Extensor Carpi Radialis Muscles Research Articles

Muscle Oxygenation, EMG, and Cardiovascular Responses for Cabin Attendants vs. Controls

The goal was to investigate the effect of acute moderate hypobaric exposure on the physiological responses to sustained contractions (local) and light to moderate dynamic exercise (systemic) for cabin attendants (CAB) and a matched control group (CON). There were 14 CAB and 13 CON who participated. The experimental protocol was designed as a 2 x 2 randomized crossover study for which subjects performed a forearm isometric test and a cycling test in normobaric (NORM) and hypobaric [HYPO; 574 mmHg approximately 8000 ft (2440 m) above sea level (ASL)] conditions. Oxygen saturation (StO2%) was measured in the extensor carpi radialis muscle at rest and during an isometric wrist extension (20% MVC). Heart rate (HR), ventilation (V(E)), and oxygen uptake (VO2) were measured at rest, during cycling exercise at intensities of 50 W and 100 W, and during recovery. Blood samples were collected and analyzed for hemoglobin concentrations. Local response: There was a significant effect of HYPO for both CAB and CON with a decrease in StO2% of 6.5% both at rest and during contraction. Systemic response: there was no general effect of HYPO on HR, VE, or VO2. No differences were found between groups in either the local or systemic response or in the blood parameters. This study shows an effect of moderate hypobaric exposure on local muscle oxygenation during rest and sustained contraction. Whether this has an impact on fatigue development during work among cabin attendants is discussed.

Comparison of Muscle Activation during Dominant Hand Wrist Flexion when Writing

[Purpose] This study investigated the difference in muscle activation of the dominant upper extremity in right-handed and left-handed persons during writing. [Subjects] There were 36 subjects (16 left- handers/ 20 right- handers), and the study was conducted from 03/01/2012 to 30/3/2012. [Methods] Six electrodes were attached to the FCU (flexor carpi ulnaris), FCR (flexor carpi radialis), ECU (extensor carpi ulnaris), ECR (extensor carpi radialis), and both UT (upper trapezius) muscles. [Results] FCU muscle activation was 16.77±9.12% in left-handers and 10.29±4.13% (%MVIC) in right-handers. FCR muscle activation was 19.09±9.43% in left-handers and 10.64±5.03% in right-handers. In addition, the UT muscle activation on the writing hand side was 11.91±5.79% in left-handers and 1.66±1.19% in right-handers. [Conclusion] As a result of this study, it was discovered that left-handers used more wrist flexion in performance of the writing task with the dominant upper extremity than right-handers, and that the left-handers activated the wrist and shoulder muscles more than the right-handers. These results indicate a potential danger of musculoskeletal disease in left-hander.

A Higher Number of TMS-Elicited MEP from a Combined Hotspot Improves Intra- and Inter-Session Reliability of the Upper Limb Muscles in Healthy Individuals

We aimed to determine, using transcranial magnetic stimulation (TMS), the number of elicited motor evoked potentials (MEPs) that induces the highest intra- and inter-sessions reliability for the extensor carpi radialis (ECR) and first dorsal interosseus (FDI) muscles. Twelve healthy subjects participated in this study on two separate days. Single pulse magnetic stimuli were triggered with Magstim 2002 to obtain MEPs from the muscles of interest, with the subjects in a relaxed position. Reliability of MEP responses was investigated in three blocks of 5, 10 and 15 trials. The intra- and inter-session reliability of the MEPs' amplitudes and latencies were assessed using intraclass correlation coefficients (ICCs). Repeated measures ANOVA and paired t-tests revealed no significant time effect in the MEP amplitude and latency measurements (P>0.05). The ICCs indicated high intra-session reliability in the MEPs' amplitudes for the ECR and FDI muscles (0.77 to 0.99, 0.90 to 0.99, respectively) and latency (0.80 to 1.00, 0.75 to 0.97, respectively). The MEPs' amplitudes also had high inter-session reliability (0.84 to 0.97, 0.88 to 0.93, respectively), as did their latency (0.80 to 0.90, 0.75 to 0.97, respectively). Highest intra- and inter-session reliability was achieved for blocks of 10 and 15 trials. Our data suggest that intra- and inter-session comparisons should be performed using at least 10 MEPs in “combined hotspot” stimulation technique to ensure highest reliability.

Failure of lower motor neuron radial outgrowth precedes retrograde degeneration in a feline model of spinal muscular atrophy

Feline spinal muscular atrophy (SMA) is a fully penetrant, autosomal recessive lower motor neuron disease in domestic cats that clinically resembles human SMA Type III. A whole genome linkage scan identified a ∼140-kb deletion that abrogates expression of LIX1, a novel SMA candidate gene of unknown function. To characterize the progression of feline SMA, we assessed pathological changes in muscle and spinal cord from 3 days of age to beyond onset of clinical signs. Electromyographic (EMG) analysis indicating denervation occurred between 10 and 12 weeks, with the first neurological signs occurring at the same time. Compound motor action potential (CMAP) amplitudes were significantly reduced in the soleus and extensor carpi radialis muscles at 8-11 weeks. Quadriceps femoris muscle fibers from affected cats appeared smaller at 10 weeks; by 12 weeks atrophic fibers were more prevalent than in age-matched controls. In affected cats, significant loss of L5 ventral root axons was observed at 12 weeks. By 21 weeks of age, affected cats had 40% fewer L5 motor axons than normal. There was no significant difference in total L5 soma number, even at 21 weeks; thus degeneration begins distal to the cell body and proceeds retrogradely. Morphometric analysis of L5 ventral roots and horns revealed that 4 weeks prior to axon loss, motor axons in affected cats failed to undergo radial enlargement, suggesting a role for the putative disease gene LIX1 in radial growth of axons.

Reliability of ultrasound-measured muscle thickness of the longissimus dorsi muscle in Thoroughbreds

The purpose of this study was to determine the reliability of B-mode ultrasound measured muscle thickness of the longissimus dorsi muscle in horses. Thirteen Thoroughbreds (5 colts, 5 fillies and 3 mares) had their muscle thickness measured by B-mode ultrasound at four sites; the longissimus dorsi (LD at 30%, 50% and 70% of back length) and extensor carpi radialis (ECR) muscle on two separate test sessions (T1 and T2). Paired t-tests revealed that there was no systematic bias in any of the muscle thickness measures. There were high intraclass correlation coefficients between the LD muscle thickness at 30, 50 and 70% of back length obtained at the T1 and T2 measurements (range: 0.95-0.98). The ECR muscle thickness was positively correlated to body weight and fat-free mass while LD muscle thickness at 50% and 70% of back length did not correlate to body dimensions. Our results suggest that ultrasound measures of muscle thickness of the LD and ECR muscles are reliable and repeatable when taken with the horse standing in a relaxed and evenly balanced position.

Morpho-functional relationship between muscular architecture and proportion of myofiber types in ovine antebrachial musculature

The antebrachium of domestic animals supports the trunk against gravity and generates propulsive force. The antigravity action of antebrachium is attributed to the contraction of flexor muscles of the carpal and digital joints. Mammalian skeletal muscles consist of myofibers, which are histochemically classified into type I, type IIA, and type IIB myofibers, of which composition reflects the proportional involvement of the muscle in varying function, such as posture maintenance and locomotion. The physiological cross-sectional area (PCSA), which are calculated from muscle volume, myofiber length, and pennation angle, reflects the maximum force of muscle. In the present study, we evaluated the PCSA of myofiber types in the antebrachial musculature and determined the magnitude of contribution from individual muscles toward varying actions of carpal and digital joints. The extensor carpi ulnaris and flexor digitorum superficialis muscles possessed a large proportional PCSA of type I myofibers, indicating the role for these muscles in maintaining a standing posture. The additional force required for walking/running was primarily provided by the flexor digitorum profundus caput humerale and extensor carpi radialis muscles. The proportional PCSA of myofiber types reflected the force generated for varying muscular function and provided insights into the dynamics of carpal and digital joints.

Distal upper extremity musculoskeletal risk factors associated with colonoscopy

Gastroenterologists are at increased risk for developing recurrent thumb, hand, and elbow pain due to colonoscopy procedures. We evaluated forearm muscle loads and wrist postures during routine colonoscopy (N=12 gastroenterologists) to understand distal upper extremity musculoskeletal risk factors associated with the 4 different subtasks of colonoscopy. Bilateral forearm extensor carpiradialis (ECR) and flexor digitorum superficialis (FDS) surface electromyography and bilateral wrist postures were recorded continuously. The mean duration of colonoscopy was 24.2 (± 12.1) minutes and was dominated by the withdrawal subtask [13.7 (± 8.8) min] followed by right colon insertion [5.8 (± 4.8) min], left colon insertion [3.5 (± 3.1) min], and retroflexion [1.2 (± 2.1) min]. Median (APDF50) and peak (APDF90) left forearm muscle activity was significantly greater than right forearm muscle activity across all subtasks. Median and peak ECR muscle activity was significantly greater during the left and right colon insertion subtasks compared to retroflexion. Both wrists were predominantly in wrist extension during all phases of colonoscopy. The left forearm muscle activity was higher than right forearm activity due to differences in wrist posture and grip force. The risk factors for the left hand may be reduced with alternative designs and support mechanisms for the colonoscope head.

Facilitation of Corticospinal Excitability during Motor Imagery of Wrist Movement with Visual or Quantitative Inspection of EMG Activity

The present study investigated facilitation of corticospinal excitability during motor imagery of wrist movement with visual or quantitative inspection of background electromyographic (EMG) activity. Ten healthy participants imagined wrist extension from a first-person perspective in response to a start cue. Transcranial magnetic stimulation was delivered to the motor cortex 2 sec. after the start cue. EMG signals were recorded from the extensor carpi radialis muscle. Trials with background EMG activity were discarded based on visual inspection. Both motor-evoked potential (MEP) and background EMG amplitudes increased during motor imagery. The amount of increase in MEP amplitude was positively correlated with the amount of increase in background EMG amplitude during motor imagery. The statistically significant increase in MEP amplitude during motor imagery disappeared when the effect of muscle activity was statistically eliminated or after trials with background EMG activity were discarded based on strict quantitative criteria. Facilitation of corticospinal excitability during motor imagery of wrist movement depends partially on muscle activity. Discarding background EMG activity during motor imagery based on visual inspection is not sufficient to equalize background EMG amplitude between resting and motor imagery. Discarding trials with background EMG activity through strict quantitative criteria is useful to equalize background EMG amplitude between at rest and during motor imagery.

Writer’s cramp: cortical excitability in tasks involving proximo-distal coordination

The aim of this work was to analyse how writer's cramp patients coordinate each element of the proximal to distal upper arm muscle chain during voluntary movement. Using transcranial magnetic stimulation, we have assessed motor cortex excitability properties in patients by recording motor-evoked potentials and silent periods in both the extensor carpi radialis (ECR) and the first dorsal interosseus muscles (FDI), activated either in isolation, or in conjunction with voluntary medial deltoid (MD) co-activation during performance of precise tasks. Ten dystonic patients and ten healthy controls were tested. In both test groups, the ECR muscle displayed a similar active motor threshold, but the excitability curves reached higher plateau values, when the proximal MD muscle was co-activated. In the dystonic group, the FDI muscle excitability curves reached higher plateau values when the MD was co-activated, whereas co-activation had no effect on the control group. In the control group, silent periods, in both the ECR and the FDI were longer when the MD was co-activated. This effect was not observed in the dystonic group. In the dystonic group, facilitation of the FDI was observed during a task involving proximo-distal coordination. No differences in silent periods were observed when the muscle was activated alone. Our results suggest that such abnormal facilitation is not only an impairment of the central inhibitory mechanisms reported for dystonic patients, but, in addition, represents true abnormality in cortical muscle activation strategies.

A phase I trial of adeno-associated virus serotype 1-γ-sarcoglycan gene therapy for limb girdle muscular dystrophy type 2C

γ-Sarcoglycanopathy or limb girdle muscular dystrophy type 2C is an untreatable disease caused by autosomal recessively inherited mutations of the γ-sarcoglycan gene. Nine non-ambulatory patients (two males, seven females, mean age 27 years; range 16-38 years) with del525T homozygous mutation of the γ-sarcoglycan gene and no γ-sarcoglycan immunostaining on muscle biopsy were divided into three equal groups to receive three escalating doses of an adeno-associated virus serotype 1 vector expressing the human γ-sarcoglycan gene under the control of the desmin promoter, by local injection into the extensor carpi radialis muscle. The first group received a single injection of 3 × 10(9) viral genomes in 100 µl, the second group received a single injection of 1.5 × 10(10) viral genomes in 100 µl, and the third group received three simultaneous 100-µl injections at the same site, delivering a total dose of 4.5 × 10(10) viral genomes. No serious adverse effects occurred during 6 months of follow-up. All nine patients became adeno-associated virus serotype 1 seropositive and one developed a cytotoxic response to the adeno-associated virus serotype 1 capsid. Thirty days later, immunohistochemical analysis of injected-muscle biopsy specimens showed γ-sarcoglycan expression in all three patients who received the highest dose (4.7-10.5% positively stained fibres), while real-time polymerase chain reaction detected γ-sarcoglycan messenger RNA. In one patient, γ-sarcoglycan protein was detected by western blot. For two other patients who received the low and intermediate doses, discrete levels of γ-sarcoglycan expression (<1% positively stained fibres) were also detectable. Expression of γ-sarcoglycan protein can be induced in patients with limb girdle muscular dystrophy type 2C by adeno-associated virus serotype 1 gene transfer, with no serious adverse effects.

Transcranial magnetic stimulation in Doberman Pinschers with clinically relevant and clinically irrelevant spinal cord compression on magnetic resonance imaging

To evaluate the use of transcranial magnetic stimulation for differentiating between clinically relevant and clinically irrelevant cervical spinal cord compression on magnetic resonance imaging (MRI). Validation study. Clinically normal Doberman Pinschers without (n = 11) and with (6) spinal cord compression on MRI and 16 Doberman Pinschers with disk-associated wobbler syndrome (DAWS). After dogs were sedated, transcranial magnetic motor evoked potentials were recorded from the extensor carpi radialis muscle (ECRM) and cranial tibial muscle (CTM). Onset latencies and peak-to-peak amplitudes were measured. Magnetic resonance imaging was performed to identify spinal cord compression. There were significant differences in ECRM and CTM onset latencies between Doberman Pinschers with DAWS and each of the 2 groups of clinically normal dogs, but there were no significant differences in ECRM and CTM onset latencies between the 2 groups of clinically normal dogs. There were significant differences in CTM peak-to-peak amplitudes between Doberman Pinschers with DAWS and each of the 2 groups of clinically normal dogs, but there were no significant differences in ECRM peak-to-peak amplitudes among groups or in CTM peak-to-peak amplitudes between the 2 groups of clinically normal dogs. There was a significant correlation between severity of spinal cord compression and ECRM onset latency, CTM onset latency, and CTM peak-to-peak amplitude. Results suggested that transcranial magnetic stimulation may be a useful diagnostic tool to differentiate between clinically relevant and clinically irrelevant spinal cord compression identified on MRI alone.

Oxygenation And Myoelectric Activity In The Forearm And Shoulder Muscles Of Males And Females

Linear relationships exist as decreasing oxygenation (StO2%) and increasing myoelectric activity (EMG) for the biceps brachii and brachioradialis muscles. This relationship is not yet established for the trapezius and extensor carpi radialis (ECR) muscles, i.e. muscles prone to work-related pain (WRMP). In regard, females have a higher incidence of WRMP. PURPOSE: To determine the relations between StO2% and EMG in the trapezius and ECR muscles of males and females during isometric contractions (10-70 % MVC). METHODS: Thirteen males and fifteen females (26 ± 5 yrs for both) were equipped with probes for near infrared spectroscopy (NIRS) and EMG over the right forearm ECR and shoulder trapezius muscles. For the ECR measurements wrist extensions, and for the trapezius elevation of the shoulder joints were performed. From NIRS data the change in StO2% from baseline (DStO2%) was calculated. EMG amplitudes (RMS, root mean square) were expressed as percentages of maximum. Slope values (k) between DStO2% and EMG RMS and correlation coefficients (R) were calculated for each subject and mean differences tested with T-tests. RESULTS: For the ECR, the mean slope for females (k=-0.67) tended to be steeper than males (k=-0.48), (p=0.10). Females also tended to correlate better (R=-0.87) than males (R=-0.60), (p=0.06). For the trapezius, slopes and correlations for males (k=-0.60, R=-0.71) and females (k=-0.56, R=-0.77) were not different. Mean (± SE) DStO2% and EMG-RMS over force are shown below. CONCLUSION: Our results show a gender specific pattern for the relation between StO2% and EMG for the ECR, but not for the trapezius. Whether this has an impact on the higher incidence of WRMP for females than males requires further investigation.FIGURE

Afferent‐induced facilitation of primary motor cortex excitability in the region controlling hand muscles in humans

Sensory inputs from cutaneous and limb receptors are known to influence motor cortex network excitability. Although most recent studies have focused on the inhibitory influences of afferent inputs on arm motor responses evoked by transcranial magnetic stimulation (TMS), facilitatory effects are rarely considered. In the present work, we sought to establish how proprioceptive sensory inputs modulate the excitability of the primary motor cortex region controlling certain hand and wrist muscles. Suprathreshold TMS pulses were preceded either by median nerve stimulation (MNS) or index finger stimulation with interstimulus intervals (ISIs) ranging from 20 to 200 ms (with particular focus on 40-80 ms). Motor-evoked potentials recorded in the abductor pollicis brevis (APB), first dorsalis interosseus and extensor carpi radialis muscles were strongly facilitated (by up to 150%) by MNS with ISIs of around 60 ms, whereas digit stimulation had only a weak effect. When MNS was delivered at the interval that evoked the optimal facilitatory effect, the H-reflex amplitude remained unchanged and APB motor responses evoked with transcranial electric stimulation were not increased as compared with TMS. Afferent-induced facilitation and short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) mechanisms are likely to interact in cortical circuits, as suggested by the strong facilitation observed when MNS was delivered concurrently with ICF and the reduction of SICI following MNS. We conclude that afferent-induced facilitation is a mechanism which probably involves muscle spindle afferents and should be considered when studying sensorimotor integration mechanisms in healthy and disease situations.

Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in muscle size and associated motor improvement in a child with cerebral palsy: An experimenter-blind study

This case study was conducted to determine Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in the commonly affected extensor carpi radialis (ECR) and triceps brachii (TRI) muscle and associated muscle strength and motor performance in a child with hemiparetic cerebral palsy (CP) using standardized clinical tests and ultrasound imaging. A single case study with pre-/post-test. A 4.9-year-old female, diagnosed with hemiparetic CP. The child received a 5-week course of CHRIST course, comprising of 60-minute periods a day, five times a week. A real-time ultrasound imaging was performed to determine the CHRIST-induced changes in cross-sectional area (CSA) of the ECR and TRI. Clinical tests including the modified Wolf Motor function test (WMFT), the modified Jebsen-taylor hand function test (Jebsen hand) and the modified Pediatric Motor Activity Log (PMAL) questionnaire were used to compare the intervention-related changes in motor performance in upper extremity. Ultrasound imaging data showed that the CSAs of both ECR and TRI muscles of the affected upper limb at relaxation and contraction states were enhanced and these therapy-induced morphological changes were associated with enhanced muscle strength and gross motor performance in reaching and grasping skills. Our results suggest that the CHRIST is effective in treating muscle weakness and motor function in a child with hemiparetic CP. This is the first evidence in literature that might shed light on the therapeutic efficacy of our novel intervention on muscle size, associated muscle strength and motor improvement.

A Single Intravenous Injection of Adeno-associated Virus Serotype-9 Leads to Whole Body Skeletal Muscle Transduction in Dogs

The success of many gene therapy applications hinges on efficient whole body transduction. In the case of muscular dystrophies, a therapeutic vector has to reach every muscle in the body. Recent studies suggest that vectors based on adeno-associated virus (AAV) are capable of body-wide transduction in rodents. However, translating this finding to large animals remains a challenge. Here we explored systemic gene delivery with AAV serotype-9 (AAV-9) in neonatal dogs. Previous attempts to directly deliver AAV to adult canine muscle have yielded minimal transduction due to a strong cellular immune response. However, in neonatal dogs we observed robust skeletal muscle transduction throughout the body after a single intravenous injection. Importantly, systemic transduction was achieved in the absence of pharmacological intervention or immune suppression and it lasted for at least 6 months (the duration of study). We also observed several unique features not predicted by murine studies. In particular, cardiac muscle was barely transduced in dogs. Many muscular dystrophy patients can be identified by neonatal screening. The technology described here may lead to an effective early intervention in these patients.

Corticospinal control of wrist muscles during expectation of a motor perturbation: A transcranial magnetic stimulation study

Voluntary movement is often perturbed by the external forces in the environment. Because corticospinal (CS) control of wrist muscles during preparation of voluntary movement has been extensively studied without variation in the external forces, very little is known about the way CS control adapts when subjects expect motor perturbations. Here, we studied the CS control of wrist muscles during expectation of an imposed wrist extension. Subjects were instructed either to compensate (COMP) the perturbation (applied at variable delays) or not to intervene (NINT). In a quarter of all trials at random, in the time window when perturbation might occur, TMS was applied over contralateral M1. Motor evoked potentials (MEPs) were measured in the FCR (flexor carpi radialis) and ECR (extensor carpi radialis) muscles, as well as the silent period (SP) in the FCR. Following the perturbation, we found a larger long-latency stretch reflex in COMP than in NINT. During the expectation of the perturbation, MEP amplitudes did not differ across conditions in FCR. However, those evoked in ECR were greater in COMP than in NINT condition. Moreover in the FCR, the silent period lasted longer in NINT. Thus, we showed a selective effect of the prepared reaction on the anticipatory tuning of CS excitability and cortical inhibition in the agonist/antagonist muscles. This tuning clearly differed from the tuning during voluntary movement preparation without variation in the external forces. This shows that the tuning of the CS system during motor preparation depends on the dynamical context of movement production.

Poster 59: Strength Training-Induced Changes in Muscle Size and Motor Improvement in Bilateral Schizencephaly: Experimenter-Blind Case Report 3-Month Follow-Up

Objective: To determine the comprehensive hand repetitive intensive strengthening training (CHRIST)−induced morphologic changes in the commonly affected extensor carpi radialis (ECR) and triceps brachii muscle and associated muscle strength and motor performance in a child with spastic quadriplegic cerebral palsy (CP) using standardized clinical tests and ultrasound imaging. Design: A single-case study with pre- and posttest. Setting: Pediatric physical therapy department at a city hospital. Participant: The patient was a 10-year-old girl who was diagnosed with spastic quadriplegic CP. Interventions: The child was trained with CHRIST for 60 minutes a day, 5 times a week, for 5 weeks. The CHRIST was designed to improve motor function and strength of the upper-extremity muscles. Main Outcome Measures: Clinical tests, including the modified Wolf Motor Function Test, Jebsen-Taylor Hand Function Test, and Pediatric Motor Activity Log questionnaire, were used to compare the intervention-related changes in motor performance. Results: Ultrasound imaging data showed that the cross-sectional areas of both the ECR and triceps brachii muscles at relaxation and contraction states were enhanced and the therapy-induced muscle structural changes were associated with enhanced muscle strength and motor performance. Our results suggest that the CHRIST was effective in treating muscle weakness and associated motor dysfunction in a child with spastic quadriplegic CP. Conclusions: As a first step in developing an innovative and effective neurorehabilitation technique, our findings demonstrated the efficacy of CHRIST for improving muscle structure and strength as well as motor performance and skills in a child with quadriplegic CP.

Verarbeitung von propriozeptiver Information beim idiopathischen Parkinson-Syndrom und der Einfluss von Levodopa

INTRODUCTION: Muscle vibration (MV) influences the perception of movement and proprioception especially without visual control. In idiopathic Parkinson's disease, MV has a smaller impact on kinaesthesia than in healthy people; this impact may be enhanced by dopaminergic medication. This peculiarity is deemed to contribute to the genesis of hypometria and bradykinesia. The exact mechanisms of the reduced influence of MV on kinaesthesia in IPD are unclear. METHODS: The processing of proprioceptive stimulation of forearm muscles was examined in 10 IPD patients in the off and on state using transcranial magnetic stimulation (TMS) and compared to that of 10 age-matched controls. A paired-pulse paradigm to investigate intracortical excitability was used to record motor evoked potentials (MEP) in the extensor and flexor carpi radialis muscles (ECR and FCR) of the more impaired arm without and during proprioceptive stimulation − 80 Hz muscle vibration (MV) of the belly of the ECR. RESULTS: In contrast to controls, MV does not facilitate MEPs in IPD in the off state. In the on state MV causes, like in controls, a selective facilitation of MEPs recorded from the vibrated muscle. This effect is considerably smaller in IPD, though. CONCLUSION: The processing of vibratory input in IPD is disturbed and can be partially normalized by levodopa. This effect can be detected by means of TMS.

Modulation of spinal inhibitory reflex responses to cutaneous nociceptive stimuli during upper limb movement

In the present study we investigated the probability, latency and duration of the inhibitory component of the withdrawal reflex elicited by painful electrical stimulation of the index finger in humans. The stimulus consisted of a train of high-intensity pulses. The investigation was carried out in several upper limb muscles during isometric contractions of different strengths and during a motor sequence consisting of reaching, picking up and transporting an object. We used a new algorithm to detect and characterize the inhibitory reflex. The reflex was found in all muscles except the brachioradialis at all the isometric contraction strengths, and showed a distal-to-proximal gradient of latency and duration. Conversely, during movement the reflex probability was high (> 80%) in the anterior deltoid and triceps muscles during reaching, in the extensor carpi radialis muscle during transporting of the object, and in the first interosseous muscle during both picking up and transporting of the object. This modulation of inhibitory reflex transmission in the upper limb muscles suggests that the motor response is organized in such a way as to inhibit the overall ongoing motor task by interrupting motion during reaching and by releasing the object during transporting. This pattern of modulation appears to differ markedly from that previously reported for the excitatory component of the withdrawal reflex. Study of the nociceptive inhibitory reflexes during movement offers new and more profound insights into the functional anatomical organization of the spinal interneuronal network mediating sensory-motor integration.

Quantitative evaluation of motor functional recovery process in chronic stroke patients during robot-assisted wrist training

This study was to investigate the motor functional recovery process in chronic stroke during robot-assisted wrist training. Fifteen subjects with chronic upper extremity paresis after stroke attended a 20-session wrist tracking training using an interactive rehabilitation robot. Electromyographic (EMG) parameters, i.e., EMG activation levels of four muscles: biceps brachii (BIC), triceps brachii (TRI, lateral head), flexor carpiradialis (FCR), and extensor carpiradialis (ECR) and their co-contraction indexes (CI) were used to monitor the neuromuscular changes during the training course. The EMG activation levels of the FCR (11.1% of decrease from the initial), BIC (17.1% of decrease from the initial), and ECR (29.4% of decrease from the initial) muscles decreased significantly during the training ( P < 0.05). Such decrease was associated with decreased Modified Ashworth Scores for both the wrist and elbow joints ( P < 0.05). Significant decrease ( P < 0.05) was also found in CIs of muscle pairs, BIC&TRI (21% of decrease from the initial), FCR&BIC (11.3% of decrease from the initial), ECR&BIC (49.3% of decrease from the initial). The decreased CIs related to the BIC muscle were mainly caused by the reduction in the BIC EMG activation level, suggesting a better isolation of the wrist movements from the elbow motions. The decreased CI of ECR& FCR in the later training sessions ( P < 0.05) was due to the reduced co-contraction phase of the antagonist muscle pair in the tracking tasks. Significant improvements ( P < 0.05) were also found in motor outcomes related to the shoulder/elbow and wrist/hand scores assessed by the Fugl–Meyer assessment before and after the training. According to the evolution of the EMG parameters along the training course, further motor improvements could be obtained by providing more training sessions, since the decreases of the EMG parameters did not reach a steady state before the end of the training. The results in this study provided an objective and quantitative EMG measure to describe the motor recovery process during poststroke robot-assisted wrist for the further understanding on the neuromuscular mechanism associated with the recovery.