Cervicomedullary Motor Evoked Potentials Research Articles

Linking corticospinal tract activation and upper-limb motor control in adults with cerebral palsy.

To quantify the cervicomedullary motor evoked potentials (CMEPs) at the cervical spinal level in adults with cerebral palsy (CP) and determine if altered CMEPs are linked with upper-extremity motor function in this population. This cross-sectional study consisted of a cohort of adults with CP (n = 15; mean age = 33 years 5 months [SD = 11 years 8 months]); Manual Ability Classification System levels I-IV) and neurotypical controls (n = 18; mean age = 30 years 10 months [SD = 10 years 4 months]), who were recruited to participate at an academic medical center. Adults with CP and typical adults (controls) were stimulated at the cervicomedullary junction to assess CMEPs at the cervical spinal cord level. Upper-extremity motor function was quantified using the Box and Blocks and Purdue Pegboard tests, self-reported upper-extremity function (UEF), and assessments of selective motor control. At higher stimulation levels, the contralateral CMEP responses of adults with CP were different from typical adults (p = 0.032). Reduced CMEP was correlated with reduced upper-limb function, including worse performance on the Box and Blocks (rho = 0.625, p = 0.025) and Purdue Pegboard tests (rho = 0.701, p = 0.010), lower self-reported UEF (rho = 0.761, p = 0.009), and overall selective motor control (rho = 0.731, p = 0.007). Changes in the activation of spinal motoneurons through corticospinal pathways may have an important role in the altered upper-extremity motor function of individuals with CP.

Effects of trunk neuromuscular electrical stimulation on the motor circuits of able-bodied individuals

Upper- and lower-limb neuromuscular electrical stimulation (NMES) is known to modulate the excitability of the neural motor circuits. However, it remains unclear whether short-duration trunk muscle NMES could achieve similar neuromodulation effects. We assessed motor evoked potentials (MEPs) elicited through transcranial magnetic stimulation of the primary motor cortex representation of the trunk extensor muscles to evaluate corticospinal excitability. Moreover, cervicomedullary motor evoked potentials (CMEPs) were assessed through cervicomedullary junction magnetic stimulation to evaluate subcortical excitability. Twelve able-bodied individuals participated in the MEP study, and another twelve in the CMEP study. During the interventions, NMES was applied bilaterally to activate the erector spinae muscle and produce intermittent contractions (20 s ON/20 s OFF) for a total of 20 min while participants remained seated. Assessments were performed: (i) before; (ii) during (in brief periods when NMES was OFF); and (iii) immediately after the interventions to compare MEP or CMEP excitability. Our results showed that MEP responses were not affected by trunk NMES, while CMEP responses were facilitated for approximately 8 min during the intervention, and returned to baseline before the end of the 20 min stimulating period. Our findings therefore suggest that short-duration NMES of the trunk extensor muscles likely does not affect the corticospinal excitability, but it has a potential to facilitate subcortical neural circuits immediately after starting the intervention. These findings indicate that short-duration application of NEMS may be helpful in rehabilitation to enhance neuromodulation of the trunk subcortical neural motor circuits.

Location-specific cutaneous electrical stimulation of the footsole modulates corticospinal excitability to the plantarflexors and dorsiflexors during standing.

Non‐noxious electrical stimulation to distinct locations of the foot sole evokes location‐specific cutaneous reflex responses in lower limb muscles. These reflexes occur at latencies that may enable them to be mediated via a transcortical pathway. Corticospinal excitability to the plantarflexors and dorsiflexors was measured in 16 participants using motor evoked potentials (MEPs). Spinal excitability was measured in eight of the original participants using cervicomedullary motor evoked potentials (CMEPs). Measurements were collected with and without preceding cutaneous stimulus to either the heel (HEEL) or metatarsal (MET) locations of the foot sole, and evoked potentials were elicited to coincide with the arrival of the cutaneous volley at either the motor cortex or spinal cord. Plantarflexor MEPs and CMEPs were facilitated with cutaneous stimulation to the HEEL for MEPs (soleus p = 0.04, medial gastrocnemius (MG) p = 0.017) and CMEPs (soleus p = 0.047 and MG p = 0.015), but they were unchanged following MET stimulation for MEPs or CMEPs. Dorsiflexor MEPs were unchanged with cutaneous stimulation at either location, but dorsiflexor CMEPs increased with cutaneous stimulation (p = 0.05). In general, the increase in CMEP amplitudes was larger than the increase in MEP amplitudes, indicating that an increase in spinal excitability likely explains most of the increase in corticospinal excitability. The larger change observed in the CMEP also indicates that excitability from supraspinal sources likely decreased, which could be due to a net change in the excitability of intracortical circuits. This study provides evidence that cutaneous reflexes from foot sole skin are likely influenced by a transcortical pathway.

5‐HT2 receptor antagonism reduces human motoneuron output to antidromic activation but not to stimulation of corticospinal axons

The intrinsic electrical properties of motoneurons strongly affect motoneuron excitability to fast‐acting excitatory ionotropic inputs. Serotonin (5‐HT) is a neurochemical that alters the intrinsic properties of motoneurons, whereby animal models and in vitro experiments indicate that 5‐HT increases motoneuron excitability by activating 5‐HT2 receptors on the somato‐dendritic compartment. In the current study, we examined how antagonism of the 5‐HT2 receptor affects motoneuron excitability in humans. We hypothesised that motoneuron excitability would be reduced. The 5‐HT2 antagonist cyproheptadine was administered to 10 healthy participants in a double‐blinded, placebo‐controlled, crossover trial. Electrical cervicomedullary stimulation was used to deliver a synchronised excitatory volley to motoneurons to elicit cervicomedullary motor evoked potentials (CMEPs) in the surface electromyography (EMG) signal of the resting biceps brachii. Likewise, electrical peripheral nerve stimulation was used to generate antidromic spikes in motoneurons and cause recurrent discharges, which were recorded with surface EMG as F‐waves in a resting hand muscle. Compared with placebo, we found that 5‐HT2 antagonism reduced the amplitude and persistence of F‐waves but did not affect CMEP amplitude. 5‐HT2 antagonism also reduced maximal contraction strength. The reduced recurrent discharge of motoneurons with 5‐HT2 antagonism suggests that 5‐HT2 receptors modulate the electrical properties of the initial segment or soma to promote excitability. Conversely, as cyproheptadine did not affect motoneuron excitability to brief synaptic input, but affected maximal contractions requiring sustained input, it seems likely that the 5‐HT2‐mediated amplification of synaptic input at motoneuron dendrites is functionally significant only when excitatory input activates persistent inward currents.

Non-local muscle fatigue is mediated at spinal and supraspinal levels.

The objective was to measure the corticospinal excitability and motoneuron responsiveness of the right and left Biceps Brachii (BB), and left Abductor Digiti Minimi (ADM) muscles in response to submaximal isotonic fatiguing contractions performed by the right BB muscle. With the familiarization session, ten young moderately active male subjects came to the lab on seven occasions. Three sets of 3min seated elbow curls at 25% of one-repetition maximum (1RM) separated by a 1-min rest performed by the right BB muscle were used as the fatiguing protocol. The motor evoked potential (MEP), cervicomedullary motor evoked potential (CMEP), and compound muscle action potential (Mmax) of the right BB muscle (baseline and after each set of the fatiguing task), the left BB and ADM muscles (baseline, post-fatigue, post-10, and post-20min) were measured. MEP and CMEP were then normalized to Mmax for statistical analysis. The results showed that in the right BB muscle, there was a significant reduction in the MEP after performing the fatiguing task (p= 0.03), while no significant effect of time was seen in the CMEP (p= 0.07). In the left BB muscle, the MEP significantly decreased from pre-fatigue to post-fatigue (p= 0.01) and post-10 (p= 0.001), while there was a significant decline in the CMEP post-fatigue (p= 0.03). In the left ADM muscle, MEP significantly decreased post-fatigue (p= 0.03) and no changes were seen in the CMEP (p= 0.12). These results not only confirm the incidence of non-local muscle fatigue (NLMF) in response to performing submaximal isotonic fatiguing contractions but also as a new finding, imply that both spinal and supraspinal modulations account for the NLMF response.

Intensity dependency of peripheral nerve stimulation in spinal LTP induced by paired associative corticospinal-motoneuronal stimulation (PCMS).

Paired associative corticospinal-motoneuronal stimulation (PCMS) induces plasticity at synapses between corticospinal tracts (CSTs) and spinal motoneurons (SMs). We investigated the effects of peripheral nerve electrical stimulation (PNS) intensity on PCMS-induced plasticity. PCMS consisted of 180 paired stimuli of transcranial magnetic stimulation (TMS) over the left primary motor cortex with PNS on the right ulnar nerve at the wrist. We compared effects induced by different PNS intensities: supramaximal, twice and three times sensory threshold intensities. For evaluating efficacy of the synapse between CSTs and SMs, single-pulse TMS was delivered at cervicomedullary junction level, and cervicomedullary motor-evoked potentials (CMEPs) were recorded from the right first-dorsal interosseous muscle before and after PCMS. PCMS with the supramaximal PNS intensity increased CMEP amplitude. The facilitatory effect of PCMS with the supramaximal PNS was larger than those of PCMS with weaker PNS intensities. Sham TMS with the supramaximal PNS showed no CMEP changes after the intervention. PNS intensity of PCMS influences the magnitude of synaptic plasticity induction between the CSTs and SMs at the spinal level, and the supramaximal intensity is the best for induction of long-term potentiation-like effects. The PNS intensity may influence the number of activated SMs by axonal backpropagating pulses with PNS which must overlap with descending volleys induced by TMS.

Cortical and Subcortical Neural Interactions Between Trunk and Upper-limb Muscles in Humans

Activities of daily living require simultaneous and coordinated activation of trunk and upper-limb segments, which involves complex interlimb interaction within the central nervous system. Although many studies have reported associations between activity of trunk and limb muscles during functional tasks, evidence on cortical and subcortical contributions to trunk-limb neural interactions is still not fully clear. Therefore, the aim of this study was to examine interactions between trunk and upper-limb muscles in the: (i) corticospinal circuits by using motor evoked potential (MEP) elicited through transcranial magnetic stimulation; and (ii) subcortical circuits by using cervicomedullary motor evoked potential (CMEP) elicited through cervicomedullary junction magnetic stimulation. Responses were evoked in the erector spinae (trunk) and flexor carpi radialis (upper-limb) muscles in twelve able-bodied individuals: (1) while participants were relaxed; (2) during trunk muscle contractions while arms were at rest; and (3) during upper-limb muscle contractions while the trunk was at rest. Our results showed that trunk muscle CMEP responses were not affected by upper-limb muscle contractions, while MEP responses were modulated. This indicates that at least the subcortical circuits may not attribute to facilitation of the trunk muscles during upper-limb contractions. On the other hand, in the upper-limb muscles, both CMEP and MEP responses were modulated during trunk contractions. These results indicate that cortical and subcortical mechanisms attributed to facilitation of upper-limb muscles during trunk contractions. In conclusion, our study demonstrated evidence that trunk-limb neural interactions may be attributed to cortical and/or subcortical mechanisms depending on the contracted muscle.

Modulation of Corticospinal Excitability with Contralateral Arm Cycling

This is the first study to examine the influence of activity in one limb on corticospinal excitability to the contralateral limb during a locomotor output. Corticospinal and spinal excitability to the biceps brachii of the ipsilateral arm were assessed using transcranial magnetic stimulation (TMS) of the motor cortex and transmastoid electrical stimulation (TMES) of corticospinal axons, respectively. Responses were evoked during the mid-elbow extension position of arm cycling across three different cycling tasks: (1) bilateral arm cycling (BL), (2) unilateral, contralateral cycling with the ipsilateral arm moving passively (IP), and (3) unilateral, contralateral cycling with the ipsilateral arm at rest (IR). Each of these three tasks were performed at two cadences: 60 and 90 rpm. TMS-induced motor evoked potential (MEPs) amplitudes were significantly smaller during BL compared to the IP and IR conditions; however, MEP amplitudes were not significantly different between IP and IR. TMES-evoked cervicomedullary MEP (CMEPs) amplitudes followed a similar pattern of task-dependent modulation, with BL having the smallest CMEPs and IR having the largest. In line with our previous findings, MEP amplitudes increased and CMEP amplitudes decreased as the cadence increased from 60 to 90 rpm. We suggest that the higher corticospinal excitability to the ipsilateral limb during the IP and IR conditions was predominantly due to disinhibition at both the cortical and spinal levels.

Motor cortical circuits contribute to crossed facilitation of trunk muscles induced by rhythmic arm movement

Training of one limb improves performance of the contralateral, untrained limb, a phenomenon known as cross transfer. It has been used for rehabilitation interventions, i.e. mirror therapy, in people with neurologic disorders. However, it remains unknown whether training of the upper limb can induce the cross-transfer effect to the trunk muscles. Using transcranial magnetic stimulation over the primary motor cortex (M1) we examined motor evoked potentials (MEPs) in the contralateral erector spinae (ES) muscle before and after 30 min of unilateral arm cycling in healthy volunteers. ES MEPs were increased after the arm cycling. To understand the origin of this facilitatory effect, we examined short-interval intracrotical inhibition (SICI) and cervicomedullary MEPs (CMEPs) in neural populations controlling in the ES muscle. Notably, SICI reduced after the arm cycling, while CMEPs remained the same. Using bilateral transcranial direct current stimulation (tDCS) in conjunction with 20 min of the arm cycling, the amplitude of ES MEPs increased to a similar extent as with 30 min of the arm cycling alone. These findings demonstrate that a single session of unilateral arm cycling induces short-term plasticity in corticospinal projections to the trunk muscle in healthy humans. The changes are likely driven by cortical mechanisms.

Spinal contribution to neuromuscular recovery differs between elbow-flexor and knee-extensor muscles after a maximal sustained fatiguing task.

Data from studies of elbow-flexor (EF) or knee-extensor (KE) muscles suggest that a fatigue-related decrease in motoneuron excitability only occurs in EF. It is unknown how motoneuron excitability changes after sustained fatiguing maximal voluntary isometric contractions (MVICs) in EF and KE in the same participants. In two sessions, eight healthy men performed a 2-min MVIC of EF or KE to induce fatigue with brief MVICs before and six times after the 2-min MVIC. Electromyographic responses elicited by corticospinal tract stimulation at the transmastoid [cervicomedullary motor-evoked potential (CMEP)] or thoracic [thoracic motor-evoked potential (TMEP)] level were recorded from EF and KE, respectively. To account for muscle excitability, CMEPs and TMEPs were normalized to maximal M-wave (Mmax) elicited by peripheral nerve stimulation during each brief MVIC. Immediately after the 2-min MVIC, biceps brachii and brachioradialis CMEP/Mmax were 88% (SD 11%) (P = 0.026) and 87% (SD 12%) (P = 0.029) of pre-MVIC (PRE) values, respectively, and remained lower than PRE after 5 s of recovery [91% (SD 8%), P = 0.036 and 87% (SD 13%), P = 0.046, respectively]. No subsequent time points differed from PRE (all P ≥ 0.253). TMEP/Mmax for rectus femoris and vastus lateralis were not different from PRE at any time during the recovery period (all P > 0.050). A different recovery pattern in motoneuron excitability occurred in EF as it recovered by 60 s whereas KE motoneurons were unaffected by the fatiguing task. The present findings may contribute to better understand muscle-specific neurophysiological differences in spinal excitability.NEW & NOTEWORTHY By comparing the changes in motoneuron excitability in elbow-flexor and knee-extensor muscles after sustained fatiguing maximal voluntary contractions, this study shows that motoneuron recovery behavior depends on the muscle performing the exercise. A different recovery pattern in motoneuron excitability occurs in elbow flexors as it recovered by 60 s whereas knee extensors were unaffected by fatigue. This finding can help to increase understanding of the effect of a fatigue and subsequent recovery on neural processes.

Effect of blood flow occlusion on corticospinal excitability during sustained low-intensity isometric elbow flexion.

Blood flow occlusion (BFO) has been used to study the influence of group III/IV muscle afferents after fatiguing exercise, but it is unknown how BFO-induced activity of these afferents affects motor cortical and motoneuronal excitability during low-intensity exercise. Therefore, the purpose of this study was to assess the acute effect of BFO on peripheral [maximal M wave (Mmax)], spinal [cervicomedullary motor evoked potential (CMEP) normalized to Mmax], and motor cortical [motor evoked potential (MEP) normalized to CMEP] excitability. Nine healthy men completed a sustained isometric contraction of the elbow flexors at 20% of maximal force under three conditions: 1) contractile failure with BFO, 2) a time-matched trial without restriction [free flow (FFiso)], and 3) contractile failure with free flow (FFfail). Time to failure for BFO (and FFiso) were ~80% shorter than that for FFfail (P < 0.05). For FFfail and FFiso, Mmax area decreased ~17% and ~7%, respectively (P < 0.05), with no change during BFO. CMEP/Mmax area increased ~226% and ~80% during BFO and FFfail, respectively (P < 0.05), with no change during FFiso (P > 0.05). The increase in normalized CMEP area was greater for BFO and FFfail compared with FFiso and for BFO compared with FFfail. MEP/CMEP area was not different among the protocols (P > 0.05) and increased ~64% with time (P < 0.05). It is likely that group III/IV muscle afferent feedback to the spinal cord modulates the large increase in motoneuronal excitability for the BFO compared with FFfail and FFiso protocols.NEW & NOTEWORTHY We have observed how blood flow occlusion modulates motor cortical, spinal, and peripheral excitability during and immediately after a sustained low-intensity isometric elbow flexion contraction to failure. We conclude that blood flow occlusion causes a greater and more rapid increase in motoneuronal excitability.

Neuromuscular Mechanisms Underlying Changes in Force Production during an Attentional Focus Task.

We examined the effects of attentional focus cues on maximal voluntary force output of the elbow flexors and the underlying physiological mechanisms. Eleven males participated in two randomized experimental sessions. In each session, four randomized blocks of three maximal voluntary contractions (MVC) were performed. The blocks consisted of two externally and two internally attentional focus cued blocks. In one of the sessions, corticospinal excitability (CSE) was measured. During the stimulation session transcranial magnetic, transmastoid and Erb’s point stimulations were used to induce motor evoked potentials (MEPs), cervicomedullary MEP (CMEPs) and maximal muscle action potential (Mmax), respectively in the biceps brachii. Across both sessions forces were lower (p = 0.024) under the internal (282.4 ± 60.3 N) compared to the external condition (310.7 ± 11.3 N). Muscle co-activation was greater (p = 0.016) under the internal (26.3 ± 11.5%) compared with the external condition (21.5 ± 9.4%). There was no change in CSE. Across both sessions, force measurements were lower (p = 0.033) during the stimulation (279.0 ± 47.1 N) compared with the no-stimulation session (314.1 ± 57.5 N). In conclusion, external focus increased force, likely due to reduced co-activation. Stimulating the corticospinal pathway may confound attentional focus. The stimulations may distract participants from the cues and/or disrupt areas of the cortex responsible for attention and focus.

The effects of forearm position and contraction intensity on cortical and spinal excitability during a submaximal force steadiness task of the elbow flexors.

Elbow flexor force steadiness is less with the forearm pronated (PRO) compared with neutral (NEU) or supinated (SUP) and may relate to neural excitability. Although not tested in a force steadiness paradigm, lower spinal and cortical excitability was observed separately for biceps brachii in PRO, possibly dependent on contractile status at the time of assessment. This study aimed to investigate position-dependent changes in force steadiness as well as spinal and cortical excitability at a variety of contraction intensities. Thirteen males (26 ± 7 yr; means ± SD) performed three blocks (PRO, NEU, and SUP) of 24 brief (~6 s) isometric elbow flexor contractions (5, 10, 25 or 50% of maximal force). During each contraction, transcranial magnetic stimulation or transmastoid stimulation was delivered to elicit a motor-evoked potential (MEP) or cervicomedullary motor-evoked potential (CMEP), respectively. Force steadiness was lower in PRO compared with NEU and SUP (P ≤ 0.001), with no difference between NEU and SUP. Similarly, spinal excitability (CMEP/maximal M wave) was lower in PRO than NEU (25 and 50% maximal force; P ≤ 0.010) and SUP (all force levels; P ≤ 0.004), with no difference between NEU and SUP. Cortical excitability (MEP/CMEP) did not change with forearm position (P = 0.055); however, a priori post hoc testing for position showed excitability was 39.8 ± 38.3% lower for PRO than NEU at 25% maximal force (P = 0.006). The data suggest that contraction intensity influences the effect of forearm position on neural excitability and that reduced spinal and, to a lesser extent, cortical excitability could contribute to lower force steadiness in PRO compared with NEU and SUP.NEW & NOTEWORTHY To address conflicting reports about the effect of forearm position on spinal and cortical excitability of the elbow flexors, we examine the influence of contraction intensity. For the first time, excitability data are considered in a force steadiness context. Motoneuronal excitability is lowest in pronation and this disparity increases with contraction intensity. Cortical excitability exhibits a similar pattern from 5 to 25% of maximal force. Lower corticospinal excitability likely contributes to relatively poor force steadiness in pronation.

Changes in motoneuron excitability during voluntary muscle activity in humans with spinal cord injury.

The excitability of resting motoneurons increases following spinal cord injury (SCI). The extent to which motoneuron excitability changes during voluntary muscle activity in humans with SCI, however, remains poorly understood. To address this question, we measured F waves by using supramaximal electrical stimulation of the ulnar nerve at the wrist and cervicomedullary motor-evoked potentials (CMEPs) by using high-current electrical stimulation over the cervicomedullary junction in the first dorsal interosseous muscle at rest and during 5 and 30% of maximal voluntary contraction into index finger abduction in individuals with chronic cervical incomplete SCI and aged-matched control participants. We found higher persistence (number of F waves present in each set) and amplitude of F waves at rest in SCI compared with control participants. With increasing levels of voluntary contraction, the amplitude, but not the persistence, of F waves increased in both groups but to a lesser extent in SCI compared with control participants. Similarly, the CMEP amplitude increased in both groups but to a lesser extent in SCI compared with controls. These results were also found at matched absolutely levels of electromyographic activity, suggesting that these changes were not related to decreases in voluntary motor output after SCI. F-wave and CMEP amplitudes were positively correlated across conditions in both groups. These results support the hypothesis that the responsiveness of the motoneuron pool during voluntary activity decreases following SCI, which could alter the generation and strength of voluntary muscle contractions.NEW & NOTEWORTHY How the excitability of motoneurons changes during voluntary muscle activity in humans with spinal cord injury (SCI) remains poorly understood. We found that F-wave and cervicomedullary motor-evoked potential amplitude, outcomes reflecting motoneuronal excitability, increased during voluntary activity compared with rest in SCI participants but to a lesser extent that in controls. These results suggest that the responsiveness of motoneurons during voluntary activity decreases following SCI, which might affect functionally relevant plasticity after the injury.

Contraction intensity-dependent variations in the responses to brain and corticospinal tract stimulation after a single session of resistance training in men.

The aim of this study was to determine the effects of acute resistance training (RT) intensity on motor-evoked potentials (MEPs) generated by transcranial magnetic brain stimulation and on cervicomedullary motor-evoked potentials (CMEPs) produced by electrical stimulation of the corticospinal tract. In four experimental sessions, 14 healthy young men performed 12 sets of eight isometric contractions of the elbow flexors at 0 (Control session), 25, 50, and 75% of the maximal voluntary contraction (MVC). Before and after each session, MEPs, CMEPs, and the associated twitch forces were recorded at rest. MEPs increased by 39% (P < 0.05 versus 25% in the control condition, Effect size (ES) = 1.04 and 1.76, respectively) after the 50% session and by 70% (P < 0.05 vs. all other conditions, ES = 0.91-2.49) after the 75% session. In contrast, CMEPs increased similarly after the 25%, 50%, and 75% sessions with an overall increase of 27% (P < 0.05 vs. control condition, ES = 1.34). The amplitude of maximal compound muscle action potentials (Mmax) was unchanged during the experiment. The MEP- and CMEP-associated twitch forces also increased after RT, but training intensity affected only the increases in MEP twitch forces. The data tentatively suggest that the intensity of muscle contraction used in acute bouts of RT affects cortical excitability.NEW & NOTEWORTHY Resistance training (RT) can acutely increase the efficacy of the corticospinal-motoneuronal synapse, motoneuron excitability and motor cortical excitability. We show that motor-evoked potential generated by transcranial magnetic stimulation but not cervicomedullary electrical stimulation increased in proportion to the intensity of training used during a single session of RT. The data suggest that the intensity of muscle contraction used in acute bouts of RT affects cortical excitability.

Corticospinal-Evoked Responses from the Biceps Brachii during Arm Cycling across Multiple Power Outputs.

Background: We examined corticospinal and spinal excitability across multiple power outputs during arm cycling using a weak and strong stimulus intensity. Methods: We elicited motor evoked potentials (MEPs) and cervicomedullary motor evoked potentials (CMEPs) in the biceps brachii using magnetic stimulation over the motor cortex and electrical stimulation of corticospinal axons during arm cycling at six different power outputs (i.e., 25, 50, 100, 150, 200 and 250 W) and two stimulation intensities (i.e., weak vs. strong). Results: In general, biceps brachii MEP and CMEP amplitudes (normalized to maximal M-wave (Mmax)) followed a similar pattern of modulation with increases in cycling intensity at both stimulation strengths. Specifically, MEP and CMEP amplitudes increased up until ~150 W and ~100 W when the weak and strong stimulations were used, respectively. Further increases in cycling intensity revealed no changes on MEP or CMEP amplitudes for either stimulation strength. Conclusions: In general, MEPs and CMEPs changed in a similar manner, suggesting that increases and subsequent plateaus in overall excitability are likely mediated by spinal factors. Interestingly, however, MEP amplitudes were disproportionately larger than CMEP amplitudes as power output increased, despite being initially matched in amplitude, particularly with strong stimulation. This suggests that supraspinal excitability is enhanced to a larger degree than spinal excitability as the power output of arm cycling increases.

Repetitive Activation Compromises Motoneuron Excitability During Fatiguing Exercise

Although fatiguing exercise is known to decrease motoneuronal excitability, the mechanisms underlying this impact remain unclear. PURPOSE: To investigate the role of repetitive motoneuron activation in determining the decrease of motoneuronal excitability during fatiguing exercise. METHODS: On 2 separate days, healthy young subjects (26 ± 6 yrs) performed intermittent isometric knee extensions (at 20% of maximal voluntary quadriceps torque): 1) voluntarily (VOL; i.e. requiring repetitive motoneuron activation), and 2) electrically-evoked (EVO, femoral motor nerve stimulation at 20 Hz; no motoneuron activation). The exercise consisted of 50 s contractions followed by 10 s breaks during which potentiated twitches (Qtw) were assessed to monitor the development of peripheral fatigue during each trial. Exercise continued in each trial until the goal of achieving a similar ~40% reduction in Qtw (ΔQtw) was reached. Before and immediately after exercise, cervicomedullary stimulations (CMS) were used to elicit unconditioned (CMS only) and conditioned (transcranial magnetic stimulation followed by CMS, 100 ms interval) cervicomedullary motor-evoked potentials (CMEPs). All CMEPs were normalized to M-waves and evoked during a constant electromyographic (EMG) activity corresponding to 20% of the EMG obtained during pre-exercise MVCs. RESULTS: In both trials, ΔQtw was, per design, comparable (~40%; P = 0.9) and unconditioned CMEPs were similar before and after exercise (P = 0.23). Conditioned CMEPs were decreased following VOL (-79%, P < 0.05). While conditioned CMEPs were also significantly decreased following EVO (-62%), the exercise-induced reduction was substantially smaller compared to VOL. CONCLUSION: Repetitive activation of the motoneurons contributes to the decrease in motoneuronal excitability during voluntary exercise. It remains unclear whether motoneuronal responsiveness to synaptic input and/or the efficacy of the corticomotoneuronal synapse account for the repetitive activation-related depression. However, as motoneuron excitability still falls during evoked exercise, other mechanisms, potentially related to neural feedback, also contribute to the exercise-induced fall in motoneuronal excitability.

Stimulation Techniques used to Assess Corticospinal Excitability Alters an Attentional Focus Maximal Voluntary Contraction of the Elbow Flexors.

PURPOSE: To investigate the role of attentional focus on force output by assessing 1) force output during maximal voluntary elbow flexion contractions, 2) corticospinal excitability and 3) motor unit activation patterns METHODS: 7 resistance-trained males completed two experimental sessions. Each session consisted of 12 maximum voluntary contractions (MVC) with 180s rest of recovery between MVC. Participants were given counter-balanced external and internal attentional focus conditions prior to each MVC to direct attention. Force output and electromyography (EMG) of the biceps brachii, triceps brachii, and brachioradialis were recorded for both sessions. Transcranial magnetic stimulation, transmastoid electrical stimulation, and brachial plexus electrical stimulation were used to produce motor evoked potentials (MEPs), cervicomedullary motor evoked potentials (CMEPs) and maximal M-waves (Mmax) in the biceps brachii during each MVC in one of the two sessions. All MEPs and CMEPs were normalized to Mmax. RESULTS: Forces produced during the stimulation session were not significantly different between external and internal focus conditions (p = 0.20). However, forces produced during the non-stimulation session were 19.9% higher with an external cue compared to internal cues (p < 0.05). As well, forces produced with external cues were 13.2% greater during the non-stimulation session compared to the stimulation session. (p<0.05). EMG activity was not found to be significantly different between attention focus cues (p≥0.1). CONCLUSIONS: The usage of stimulation techniques likely distracted participants from the attentional focus cues provided during the stimulation session. Therefore, we were unable to successfully assess changes in corticospinal excitability between focus cues. However, we were still able to show that external cues direct greater force production of the elbow flexors compared to internal cues.

Delayed-Onset Muscle Soreness and Topical Analgesic Alter Corticospinal Excitability of the Biceps Brachii.

The interactive effect of delayed-onset muscle soreness (DOMS) and a topical analgesic on corticospinal excitability was investigated. Thirty-two participants completed Experiments A (no DOMS) and B (DOMS). For each experiment, participants were randomly assigned to two groups: 1) topical analgesic gel (topical analgesic, n = 8), or 2) placebo gel (placebo, n = 8) group. Before the application of gel (pregel), as well as 5, 15, 30, and 45 min postgel, motor-evoked potential (MEP) area, latency, and silent period, as well as cervicomedullary MEP and maximal compound motor unit action potential areas and latencies were measured. In addition, pressure-pain threshold (PPT) was measured pre-DOMS and at the same timepoints in experiment B. In experiment A, neither group showed a significant change for any outcome measure. In experiment B, both groups exhibited a significant decrease in PPT from pre-DOMS to pregel. After the application of topical analgesic, but not placebo, there was a significant increase in PPT at 45 min postgel, respectively, compared with pregel and a main effect of time for the silent period to increase compared with pregel. Participants with DOMS had reduced MEP and cervicomedullary MEP areas and increased corticospinal silent periods compared with those who did not have DOMS. These findings suggest that DOMS reduced corticospinal excitability and after the administration of menthol-based topical analgesic, there was a reduction in pain, which was accompanied by increased corticospinal inhibition.

Muscle length and joint angle influence spinal but not corticospinal excitability to the biceps brachii across forearm postures.

Forearm rotation (supination/pronation) alters corticospinal excitability to the biceps brachii, but it is unclear whether corticospinal excitability is influenced by joint angle, muscle length, or both. Thus the purpose of this study was to separately examine elbow joint angle and muscle length on corticospinal excitability. Corticospinal excitability to the biceps and triceps brachii was measured using motor evoked potentials (MEPs) elicited via transcranial magnetic stimulation. Spinal excitability was measured using cervicomedullary motor evoked potentials (CMEPs) elicited via transmastoid electrical stimulation. Elbow angles were manipulated with a fixed biceps brachii muscle length (and vice versa) across five unique postures: 1) forearm neutral, elbow flexion 90°; 2) forearm supinated, elbow flexion 90°; 3) forearm pronated, elbow flexion 90°; 4) forearm supinated, elbow flexion 78°; and 5) forearm pronated, elbow flexion 113°. A musculoskeletal model determined biceps brachii muscle length for postures 1-3, and elbow joint angles (postures 4-5) were selected to maintain biceps length across forearm orientations. MEPs and CMEPs were elicited at rest and during an isometric contraction of 10% of maximal biceps muscle activity. At rest, MEP amplitudes to the biceps were largest during supination, which was independent of elbow joint angle. CMEP amplitudes were not different when the elbow was fixed at 90° but were largest in pronation when muscle length was controlled. During an isometric contraction, there were no significant differences across forearm postures for either MEP or CMEP amplitudes. These results highlight that elbow joint angle and biceps brachii muscle length can each independently influence spinal excitability. NEW & NOTEWORTHY Changes in upper limb posture can influence the responsiveness of the central nervous system to artificial stimulations. We established a novel approach integrating neurophysiology techniques with biomechanical modeling. Through this approach, the effects of elbow joint angle and biceps brachii muscle length on corticospinal and spinal excitability were assessed. We demonstrate that spinal excitability is uniquely influenced by joint angle and muscle length, and this highlights the importance of accounting for muscle length in neurophysiological studies.