Modulation Of Corticomotor Excitability Research Articles

Corticomotor plasticity as a predictor of response to high frequency transcranial magnetic stimulation treatment for major depressive disorder

BackgroundMany patients with treatment-resistant depression (TRD) respond to repetitive transcranial magnetic stimulation (rTMS) treatment. This study aimed to investigate whether modulation of corticomotor excitability by rTMS predicts response to rTMS treatment for TRD in 10 Hz and intermittent theta-burst stimulation (iTBS) protocols. MethodsThirteen TRD patients underwent two evaluations of corticomotor plasticity—assessed as the post-rTMS (10 Hz, iTBS) percent change (%∆) in motor evoked potential (MEP) amplitude elicited by single-pulse TMS. Following corticomotor plasticity evaluations, patients subsequently underwent a standard 6-week course of 10 Hz rTMS (4 s train, 26 s inter-train interval, 3000 total pulses, 120% of motor threshold) to the left dorsolateral prefrontal cortex. Treatment efficacy was assessed by the Beck Depression Inventory II (BDI-II) and Hamilton Depression Rating Scale (HAM-D). The change in MEPs was compared between 10 Hz and iTBS conditions and related to the change in BDI-II and HAM-D scores. ResultsAnalyses of variance revealed that across all time-points, higher post-10 Hz MEP change was a significant predictor of greater improvement on the BDI-II (p < 0.001) and HAM-D (p = 0.022). This relationship was not observed with iTBS (p-values≥0.100). Post-hoc tests revealed the MEP change 20 min post-10 Hz was the strongest predictor of BDI-II improvement. LimitationsCortical excitability was measured from the motor cortex, rather than the dorsolateral prefrontal cortex, where treatment is applied. The 10 Hz and iTBS protocols were performed at different intensities consistent with common practice. ConclusionsModulation of corticomotor excitability by 10 Hz can predict response to rTMS treatment with 10 Hz rTMS.

The modulation of short and long-latency interhemispheric inhibition during bimanually coordinated movements

Bimanual coordination is essential for the performance of many everyday tasks. There are several types of bimanually coordinated movements, classified according to whether the arms are acting to achieve a single goal (cooperative) or separate goals (independent), and whether the arms are moving symmetrically or asymmetrically. Symmetric bimanual movements are thought to facilitate corticomotor excitability (CME), while asymmetric bimanual movements are thought to recruit interhemispheric inhibition to reduce functional coupling between the motor cortices. The influences of movement symmetry and goal conceptualisation on interhemispheric interactions have not been studied together, and not during bimanually active dynamic tasks. The present study used transcranial magnetic stimulation (TMS) to investigate the modulation of CME and short- and long-latency interhemispheric inhibition (SIHI and LIHI, respectively) during bimanually active dynamic tasks requiring different types of bimanual coordination. Twenty healthy right-handed adults performed four bimanual tasks in which they held a dumbbell in each hand (independent) or a custom device between both hands (cooperative) while rhythmically flexing and extending their wrists symmetrically or asymmetrically. Motor-evoked potentials were recorded from the right extensor carpi ulnaris. We found CME was greater during asymmetric tasks than symmetric tasks, and movement symmetry did not modulate SIHI or LIHI. There was no effect of goal conceptualisation nor any interaction with movement symmetry for CME, SIHI or LIHI. Based on these results, movement symmetry and goal conceptualisation may not modulate interhemispheric inhibition during dynamic bimanual tasks. These findings contradict prevailing thinking about the roles of CME and interhemispheric inhibition in bimanual coordination.

Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS).

Advances in our understanding of neural plasticity have prompted the emergence of neuromodulatory interventions, which modulate corticomotor excitability (CME) and hold potential for accelerating stroke recovery. Endogenous paired associative stimulation (ePAS) involves the repeated pairing of a single pulse of peripheral electrical stimulation (PES) with endogenous movement-related cortical potentials (MRCPs), which are derived from electroencephalography. However, little is known about the optimal parameters for its delivery. A factorial design with repeated measures delivered four different versions of ePAS, in which PES intensities and movement type were manipulated. Linear mixed models were employed to assess interaction effects between PES intensity (suprathreshold (Hi) and motor threshold (Lo)) and movement type (Voluntary and Imagined) on CME. ePAS interventions significantly increased CME compared to control interventions, except in the case of Lo-Voluntary ePAS. There was an overall main effect for the Hi-Voluntary ePAS intervention immediately post-intervention (p = 0.002), with a sub-additive interaction effect at 30 min’ post-intervention (p = 0.042). Hi-Imagined and Lo-Imagined ePAS significantly increased CME for 30 min post-intervention (p = 0.038 and p = 0.043 respectively). The effects of the two PES intensities were not significantly different. CME was significantly greater after performing imagined movements, compared to voluntary movements, with motor threshold PES (Lo) 15 min post-intervention (p = 0.012). This study supports previous research investigating Lo-Imagined ePAS and extends those findings by illustrating that ePAS interventions that deliver suprathreshold intensities during voluntary or imagined movements (Hi-Voluntary and Hi-Imagined) also increase CME. Importantly, our findings indicate that stimulation intensity and movement type interact in ePAS interventions. Factorial designs are an efficient way to explore the effects of manipulating the parameters of neuromodulatory interventions. Further research is required to ensure that these parameters are appropriately refined to maximise intervention efficacy for people with stroke and to support translation into clinical practice.

Comparison of Transcranial Direct Current Stimulation Electrode Montages for the Lower Limb Motor Cortex.

Transcranial direct current stimulation (tDCS) has been widely explored as a neuromodulatory adjunct to modulate corticomotor excitability and improve motor behavior. However, issues with the effectiveness of tDCS have led to the exploration of empirical and experimental alternate electrode placements to enhance neuromodulatory effects. Here, we conducted a preliminary study to compare a novel electrode montage (which involved placing 13 cm2 electrodes anterior and posterior to the target location) to the traditionally used electrode montage (13 cm2 stimulating electrode over the target area and the 35 cm2 reference electrode over the contralateral orbit). We examined the effects of tDCS of the lower limb motor area (M1) by measuring the corticomotor excitability (CME) of the tibialis anterior muscle using transcranial magnetic stimulation in twenty healthy participants. We examined behavioral effects using a skilled motor control task performed with the ankle. We did not find one electrode montage to be superior to the other for changes in the CME or motor control. When the group was dichotomized into responders and non-responders (based on upregulation in CME), we found that the responders showed significant upregulation from baseline after tDCS for both montages. However, only the responders in the traditional montage group showed significant changes in motor control after tDCS. These results do not support the superiority of the new anterior–posterior montage over the traditional montage. Further work with a larger cohort and multiple cumulative sessions may be necessary to confirm our results.

Infraslow activity as a potential modulator of corticomotor excitability.

Fluctuations in cortical excitability are a candidate mechanism involved in the trial-to-trial variation of motor evoked potentials (MEPs) to transcranial magnetic stimulation (TMS). We explore whether infraslow EEG activity (<0.1 Hz) modulates corticomotor excitability by evaluating the presence of temporal and phase clustering of TMS-induced MEPs. In addition, we evaluate the dependence of MEP amplitude on the phase of the infraslow activity. Twenty-three subjects were stimulated at an intensity above the resting motor threshold (rMT) and ten at the rMT. We evaluated whether temporal and phase clustering of MEP size and MEP generation were present, using 1,000 surrogates with a similar amplitude or occurrence distribution. To evaluate the MEP amplitude dependence, we used the least-square method to approximate the linear circular data by fitting a sine function. We observed significant temporal clustering at a group level, in all individual subjects stimulated at rMT and in the majority of those stimulated above rMT, suggesting underlying determinism of corticomotor excitability instead of randomly generated fluctuations. The majority of subjects showed significant phase clustering for MEP size and for MEP occurrence, and significant phase clustering was found at the group level. Furthermore, in approximately one-quarter to one-half of the subjects we found a significant correlation and dependence of MEP amplitude on the phase of infraslow activity, respectively. Although other mechanisms very likely contribute as well, our findings seem to suggest that infraslow activity is involved in the variability of cortical excitability and TMS-induced responses. NEW & NOTEWORTHY Cortical excitability measures are highly variable during transcranial magnetic stimulation. Although ongoing brain oscillations are assumed to modulate excitability, no consistent associations are found for the traditional frequency bands. We focus on the role of infraslow EEG activity, defined as rhythms with frequencies < 0.1 Hz. We provide experimental evidence suggesting that infraslow activity most likely modulates corticomotor excitability and that response variation could be reduced when stimulation is targeted at a specific infraslow phase.

Modulation of corticomotor excitability in response to distal focal cooling.

BackgroundThermal stimulation has been proposed as a modality to facilitate motor recovery in neurological populations, such as stroke. Recently (Ansari, Remaud & Tremblay, 2018), we showed that application of cold or warm stimuli distally to a single digit produced a variable and short lasting modulation in corticomotor excitability. Here, our goal was to extend these observations to determine whether an increase in stimulation area could elicit more consistent modulation.MethodsParticipants (n = 22) consisted of a subset who participated in our initial study. Participants were asked to come for a second testing session where the thermal protocol was repeated but with extending the stimulation area from single-digit (SD) to multi-digits (MD, four fingers, no thumb). As in the first session, skin temperature and motor evoked potentials (MEPs) elicited with transcranial magnetic stimulation were measured at baseline (BL, neutral gel pack at 22 °C), at 1 min during the cooling application (pre-cooled 10 °C gel pack) and 5 and 10 min post-cooling (PC5 and PC10). The analysis combined the data obtained previously with single-SD cooling (Ansari, Remaud & Tremblay, 2018) with those obtained here for MD cooling.ResultsAt BL, participants exhibited comparable measures of resting corticomotor excitability between testing sessions. MD cooling induced similar reductions in skin temperature as those recorded with SD cooling with a peak decline at C1 of respectively, −11.0 and −10.3 °C. For MEPs, the primary analysis revealed no main effect attributable to the stimulation area. A secondary analysis of individual responses to MD cooling revealed that half of the participants exhibited delayed MEP facilitation (11/22), while the other half showed delayed inhibition (10/22); which was sustained in the post-cooling phase. More importantly, a correlation between variations in MEP amplitude recorded during the SD cooling session with those recorded in the second session with MD cooling, revealed a very good degree of correspondence between the two at the individual level.ConclusionThese results indicate that increasing the cooling area in the distal hand, while still eliciting variable responses, did produce more sustained modulation in MEP amplitude in the post-cooling phase. Our results also highlight that responses to cooling in terms of either depression or facilitation of corticomotor excitability tend to be fairly consistent in a given individual with repeated applications.

Modulation of corticomotor excitability following 10 Hz repetitive transcranial magnetic stimulation predicts clinical response in patients with treatment-resistant depression

Modulation of corticomotor excitability following 10 Hz repetitive transcranial magnetic stimulation predicts clinical response in patients with treatment-resistant depression

Effects of bilateral priming on motor cortex function in healthy adults.

Bilateral priming is a rehabilitation adjuvant that can improve upper limb motor recovery poststroke. It uses a table-top device to couple the upper limbs together such that active flexion and extension of one wrist leads to passive movement of the opposite wrist in a mirror symmetric pattern. Bilateral priming increases corticomotor excitability (CME) in the primary motor cortex (M1) of the passively driven wrist; however, the neurophysiological mechanisms underlying this increase remain unclear. This study explored these mechanisms by using transcranial magnetic stimulation over the right M1 and recording motor-evoked potentials from the passively driven left extensor carpi radialis of healthy adults. Intracortical measures were recorded before and 5 and 35 min after a single 15-min session of priming. One-millisecond short-interval intracortical inhibition, long-interval intracortical inhibition, late cortical disinhibition (LCD), and intracortical facilitation were recorded with a posterior-anterior (PA) intracortical current, whereas CME and short-interval intracortical facilitation (SICF) were recorded with both PA and anterior-posterior (AP) currents. CME with PA stimulation was also recorded ~1 h postpriming. PA CME was elevated 35 min postpriming and remained elevated ~1 h postpriming. LCD decreased, and AP SICF increased at both 5 and 35 min postpriming. However, these changes in LCD and AP SICF are unlikely to be the cause of the increased PA CME because of the differing timelines of their effects and AP and PA currents activating separate interneuron circuits. These results suggest that bilateral priming does not increase CME through alterations of the intracortical circuits investigated here. NEW & NOTEWORTHY This is the first study to measure how bilateral priming modulates corticomotor excitability with posterior-anterior and anterior-posterior intracortical currents, 1-ms short-interval intracortical inhibition, late cortical disinhibition, intracortical facilitation, and short-interval intracortical facilitation. We found corticomotor excitability with a posterior-anterior current increased by 35 min until ~1 h postpriming. Short-interval intracortical facilitation with an anterior-posterior current was greater for at least 35 min postpriming. This provides further insight into the neurophysiological mechanisms underlying bilateral priming.

Paired associative stimulation modulates corticomotor excitability in chronic stroke: A preliminary investigation.

Background:Paired associative stimulation (PAS) combining repeated pairing of electrical stimulation of a peripheral nerve with transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) can induce neuroplastic adaptations in the human brain and enhance motor learning in neurologically-intact individuals. However, the extent to which PAS is an effective technique for inducing associative plasticity and improving motor function in individuals post-stroke is unclear.Objective:The objective of this pilot study was to investigate the effects of a single session of PAS to modulate corticomotor excitability and motor skill performance in individuals post-stroke.Methods:Seven individuals with chronic stroke completed two separate visits separated by at least one week. We assessed general corticomotor excitability, intracortical network activity and behavioral outcomes prior to and at three time points following PAS and compared these outcomes to those following a sham PAS condition (PASSHAM).Results:Following PAS, we found increased general corticomotor excitability but no significant difference in behavioral measures between PAS conditions. There was a relationship between PAS-induced corticomotor excitability increase and enhanced motor skill performance across post-PAS testing time points.Conclusion:These results provide preliminary evidence for the potential of PAS to increase corticomotor excitability that could favorably impact motor skill performance in chronic individuals post-stroke and are an important first step for future studies investigating the clinical application and behavioral relevance of PAS interventions in post stroke patient populations.

Observing back pain provoking lifting actions modulates corticomotor excitability of the observer's primary motor cortex.

Observing another person experiencing exogenously inflicted pain (e.g. by a sharp object penetrating a finger) modulates the excitability of the observer' primary motor cortex (M1). By contrast, far less is known about the response to endogenously evoked pain such as sudden back pain provoked by lifting a heavy object. Here, participants (n=26) observed the lifting of a heavy object. During this action the actor (1) flexed and extended the legs (LEG), (2) flexed and extended the back (BACK) or (3) flexed and extended the back which caused visible pain (BACKPAIN). Corticomotor excitability was measured by applying a single transcranial magnetic stimulation pulse to the M1 representation of the muscle erector spinae and participants scored their perception of the actor's pain on the numeric pain rating scale (NPRS). The participants scored vicarious pain as highest during the BACKPAIN condition and lowest during the LEG condition. MEP size was significantly lower for the LEG than the BACK and BACKPAIN condition. Although we found no statistical difference in the motor-evoked potential (MEP) size between the conditions BACK and BACKPAIN, there was a significant correlation between the difference in NPRS scores between the conditions BACKPAIN and BACK and the difference in MEP size between these conditions. Participants who believed the vicarious pain to be much stronger in the BACKPAIN than in the BACK condition also exhibited higher MEPs for the BACKPAIN than the BACK condition. Our results indicate that observing how others lift heavy objects facilitates motor representations of back muscles in the observer. Modulation occurs in a movement-specific manner and is additionally modulated by the extent to which the participants perceived the actor's pain. Our findings suggest that movement observation might be a promising paradigm to study the brain's response to back pain.

Modulation of sensorimotor circuits during retrieval of negative Autobiographical Memories: Exploring the impact of personality dimensions

Autobiographical Memory (AM) retrieval refers to recollection of experienced past events. Previous Transcranial Magnetic Stimulation (TMS) studies have shown that presentation of emotional negative stimuli affects human motor cortex excitability resulting in larger motor evoked potentials (MEPs). Up to date no TMS studies have been carried out in order to investigate the effect of personal memories with negative emotional value on corticospinal excitability. In this study we hypothesized that negative AM retrieval will modulate corticomotor excitability and sensorimotor integration as determined by TMS neurophysiological parameters. Furthermore, we investigated whether TMS responses during retrieval of negative AM are associated with specific personality traits.Twelve healthy subjects were asked to recall either a negative or a neutral AM across two different days in a randomized order. During this memory retrieval, the following TMS parameters were recorded: MEPs; Short- interval intracortical inhibition (SICI) and Intracortical facilitation (ICF); Short-latency afferent inhibition (SAI) and Long- latency afferent inhibition (LAI). Personality traits were assessed by using the Big Five scale. Statistical analysis was performed using factorial ANOVAs and multiple linear regression models. When compared to retrieval of neutral AM, recollection of negative AM induced a larger increase in MEP amplitude, an increase in ICF, and a decrease in SAI. The neuroticism personality trait was a significant predictor of the MEP amplitude increase during retrieval of negative AM. Altogether these results indicate that cortical excitability and sensorimotor integration are selectively modulated by the valence of AM. These results provide the first TMS evidence that the modulatory effect of the AM retrieval is associated with specific personality traits.

Peripheral electrical stimulation increases corticomotor excitability and enhances the rate of visuomotor adaptation

Peripheral electrical stimulation (PES) modulates corticomotor excitability but its effect on motor performance has not been thoroughly investigated. The purpose of this study was to assess whether increases and/or decreases in corticomotor excitability, induced by PES, influenced motor performance using a visuomotor adaptation task. Three PES interventions (motor stimulation, sensory stimulation or sham) were delivered to the first dorsal interosseous (FDI) in 30 healthy participants matched for age, gender and handedness. Motor stimulation was applied to increase corticomotor excitability, sensory stimulation to decrease corticomotor excitability, while sham stimulation acted as a control. Corticomotor excitability was assessed using the amplitude of motor evoked potentials to transcranial magnetic stimulation recorded from FDI before and after each intervention. Following PES, participants completed a visuomotor adaptation task. This required participants to move a cursor accurately towards virtual targets with index finger movements when the cursor trajectory was rotated 30° counter clockwise. Performance was assessed as angular error (a measure of movement accuracy) and reaction time. The rate of visuomotor adaptation was greater following motor PES compared to sham, but not sensory, with no difference observed between sensory and sham. However, visuomotor adaptation performance overall (the total change in performance from beginning to end) was similar across intervention groups. These findings suggest that motor PES applied prior to task acquisition can facilitate the speed of adaptation.

Posture-Dependent Corticomotor Excitability Differs Between the Transferred Biceps in Individuals With Tetraplegia and the Biceps of Nonimpaired Individuals

Background. Following biceps transfer to enable elbow extension in individuals with tetraplegia, motor re-education may be facilitated by greater corticomotor excitability. Arm posture modulates corticomotor excitability of the nonimpaired biceps. If arm posture also modulates excitability of the transferred biceps, posture may aid in motor re-education. Objective. Our objective was to determine whether multi-joint arm posture affects corticomotor excitability of the transferred biceps similar to the nonimpaired biceps. We also aimed to determine whether corticomotor excitability of the transferred biceps is related to elbow extension strength and muscle length. Methods. Corticomotor excitability was assessed in 7 arms of individuals with tetraplegia and biceps transfer using transcranial magnetic stimulation and compared to biceps excitability of nonimpaired individuals. Single-pulse transcranial magnetic stimulation was delivered to the motor cortex with the arm in functional postures at rest. Motor-evoked potential amplitude was recorded via surface electromyography. Elbow moment was recorded during maximum isometric extension trials, and muscle length was estimated using a biomechanical model. Results. Arm posture modulated corticomotor excitability of the transferred biceps differently than the nonimpaired biceps. Elbow extension strength was positively related and muscle length was unrelated, respectively, to motor-evoked potential amplitude across the arms with biceps transfer. Conclusions. Corticomotor excitability of the transferred biceps is modulated by arm posture and may contribute to strength outcomes after tendon transfer. Future work should determine whether modulating corticomotor excitability via posture promotes motor re-education during the rehabilitative period following surgery.

Posture interacts with arm weight support to modulate corticomotor excitability to the upper limb

The use of arm weight support (WS) to optimize movement quality may be an avenue for improved upper limb stroke rehabilitation; however, the underlying neurophysiological effects of WS are not well understood. Rehabilitation exercises may be performed when sitting or standing, but the interaction of posture with WS has not been examined until now. We explored the effect of posture with WS on corticomotor excitability (CME) in healthy adults. Thirteen participants performed static shoulder abduction in two postures (sitting and standing) at three levels of WS (0, 45, and 90% of full support). Transcranial magnetic stimulation of primary motor cortex was used to elicit motor-evoked potentials (MEPs) in eight upper limb muscles. Stimulus-response (SR) curves were fitted to the MEP data using nonlinear regression. Whole-body posture interacted with WS to influence tonic activity and CME in all muscles examined. SR curve parameters revealed greater CME when standing compared to sitting for upper arm muscles, but lower CME to the shoulder, forearm, and hand. Distal to the shoulder, tonic activity and CME were modulated independent of any explicit differences in task requirements. Overall, these results support a model of integrated upper limb control influenced by whole-body posture and WS. These findings have implications for the application of WS in settings such as upper limb rehabilitation after stroke.

The role of the cerebellum in motor imagery

ObjectiveAlthough it is well documented that the cerebellum plays a role in motor imagery (MI), its exact role in MI is still obscure. Since motor imagery and execution of movement share common pathways, and the cerebellum has an inhibitory effect on the motor cortex, we speculated that the cerebellum also has an inhibitory role on MI. MethodsTo test this hypothesis, 12 healthy individuals aged 27–47 years (mean age 33.3 years) were enrolled in the study. Subjects were asked to imagine two different tasks, one complex (MI-c) and one simple (MI-s) motor task. The intensity of anodal cerebellar transcranial direct current stimulation (ctDCS) was set at 2mA for 20min. Sham ctDCS consisted of 30s current stimulation. ResultsMI-s resulted in significantly increased log MEP amplitude during MI, compared with control MEP amplitude,(p=0.000). The increase in log MEP amplitude during MI disappeared after anodal ctDCS. Before sham ctDCS, both MI-s and MI-c resulted in log MEP amplitude increases (p=0.000). This facilitator effect of both MI-c and MI-s on log MEP amplitude was also persistent after sham ctDCS (p=0.000). ConclusionsThe study demonstrates for the first time that the cerebellum has an inhibitory effect on MI. SignificanceCombining ctDCS with MI significantly modulates corticomotor excitability.

ID 217 – Transcranial direct current stimulation effects on the ipsilateral proximal upper limb are movement-frequency dependent

The aim of this work was to explore whether selective muscle activation of the biceps brachii (BB) is modified by cathodal transcranial direct current stimulation (c-tDCS) in a movement frequency-dependent manner. Seventeen healthy participants were asked to perform repetitive isometric elbow flexion and forearm pronation at 0.75, 1.0, and 1.25 Hz, paced by an auditory metronome, before and after c-tDCS (1 mA, 15 min) applied to the primary motor cortex (M1) ipsilateral to the task side. Selectivity in the modulation of corticomotor excitability was expressed as a ratio of motor evoked potential (MEP) size in BB immediately before forearm pronation task relative to elbow flexion. Transcranial magnetic stimulation delivered to the right M1 representation of the left BB at 130% of active motor threshold either 150 or 200 ms prior to every fifth metronome beat. Cathodal tDCS over the ipsilateral M1 significantly improved MEP selectivity ratios in a frequency dependent manner primarily through selective suppression of the BB antagonist (i.e., during forearm pronation). Cathodal tDCS reduced the MEP selectivity ratio for movement-frequencies of 1.0 and 1.25 Hz but not 0.75 Hz compared to sham. Cathodal tDCS is capable of improving selective muscle activation of the ipsilateral proximal upper limb in a frequency-dependent manner.

Corticomotor Excitability is Increased Following an Acute Bout of Blood Flow Restriction Resistance Exercise.

We used transcranial magnetic stimulation (TMS) to investigate whether an acute bout of resistance exercise with blood flow restriction (BFR) stimulated changes in corticomotor excitability (motor evoked potential, MEP) and short-interval intracortical inhibition (SICI), and compared the responses to two traditional resistance exercise methods. Ten males completed four unilateral elbow flexion exercise trials in a balanced, randomized crossover design: (1) heavy-load (HL: 80% one-repetition maximum [1-RM]); (2) light-load (LL; 20% 1-RM) and two other light-load trials with BFR applied; (3) continuously at 80% resting systolic blood pressure (BFR-C); or (4) intermittently at 130% resting systolic blood pressure (BFR-I). MEP amplitude and SICI were measured using TMS at baseline, and at four time-points over a 60 min post-exercise period. MEP amplitude increased rapidly (within 5 min post-exercise) for BFR-C and remained elevated for 60 min post-exercise compared with all other trials. MEP amplitudes increased for up to 20 and 40 min for LL and BFR-I, respectively. These findings provide evidence that BFR resistance exercise can modulate corticomotor excitability, possibly due to altered sensory feedback via group III and IV afferents. This response may be an acute indication of neuromuscular adaptations that underpin changes in muscle strength following a BFR resistance training programme.

One-hour peripheral electrical stimulation modulates corticomotor excitability and hand dexterity in people with chronic stroke

Methods: This was a multi-centered, randomized controlled study that enrolled preterm infants with VLBW from three medical centers in northern and southern Taiwan. The FCIP group infants received 5-session in-hospital intervention and 7-session after-discharge intervention until 12 months of corrected age; whereas the usual care program (UCP) group infants received 5-session in-hospital intervention and 7-session after-discharge phone calls scheduled at the same time as those of the FCIP. The FCIP contained parentand child-focused services; whereas the UCP contained child-focused services mainly. Outcome measurements included morbidity, growth and neurobehavioral performance at term-equivalent age. Results: This study included 262 VLBW preterm infants (127 in the FCIP and 135 in the UCP). The two groups were similar in perinatal and demographic characteristics. The FCIP group infants required a shorter duration of hospital stay (56.1± 24 days vs. 62.5± 24.7 days), achieved greater daily weight gains from birth to term age (26.8± 7 g vs. 24.7± 7.4 g) and from 36 weeks’ postmenstrual age to term age (39.5± 14.1 g vs. 35± 15.3 g), and exhibited higher neurobehavioral total scores (71.6± 4.6 vs.70.1± 4.1) and muscle tone andmotor pattern score (23.9± 1.9 vs.23.± 2.1) (all p< 0.05). Conclusion(s): The FCIP yielded short-term benefit in shortening the length of hospital stay and enhancing growth and neurobehavioral performance in VLBW preterm infants during the neonatal period. A continued follow-up of these infants is currently underway to examine the long-term effectiveness. Implications:The results provided important information for the design of intervention program and assessment of intervention effect in VLBW preterm infants.

“I-wave” recruitment predicts response to tDCS in the upper limb, but only so far

Anodal transcranial direct current stimulation (a-tDCS) of primary motor cortex (M1) facilitates motor evoked potentials (MEPs) in hand muscles. Recent evidence highlighted substantial inter-individual variability after tDCS based on the difference in MEP latency between latero-medial (LM) and anterior-posterior (AP) directed transcranial magnetic stimulation (TMS) (Hamada 2013; Wiethoff 2014). This difference in MEP latency is presumed to reflect the balance of early versus late I-wave recruitment to TMS. The present study examined whether AP-LM MEP latency difference could predict an individual’s MEP facilitation to a-tDCS or dual-hemisphere tDCS in the muscles of the forearm (Extensor Carpi Radialis; ECR) and proximal upper limb (Biceps Brachii; BB). We conducted a randomised double-blind study with 18 healthy adults. Each received anodal, dual-hemisphere, or sham tDCS in separate sessions (tDCS, 1 mA for 15 min). The anode was positioned over right M1 and the cathode over left supraorbit for a-tDCS or left M1 for dual-hemisphere tDCS (both 27 cm2). MEPs in BB and ECR were collected before and immediately after tDCS with posterior-anterior induced cortical current. tDCS effect on MEP size was measured (Post-Pre)/Pre. Linear regression analyses showed a-tDCS modulated MEP size dependent on AP-LM MEP latency for ECR only (p=0.01). Individuals with small MEP latency difference showed the expected facilitation of MEPs after a-tDCS, whereas those with large MEP latency difference had suppressed MEPs after a-tDCS. No association was found between AP-LM MEP latency difference and BB MEP modulation after a-tDCS. There was no observed association between AP-LM MEP latency difference after dual-hemisphere tDCS or sham in either muscle (p>0.1). These results support previous findings that a-tDCS modulates corticomotor excitability depending on I-wave recruitment, for more distal muscles of the hand, and the present results extend these finding to the forearm. These findings may inform how to individualise a-tDCS in future applications.

Partial weight support differentially affects corticomotor excitability across muscles of the upper limb.

Partial weight support may hold promise as a therapeutic adjuvant during rehabilitation after stroke by providing a permissive environment for reducing the expression of abnormal muscle synergies that cause upper limb impairment. We explored the neurophysiological effects of upper limb weight support in 13 healthy young adults by measuring motor‐evoked potentials (MEPs) from transcranial magnetic stimulation (TMS) of primary motor cortex and electromyography from anterior deltoid (AD), biceps brachii (BB), extensor carpi radialis (ECR), and first dorsal interosseous (FDI). Five levels of weight support, varying from none to full, were provided to the arm using a commercial device (Saebo Mobile Arm Support). For each level of support, stimulus–response (SR) curves were derived from MEPs across a range of TMS intensities. Weight support affected background EMG activity in each of the four muscles examined (P <0.0001 for each muscle). Tonic background activity was primarily reduced in the AD. Weight support had a differential effect on the size of MEPs across muscles. After curve fitting, the SR plateau for ECR increased at the lowest support level (P =0.004). For FDI, the SR plateau increased at the highest support level (P =0.0003). These results indicate that weight support of the proximal upper limb modulates corticomotor excitability across the forearm and hand. The findings support a model of integrated control of the upper limb and may inform the use of weight support in clinical settings.