Neural Adaptations Associated with Interlimb Transfer in a Ballistic Wrist Flexion Task

Patients with chronic ankle instability exhibit increased sensorimotor cortex activation and correlation with poorer lateral balance control ability during single-leg stance: a FNIRS study

Introduction

Chronic Ankle Instability (CAI) is a musculoskeletal condition that evolves from acute ankle sprains, and its underlying mechanisms have yet to reach a consensus. Mounting evidence suggests that neuroplastic changes in the brain following ankle injuries play a pivotal role in the development of CAI. Balance deficits are a significant risk factor associated with CAI, yet there is a scarcity of evidence regarding the sensorimotor cortical plasticity related to balance control in affected individuals. This study aims to evaluate the differences in cortical activity and balance abilities between patients with CAI and uninjured individuals during a single-leg stance, as well as the correlation between these factors, in order to elucidate the neurophysiological alterations in balance control among patients with CAI.

Methods

The study enrolled 24 patients with CAI and 24 uninjured participants. During single-leg stance, cortical activity was measured using a functional near-infrared spectroscopy (fNIRS) system, which included assessments of the pre-motor cortex (PMC), supplementary motor area (SMA), primary motor cortex (M1), and primary somatosensory cortex (S1). Concurrently, balance parameters were tested utilizing a three-dimensional force platform.

Results

Independent sample t-tests revealed that, compared with the uninjured individuals, the patients with CAI exhibited a significant increase in the changes of oxyhemoglobin concentration (ΔHbO) during single-leg stance within the left S1 at Channel 5 (t = 2.101, p = 0.041, Cohen's d = 0.607), left M1 at Channel 6 (t = 2.363, p = 0.022, Cohen's d = 0.682), right M1 at Channel 15 (t = 2.273, p = 0.029, Cohen's d = 0.656), and right PMC/SMA at Channel 11 (t = 2.467, p = 0.018, Cohen's d = 0.712). Additionally, the center of pressure root mean square (COP-RMS) in the mediolateral (ML) direction was significantly greater (t = 2.630, p = 0.012, Cohen's d = 0.759) in the patients with CAI. Furthermore, a moderate positive correlation was found between ML direction COP-RMS and ΔHbO2 in the M1 (r = 0.436; p = 0.033) and PMC/SMA (r = 0.488, p = 0.016), as well as between anteroposterior (AP) direction COP-RMS and ΔHbO in the M1 (r = 0.483, p = 0.017).

Conclusion

Patients with CAI demonstrate increased cortical activation in the bilateral M1, ipsilateral PMC/SMA, and contralateral S1. This suggests that patients with CAI may require additional brain resources to maintain balance during single-leg stance, representing a compensatory mechanism to uphold task performance amidst diminished lateral balance ability in the ankle joint.

Acute Effects of Strength and Skill Training on the Cortical and Spinal Circuits of Contralateral Limb

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.

Localization of long-term synaptic plasticity defects in cerebellar circuits using optokinetic reflex learning profile

Objective.Functional maps of the central nervous system attribute the coordination and control of many body movements directly or indirectly to the cerebellum. Despite this general picture, there is little information on the function of cerebellar neural components at the circuit level. The presence of multiple synaptic junctions and the synergistic action of different types of plasticity make it virtually difficult to determine the distinct contribution of cerebellar neural processes to behavioral manifestations. In this study, investigating the effect of long-term synaptic changes on cerebellar motor learning, we intend to provide quantitative criteria for localizing defects in the major forms of synaptic plasticity in the cerebellum.Approach.To this end, we develop a firing rate model of the cerebellar circuits to simulate learning of optokinetic reflex (OKR), one of the most well-known cerebellar-dependent motor tasks. In the following, by comparing the simulated OKR learning profile for normal and pathosynaptic conditions, we extract the learning features affected by long-term plasticity disorders. Next, conducting simulation with different massed (continuous with no rest) and spaced (interleaved with rest periods) learning paradigms, we estimate the detrimental impact of plasticity defects at corticonuclear synapses on short- and long-term motor memory.Main results.Our computational approach predicts a correlation between location and grade of the defect with some learning factors such as the rate of formation and retention of motor memory, baseline performance, and even cerebellar motor reserve capacity. Further, spacing analysis reveal the dependence of learning paradigm efficiency on the spatiotemporal characteristic of defect in the network. Indeed, defects in cortical memory formation and nuclear memory consolidation mainly harm massed and spaced learning, respectively. This result is used to design a differential assay for identifying the faulty phases of cerebellar learning.Significance.The proposed computational framework can help develop neural-screening systems and prepare meso-scale functional maps of the cerebellar circuits.

Neural mechanisms mediating cross education: With additional considerations for the ageing brain

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.

Somatotopic Specificity of Perceptual and Neurophysiological Changes Associated with Visuo-proprioceptive Realignment

When visual and proprioceptive estimates of hand position disagree (e.g., viewing the hand underwater), the brain realigns them to reduce mismatch. This perceptual change is reflected in primary motor cortex (M1) excitability, suggesting potential relevance for hand movement. Here, we asked whether fingertip visuo-proprioceptive misalignment affects only the brain's representation of that finger (somatotopically focal), or extends to other parts of the limb that would be needed to move the misaligned finger (somatotopically broad). In Experiments 1 and 2, before and after misaligned or veridical visuo-proprioceptive training at the index finger, we used transcranial magnetic stimulation to assess M1 representation of five hand and arm muscles. The index finger representation showed an association between M1 excitability and visuo-proprioceptive realignment, as did the pinkie finger representation to a lesser extent. Forearm flexors, forearm extensors, and biceps did not show any such relationship. In Experiment 3, participants indicated their proprioceptive estimate of the fingertip, knuckle, wrist, and elbow, before and after misalignment at the fingertip. Proprioceptive realignment at the knuckle, but not the wrist or elbow, was correlated with realignment at the fingertip. These results suggest the effects of visuo-proprioceptive mismatch are somatotopically focal in both sensory and motor domains.

Ipsilateral and contralateral responses following unimanual fatigue with and without illusionary mirror visual feedback

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.

Symmetric interlimb transfer of newly acquired skilled movements

In this study, we aimed to examine features of interlimb generalization or "transfer" of newly acquired motor skills, with a broader goal of better understanding the mechanisms mediating skill learning. Right-handed participants (n = 36) learned a motor task that required them to make very rapid but accurate reaches to one of eight randomly presented targets, thus bettering the typical speed-accuracy tradeoff. Subjects were divided into an "RL" group that first trained with the right arm and was then tested on the left and an "LR" group that trained with the left arm and was subsequently tested on the right. We found significant interlimb transfer in both groups. Remarkably, we also observed that participants learned faster with their left arm compared with the right. We hypothesized that this could be due to a previously suggested left arm/right hemisphere advantage for movements under variable task conditions. To corroborate this, we recruited two additional groups of participants (n = 22) that practiced the same task under a single target condition. This removal of task level variability eliminated learning rate differences between the arms, yet interlimb transfer remained robust and symmetric, as in the first experiment. Additionally, the strategy used to reduce errors during learning, albeit heterogeneous across subjects particularly in our second experiment, was adopted by the untrained arm. These findings may be best explained as the outcome of the operation of cognitive strategies during the early stages of motor skill learning.NEW & NOTEWORTHY How newly acquired motor skills generalize across effectors is not well understood. Here, we show that newly learned skilled actions transfer symmetrically across the arms and that task-level variability influences learning rate but not transfer magnitude or direction. Interestingly, strategies developed during learning with one arm transfer to the untrained arm. This likely reflects the outcome of learning driven by cognitive mechanisms during the initial stages of motor skill acquisition.

Neuromuscular electrical stimulation-promoted plasticity of the human brain

The application of neuromuscular electrical stimulation (NMES) to paretic limbs has demonstrated utility for motor rehabilitation following brain injury. When NMES is delivered to a mixed peripheral nerve, typically both efferent and afferent fibres are recruited. Muscle contractions brought about by the excitation of motor neurons are often used to compensate for disability by assisting actions such as the formation of hand aperture, or by preventing others including foot drop. In this context, exogenous stimulation provides a direct substitute for endogenous neural drive. The goal of the present narrative review is to describe the means through which NMES may also promote sustained adaptations within central motor pathways, leading ultimately to increases in (intrinsic) functional capacity. There is an obvious practical motivation, in that detailed knowledge concerning the mechanisms of adaptation has the potential to inform neurorehabilitation practice. In addition, responses to NMES provide a means of studying CNS plasticity at a systems level in humans. We summarize the fundamental aspects of NMES, focusing on the forms that are employed most commonly in clinical and experimental practice. Specific attention is devoted to adjuvant techniques that further promote adaptive responses to NMES thereby offering the prospect of increased therapeutic potential. The emergent theme is that an association with centrally initiated neural activity, whether this is generated in the context of NMES triggered by efferent drive or via indirect methods such as mental imagery, may in some circumstances promote the physiological changes that can be induced through peripheral electrical stimulation.

The time course of cross-education during short-term isometric strength training

PURPOSE

This study examined the time course of contralateral adaptations in maximal isometric strength (MVC), rate of force development (RFD), and rate of electromyographic (EMG) rise (RER) during 4 weeks of unilateral isometric strength training with the non-dominant elbow flexors.

METHODS

Twenty participants were allocated to strength training (n = 10, three female, two left hand dominant) or control (n = 10, three female, two left hand dominant) groups. Both groups completed testing at baseline and following each week of training to evaluate MVC strength, EMG amplitude, RFD and RER at early (RFD₅₀, RER₅₀) and late (RFD₂₀₀, RER₂₀₀) contraction phases for the dominant 'untrained' elbow flexors. The training group completed 11 unilateral isometric training sessions across 4 weeks.

RESULTS

The contralateral improvements for MVC strength (P < 0.01) and RFD₂₀₀ (P = 0.017) were evidenced after 2 weeks, whereas RFD₅₀ (P < 0.01) and RER₅₀ (P = 0.02) showed significant improvements after 3 weeks. Each of the dependent variables was significantly (P < 0.05) greater than baseline values at the end of the training intervention for the trained arm. No changes in any of the variables were observed for the control group (P > 0.10).

CONCLUSIONS

Unilateral isometric strength training for 2-3 weeks can produce substantial increases in isometric muscle strength and RFD for both the trained and untrained arms. These data have implications for rehabilitative exercise design and prescription.

Determining the potential sites of neural adaptation to cross-education: implications for the cross-education of muscle strength

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.

The TMS Motor Map Does Not Change Following a Single Session of Mirror Training Either with Or without Motor Imagery

Both motor imagery and mirror training have been used in motor rehabilitation settings to promote skill learning and plasticity. As motor imagery and mirror training are suggested to be closely linked, it was hypothesized that mirror training augmented by motor imagery would increase corticospinal excitability (CSE) significantly compared to mirror training alone. Forty-four participants were split over two experimental groups. Each participant visited the laboratory once to receive either mirror training alone or mirror training augmented with layered stimulus response training (LSRT), a type of motor imagery training. Participants performed 16 min of mirror training, making repetitive grasping movements paced by a metronome. Transcranial magnetic stimulation (TMS) mapping was performed before and after the mirror training to test for changes in CSE of the untrained hand. Self-reports suggested that the imagery training was effective in helping the participant to perform the mirror training task as instructed. Nonetheless, neither training type resulted in a significant change of TMS map area, nor was there an interaction between the groups. The results from the study revealed no effect of a single session of 16 min of either mirror training or mirror training enhanced by imagery on TMS map area. Despite the negative result of the present experiment, this does not suggest that either motor imagery or mirror training might be ineffective as a rehabilitation therapy. Further study is required to allow disentangling the role of imagery and action observation in mirror training so that mirror training can be further tailored to the individual according to their abilities.

Strong Functional Connectivity among Homotopic Brain Areas Is Vital for Motor Control in Unilateral Limb Movement

The mechanism underlying brain region organization for motor control in humans remains poorly understood. In this functional magnetic resonance imaging (fMRI) study, right-handed volunteers were tasked to maintain unilateral foot movements on the right and left sides as consistently as possible. We aimed to identify the similarities and differences between brain motor networks of the two conditions. We recruited 18 right-handed healthy volunteers aged 25 ± 2.3 years and used a whole-body 3T system for magnetic resonance (MR) scanning. Image analysis was performed using SPM8, Conn toolbox and Brain Connectivity Toolbox. We determined a craniocaudally distributed, mirror-symmetrical modular structure. The functional connectivity between homotopic brain areas was generally stronger than the intrahemispheric connections, and such strong connectivity led to the abovementioned modular structure. Our findings indicated that the interhemispheric functional interaction between homotopic brain areas is more intensive than the interaction along the conventional top-down and bottom-up pathways within the brain during unilateral limb movement. The detected strong interhemispheric horizontal functional interaction is an important aspect of motor control but often neglected or underestimated. The strong interhemispheric connectivity may explain the physiological phenomena and effects of promising therapeutic approaches. Further accurate and effective therapeutic methods may be developed on the basis of our findings.

Deep sleep maintains learning efficiency of the human brain

It is hypothesized that deep sleep is essential for restoring the brain’s capacity to learn efficiently, especially in regions heavily activated during the day. However, causal evidence in humans has been lacking due to the inability to sleep deprive one target area while keeping the natural sleep pattern intact. Here we introduce a novel approach to focally perturb deep sleep in motor cortex, and investigate the consequences on behavioural and neurophysiological markers of neuroplasticity arising from dedicated motor practice. We show that the capacity to undergo neuroplastic changes is reduced by wakefulness but restored during unperturbed sleep. This restorative process is markedly attenuated when slow waves are selectively perturbed in motor cortex, demonstrating that deep sleep is a requirement for maintaining sustainable learning efficiency.

Deep sleep is hypothesized to restore the brain's capacity to learn. Here the authors provide causal evidence by specifically perturbing slow wave activity over the motor cortex during NREM sleep in humans and demonstrate a reduction in neurophysiological markers of plasticity and capacity for motor learning.

The Effects of Mirror Feedback during Target Directed Movements on Ipsilateral Corticospinal Excitability

Mirror visual feedback (MVF) training is a promising technique to promote activation in the lesioned hemisphere following stroke, and aid recovery. However, current outcomes of MVF training are mixed, in part, due to variability in the task undertaken during MVF. The present study investigated the hypothesis that movements directed toward visual targets may enhance MVF modulation of motor cortex (M1) excitability ipsilateral to the trained hand compared to movements without visual targets. Ten healthy subjects participated in a 2 × 2 factorial design in which feedback (veridical, mirror) and presence of a visual target (target present, target absent) for a right index-finger flexion task were systematically manipulated in a virtual environment. To measure M1 excitability, transcranial magnetic stimulation (TMS) was applied to the hemisphere ipsilateral to the trained hand to elicit motor evoked potentials (MEPs) in the untrained first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles at rest prior to and following each of four 2-min blocks of 30 movements (B1–B4). Targeted movement kinematics without visual feedback was measured before and after training to assess learning and transfer. FDI MEPs were decreased in B1 and B2 when movements were made with veridical feedback and visual targets were absent. FDI MEPs were decreased in B2 and B3 when movements were made with mirror feedback and visual targets were absent. FDI MEPs were increased in B3 when movements were made with mirror feedback and visual targets were present. Significant MEP changes were not present for the uninvolved ADM, suggesting a task-specific effect. Analysis of kinematics revealed learning occurred in visual target-directed conditions, but transfer was not sensitive to mirror feedback. Results are discussed with respect to current theoretical mechanisms underlying MVF-induced changes in ipsilateral excitability.

Structural and Functional Cortical Connectivity Mediating Cross Education of Motor Function

Cross-education (CE) is the process whereby training with one limb leads to subsequent improvement in performance by the opposite untrained limb. We used multimodal neuroimaging in humans to investigate the mediating neural mechanisms by relating quantitative estimates of functional and structural cortical connectivity to individual levels of interlimb transfer. Resting-state (rs)-fMRI and diffusion weighted imaging (DWI) scans were undertaken before unilateral ballistic wrist flexion training. The rs-fMRI sequence was repeated immediately afterward. The increase in performance of the untrained limb was 83.6% of that observed for the trained limb and significantly greater than that of a control group who undertook no training. Functional connectivity in the resting motor network between right and left supplementary motor areas (SMA) was elevated after training. These changes were not, however, correlated with individual levels of transfer. Analysis of the DWI data using constrained spherical deconvolution-based tractography indicated that fractional anisotropy and apparent fiber density in tracts connecting bilateral SMA were negatively correlated with and predictive of transfer. The findings suggest that interhemispheric interactions between bilateral SMA play an instrumental role in CE and that the structural integrity of the connecting white matter pathways influences the level of transfer.

SIGNIFICANCE STATEMENT Strength or skill training with one limb also brings about improvements in the performance of the opposite, untrained limb. This phenomenon, termed cross-education (CE), has obvious potential for the rehabilitation of functional capacity that has been lost through brain insult or musculoskeletal injury. The neural mechanisms that give rise to CE are, however, poorly understood. We used a combination of neuroimaging methods to investigate the pathways in the human brain that mediate CE. We determined that the supplementary motor area (SMA) plays an important role in the interlimb transfer of performance gains and demonstrate that the quality of the white matter fibers connecting right and left SMA predicts the benefit that an individual derives from CE.

Long-term progressive motor skill training enhances corticospinal excitability for the ipsilateral hemisphere and motor performance of the untrained hand

It is well established that unilateral motor practice can lead to increased performance in the opposite non-trained hand. Here, we test the hypothesis that progressively increasing task difficulty during long-term skill training with the dominant right hand increase performance and corticomotor excitability of the left non-trained hand. Subjects practiced a visuomotor tracking task engaging right digit V for 6 weeks with either progressively increasing task difficulty (PT) or no progression (NPT). Corticospinal excitability (CSE) was evaluated from the resting motor threshold (rMT) and recruitment curve parameters following application of transcranial magnetic stimulation (TMS) to the ipsilateral primary motor cortex (iM1) hotspot of the left abductor digiti minimi muscle (ADM). PT led to significant improvements in left-hand motor performance immediately after 6 weeks of training (63 ± 18%, P < 0.001) and 8 days later (76 ± 14%, P < 0.001). In addition, PT led to better task performance compared to NPT (19 ± 15%, P = 0.024 and 27 ± 15%, P = 0.016). Following the initial training session, CSE increased across all subjects. After 6 weeks of training and 8 days later, only PT was accompanied by increased CSE demonstrated by a left and upwards shift in the recruitment curves, e.g. indicated by increased MEP_max (P = 0.012). Eight days after training similar effects were observed, but 14 months later motor performance and CSE were similar between groups. We suggest that progressively adjusting demands for timing and accuracy to individual proficiency promotes motor skill learning and drives the iM1-CSE resulting in enhanced performance of the non-trained hand. The results underline the importance of increasing task difficulty progressively and individually in skill learning and rehabilitation training.