Affiliation(s)
- Ashlyn K Frazer
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia.
| | - Alan J Pearce
- Discipline of Exercise Science, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK.,Water Research Group, School of Biological Sciences, North West University, Potchefstroom, South Africa
| | - Kevin Thomas
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Stuart Goodall
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Dawson J Kidgell
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
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26
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Manca A, Hortobágyi T, Rothwell J, Deriu F. Neurophysiological adaptations in the untrained side in conjunction with cross-education of muscle strength: a systematic review and meta-analysis. J Appl Physiol (1985) 2018; 124:1502-1518. [DOI: 10.1152/japplphysiol.01016.2017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We reviewed the evidence from randomized controlled trials (RCTs) focusing on the neurophysiological adaptations in the untrained side associated with cross-education of strength (CE) and pooled data into definite effect estimates for neurophysiological variables assessed in chronic CE studies. Furthermore, scoping directions for future research were provided to enhance the homogeneity and comparability of studies investigating the neural responses to CE. The magnitude of CE was 21.1 ± 18.2% (mean ± SD; P < 0.0001) in 22 RCTs ( n = 467 subjects) that measured at least 1 neurophysiological variable in the untrained side, including the following: electromyography (EMG; 14 studies); motor evoked potential (MEP; 8 studies); short-interval intracortical inhibition (SICI), recruitment curve, and M wave (6 studies); cortical silent period (cSP; 5 studies); interhemispheric inhibition, intracortical facilitation (ICF), and H reflex (2 studies); and V wave, short-interval ICF, short-latency afferent inhibition, and long-latency afferent inhibition (1 study). Only EMG, MEP, ICF, cSP, and SICI could be included in the meta-analysis (18 studies, n = 387). EMG ( P = 0.26, n = 235) and MEP amplitude ( P = 0.11, n = 145) did not change in the untrained limb after CE. cSP duration ( P = 0.02, n = 114) and SICI ( P = 0.001, n = 95) decreased in the untrained hemisphere according to body region and type and intensity of training. The magnitude of CE did not correlate with changes in these transcranial magnetic stimulation (TMS) measures. The design of this meta-analytical study and the lack of correlations prevented the ability to link mechanistically the observed neurophysiological changes to CE. Notwithstanding the limited amount of data available for pooling, the use of TMS to assess the ipsilateral neurophysiological responses to unilateral training still confirms the central neural origin hypothesis of chronic CE induced by strength training. However, how these neural adaptations contribute to CE remains unclear.
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Affiliation(s)
- Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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27
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Andrushko JW, Gould LA, Farthing JP. Contralateral effects of unilateral training: sparing of muscle strength and size after immobilization. Appl Physiol Nutr Metab 2018; 43:1131-1139. [PMID: 29800529 DOI: 10.1139/apnm-2018-0073] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The contralateral effects of unilateral strength training, known as cross-education of strength, date back well over a century. In the last decade, a limited number of studies have emerged demonstrating the preservation or "sparing" effects of cross-education during immobilization. Recently published evidence reveals that the sparing effects of cross-education show muscle site specificity and involve preservation of muscle cross-sectional area. The new research also demonstrates utility of training with eccentric contractions as a potent stimulus to preserve immobilized limb strength across multiple modes of contraction. The cumulative data in nonclinical settings suggest that cross-education can completely abolish expected declines in strength and muscle size in the range of ∼13% and ∼4%, respectively, after 3-4 weeks of immobilization of a healthy arm. The evidence hints towards the possibility that unique mechanisms may be involved in preservation effects of cross-education, as compared with those that lead to functional improvements under normal conditions. Cross-education effects after strength training appear to be larger in clinical settings, but there is still only 1 randomized clinical trial demonstrating the potential utility of cross-education in addition to standard treatment. More work is necessary in both controlled and clinical settings to understand the potential interaction of neural and muscle adaptations involved in the observed sparing effects, but there is growing evidence to advocate for the clinical utility of cross-education.
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Affiliation(s)
- Justin W Andrushko
- a College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada
| | - Layla A Gould
- a College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada.,b College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jonathan P Farthing
- a College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada
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The ipsilateral corticospinal responses to cross-education are dependent upon the motor-training intervention. Exp Brain Res 2018; 236:1331-1346. [PMID: 29511785 DOI: 10.1007/s00221-018-5224-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/01/2018] [Indexed: 01/06/2023]
Abstract
This study aimed to identify the ipsilateral corticospinal responses of the contralateral limb following different types of unilateral motor-training. Three groups performing unilateral slow-paced strength training (SPST), non-paced strength training (NPST) or visuomotor skill training (VT) were compared to a control group. It was hypothesised that 4 weeks of unilateral SPST and VT, but not NPST, would increase ipsilateral corticospinal excitability (CSE) and reduce short-interval cortical inhibition (SICI), resulting in greater performance gains of the untrained limb. Tracking error of the untrained limb reduced by 29 and 41% following 2 and 4 weeks of VT. Strength of the untrained limb increased by 8 and 16% following 2 and 4 weeks of SPST and by 6 and 13% following NPST. There was no difference in cross-education of strength or tracking error. For the trained limb, SPST and NPST increased strength (28 and 26%), and VT improved by 47 and 58%. SPST and VT increased ipsilateral CSE by 89 and 71% at 2 weeks. Ipsilateral CSE increased 105 and 81% at 4 weeks following SPST and VT. The NPST group and control group showed no changes at 2 and 4 weeks. SPST and VT reduced ipsilateral SICI by 45 and 47% at 2 weeks; at 4 weeks, SPST and VT reduced SICI by 48 and 38%. The ipsilateral corticospinal responses are determined by the type of motor-training. There were no differences in motor performance between SPST, NPST and VT. The data suggests that the corticospinal responses to cross-education are different and determined by the type of motor-training.
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Colomer-Poveda D, Romero-Arenas S, Hortobagyi T, Márquez G. Does ipsilateral corticospinal excitability play a decisive role in the cross-education effect caused by unilateral resistance training? A systematic review. Neurologia 2018; 36:285-297. [PMID: 29305060 DOI: 10.1016/j.nrl.2017.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Unilateral resistance training has been shown to improve muscle strength in both the trained and the untrained limb. One of the most widely accepted theories is that this improved performance is due to nervous system adaptations, specifically in the primary motor cortex. According to this hypothesis, increased corticospinal excitability (CSE), measured with transcranial magnetic stimulation, is one of the main adaptations observed following prolonged periods of training. The principal aim of this review is to determine the degree of adaptation of CSE and its possible functional association with increased strength in the untrained limb. DEVELOPMENT We performed a systematic literature review of studies published between January 1970 and December 2016, extracted from Medline (via PubMed), Ovid, Web of Science, and Science Direct online databases. The search terms were as follows: (transcranial magnetic stimulation OR excitability) AND (strength training OR resistance training OR force) AND (cross transfer OR contralateral limb OR cross education). A total of 10 articles were found. CONCLUSION Results regarding increased CSE were inconsistent. Although the possibility that the methodology had a role in this inconsistency cannot be ruled out, the results appear to suggest that there may not be a functional association between increases in muscle strength and in CSE.
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Affiliation(s)
- D Colomer-Poveda
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Deporte-UCAM, Universidad Católica de Murcia, Murcia, España
| | - S Romero-Arenas
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Deporte-UCAM, Universidad Católica de Murcia, Murcia, España
| | - T Hortobagyi
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Países Bajos
| | - G Márquez
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Deporte-UCAM, Universidad Católica de Murcia, Murcia, España.
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Mason J, Frazer AK, Horvath DM, Pearce AJ, Avela J, Howatson G, Kidgell DJ. Ipsilateral corticomotor responses are confined to the homologous muscle following cross-education of muscular strength. Appl Physiol Nutr Metab 2017; 43:11-22. [PMID: 28829918 DOI: 10.1139/apnm-2017-0457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cross-education of strength occurs when strength-training 1 limb increases the strength of the untrained limb and is restricted to the untrained homologous muscle. Cortical circuits located ipsilateral to the trained limb might be involved. We used transcranial magnetic stimulation (TMS) to determine the corticomotor responses from the untrained homologous (biceps brachii) and nonhomologous (flexor carpi radialis) muscle following strength-training of the right elbow flexors. Motor evoked potentials were recorded from the untrained left biceps brachii and flexor carpi radialis during a submaximal contraction from 20 individuals (10 women, 10 men; aged 18-35 years; training group, n = 10; control group, n = 10) before and after 3 weeks of strength-training the right biceps brachii at 80% of 1-repetition maximum. Recruitment-curves for corticomotor excitability and inhibition of the untrained homologous and nonhomologous muscle were constructed and assessed by examining the area under the recruitment curve. Strength-training increased strength of the trained elbow flexors (29%), resulting in an 18% increase in contralateral strength of the untrained elbow flexors (P < 0.0001). The trained wrist flexors increased by 19%, resulting in a 12% increase in strength of the untrained wrist flexors (P = 0.005). TMS showed increased corticomotor excitability and decreased corticomotor inhibition for the untrained homologous muscle (P < 0.05); however, there were no changes in the untrained nonhomologous muscle (P > 0.05). These findings show that the cross-education of muscular strength is spatially distributed; however, the neural adaptations are confined to the motor pathway ipsilateral to the untrained homologous agonist.
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Affiliation(s)
- Joel Mason
- a Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne 3155, Australia
| | - Ashlyn K Frazer
- a Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne 3155, Australia
| | - Deanna M Horvath
- b Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne 3086, Australia
| | - Alan J Pearce
- c Discipline of Sport & Exercise Science, School of Allied Health, La Trobe University, Melbourne 3086, Australia
| | - Janne Avela
- d Department of Biology and Physical Activity, University of Jyväskylä, Jyväskylä 40014, Finland
| | - Glyn Howatson
- e Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK.,f Water Research Group, School of Environmental Sciences and Development, Northwest University, Potchefstroom 2520, South Africa
| | - Dawson J Kidgell
- a Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne 3155, Australia
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Hendy AM, Lamon S. The Cross-Education Phenomenon: Brain and Beyond. Front Physiol 2017; 8:297. [PMID: 28539892 PMCID: PMC5423908 DOI: 10.3389/fphys.2017.00297] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/24/2017] [Indexed: 12/17/2022] Open
Abstract
Objectives: Unilateral resistance training produces strength gains in the untrained homologous muscle group, an effect termed “cross-education.” The observed strength transfer has traditionally been considered a phenomenon of the nervous system, with few studies examining the contribution of factors beyond the brain and spinal cord. In this hypothesis and theory article, we aim to discuss further evidence for structural and functional adaptations occurring within the nervous, muscle, and endocrine systems in response to unilateral resistance training. The limitations of existing cross-education studies will be explored, and novel potential stakeholders that may contribute to the cross-education effect will be identified. Design: Critical review of the literature. Method: Search of online databases. Results: Studies have provided evidence that functional reorganization of the motor cortex facilitates, at least in part, the effects of cross-education. Cross-activation of the “untrained” motor cortex, ipsilateral to the trained limb, plays an important role. While many studies report little or no gains in muscle mass in the untrained limb, most experimental designs have not allowed for sensitive or comprehensive investigation of structural changes in the muscle. Conclusions: Increased neural drive originating from the “untrained” motor cortex contributes to the cross-education effect. Adaptive changes within the muscle fiber, as well as systemic and hormonal factors require further investigation. An increased understanding of the physiological mechanisms contributing to cross-education will enable to more effectively explore its effects and potential applications in rehabilitation of unilateral movement disorders or injury.
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Affiliation(s)
- Ashlee M Hendy
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin UniversityGeelong, VIC, Australia
| | - Séverine Lamon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin UniversityGeelong, VIC, Australia
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Hartman K, Altschuler EL. Mirror Therapy for Hemiparesis Following Stroke: A Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0131-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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