Motor Point Research Articles

The Hippocampus Represents Information about Movements in Their Temporal Position in a Learned Motor Sequence.

Our repertoire of motor skills is filled with sequential movements that need to be performed in a specific order. Here, we used functional magnetic resonance imaging to investigate whether the human hippocampus, a region known to support temporal order in non-motor memory, represents information about the order of sequential motor actions in human participants (both sexes). We also examined such representations in other regions of the motor network (i.e., the premotor cortex, supplementary motor area, anterior superior parietal lobule, and striatum) already known for their critical role in motor sequence learning. Results showed that the hippocampus represents information about movements in their learned temporal position in the sequence, but not about movements or temporal positions in random movement patterns. Other regions of the motor network coded for movements in their learned temporal position, as well as movements and positions in random movement patterns. Importantly, movement coding contributed to sequence learning patterns in primary, supplementary, and premotor cortices but not in striatal and parietal regions. Our findings deepen our understanding of how striatal and cortical regions contribute to motor sequence learning and point to the capacity of the hippocampus to represent movements in their temporal context, an ability possibly explaining its contribution to motor learning.

Localizing motor entry points of adductor muscles of thigh for motor point procedures in the treatment of adductor spasticity.

Spasticity which is focal or segmental such as affecting a single muscle group or limb can be treated by chemical neurolysis or surgical denervation at the neurovascular hilus. This study determines the motor entry points (MEPs) of adductor muscles of the thigh in the adult Indian population and identifies precise anatomical landmarks for the successful performance motor point procedures for the relief of muscle spasticity. A total of 10 adult lower limbs were dissected, and nerve branches to adductor muscles were carefully exposed up to their MEP. The morphometry of adductor muscles, precise locations of proximal and distal MEPs, and ideal sites for motor point procedures were identified. The median number of MEPs in adductor longus was two. Most of them were located between 40% and 50% of the muscle length i.e., in the third-fifth of the total muscle length. Adductor magnus and gracilis had a median number of one and six MEPs respectively. The ideal site of motor point procedures is in the second-fifth of the muscle length for both. This preliminary study describes the location of MEPs and ideal sites of motor point procedures in the adductor muscle of the thigh. However, further cadaveric and electromyographic studies with larger samples are necessary to investigate precise locations of MEPs aiding in the treatment of spasticity.

Motor point stimulation activates fewer Ia-sensory nerves than peripheral nerve stimulation in human soleus muscle.

Peripheral nerve stimulation (PNS) and motor point stimulation (MPS) are noninvasive techniques used to induce muscle contraction, aiding motor function restoration in individuals with neurological disorders. Understanding sensory inputs from PNS and MPS is crucial for facilitating neuroplasticity and restoring impaired motor function. Although previous studies suggest that MPS could induce Ia-sensory inputs less than PNS, experimental evidence supporting this claim is insufficient. Here, we implemented a conditioning paradigm combining transcutaneous spinal cord stimulation (tSCS) with PNS or MPS to investigate their Ia-sensory inputs. This paradigm induces postactivation depression of spinal reflexes associated with transient decreases in neurotransmitter release from Ia-afferent terminals, allowing us to examine the Ia-sensory input amount from PNS and MPS based on the depression degree. We hypothesized that MPS would induce less postactivation depression than PNS. Thirteen individuals underwent MPS and PNS on the soleus muscle as conditioning stimuli, with tSCS applied to the skin between the spinous processes (L1-L2) as test stimuli. PNS- and MPS-conditioned spinal reflexes were recorded at five interstimulus intervals (ISIs) and four intensities. Results revealed that all PNS conditioning showed significant decreases in spinal reflex amplitudes, indicating postactivation depression. Furthermore, PNS conditioning exhibited greater depression for shorter ISIs and higher conditioning intensities. In contrast, MPS conditioning demonstrated intensity-dependent depression, but without all-conditioning depression and clear ISI dependency as seen in PNS conditioning. In addition, PNS induced significantly greater depression than MPS across most conditions. Our findings provide experimental evidence supporting the conclusion that MPS activates Ia-sensory nerves less than PNS.NEW & NOTEWORTHY Peripheral nerve stimulation (PNS) and motor point stimulation (MPS) induce neuroplasticity, but differences in their effects on Ia-sensory inputs are unclear. We investigated their Ia-sensory inputs using a conditioning paradigm with spinal reflexes. Results showed that PNS conditioning significantly inhibited spinal reflexes than MPS conditioning, indicating greater postactivation depression due to Ia-sensory nerve activation. These findings provide experimental evidence that MPS activates Ia-sensory nerves to a lesser extent than PNS, enhancing our understanding of neuroplasticity.

Sleep consolidation potentiates sensorimotor adaptation.

Contrary to its well-established role in declarative learning, the impact of sleep on motor memory consolidation remains a subject of debate. Current literature suggests that while motor skill learning benefits from sleep, consolidation of sensorimotor adaptation (SMA) depends solely on the passage of time. This has led to the proposal that SMA may be an exception to other types of memories. Here, we addressed this ongoing controversy in humans through three comprehensive experiments using the visuomotor adaptation paradigm (N=290, 150 females). In Experiment 1, we investigated the impact of sleep on memory retention when the temporal gap between training and sleep was not controlled. In line with the previous literature, we found that memory consolidates with the passage of time. In Experiment 2, we used an anterograde interference protocol to determine the time window during which SMA memory is most fragile and, thus, potentially most sensitive to sleep intervention. Our results show that memory is most vulnerable during the initial hour post-training. Building on this insight, in Experiment 3 we investigated the impact of sleep when it coincided with the critical first hour of memory stabilization. This manipulation unveiled a benefit of sleep (30% memory enhancement) alongside an increase in spindle density and spindle-SO coupling during NREM sleep, two well-established neural markers of sleep consolidation. Our findings reconcile seemingly conflicting perspectives on the active role of sleep in motor learning and point to common mechanisms at the basis of memory formation.Significance statement While there is compelling evidence that sleep improves declarative memory, its role in the consolidation of motor memories remains a long-standing debate. For example, it is currently established that sensorimotor adaptation (SMA) consolidates with the passage of time, irrespective of sleep. This has led to the proposal that SMA may be an exception to other types of memories. Our findings indicate that SMA memories may indeed consolidate with both the passage of time and sleep, depending on the proximity between training and bedtime. Our work sheds light on this controversy and points to the existence of common mechanisms supporting consolidation across memory domains. Furthermore, it may impact rehabilitation programs, expediting motor injury recovery by aligning training sessions with sleep.

Targeted Muscle Reinnervation for a Symptomatic Neuroma in a Traumatic Transmetatarsal Amputee: A Case Report.

An overall healthy 48-year-old man suffered a left foot mangled crush injury resulting in a post-transmetatarsal amputation and subsequently developing a painful neuroma on the plantar surface of the foot. To avoid the zone of injury, targeted muscle reinnervation was used to treat the neuroma by coapting the tibial nerve to the motor point of the flexor hallucis longus (FHL) muscle. At 1-year follow-up, the patient reported no pain at rest, returned to work, and could ambulate with an orthosis for 30 minutes. Rare tibial nerve coaptations to the FHL could serve as a treatment option for patients with neuromas in traumatic postmetatarsal amputation.

Using Physiological Markers to Assess Comfort during Neuromuscular Electrical Stimulation Induced Muscle Contraction in a Virtually Guided Environment: Pilot Study for a Path toward Combating ICU-Acquired Weakness.

We assessed the feasibility of implementing a virtually guided Neuromuscular Electrical Stimulation (NMES) protocol over the tibialis anterior (TA) muscle while collecting heart rate (HR), Numeric Pain Rating Scale (NPRS), and quality of contraction (QoC) data. We investigated if HR, NPRS, and QoC differ ON and OFF the TA motor point and explored potential relationships between heart rate variability (HRV) and the NPRS. Twelve healthy adults participated in this cross-sectional study. Three NMES trials were delivered ON and OFF the TA motor point. HR, QoC, and NPRS data were collected. There was no significant difference in HRV ON and OFF the motor point (p > 0.05). The NPRS was significantly greater OFF the motor point (p < 0.05). The QoC was significantly different between motor point configurations (p < 0.05). There was no correlation between the NPRS and HRV (p > 0.05, r = -0.129). We recommend non-electrical methods of measuring muscle activity for future studies. The NPRS and QoC can be administered virtually. Time-domain HRV measures could increase the validity of the protocol. The variables should be explored further virtually to enhance the protocol before eventual ICU studies.

In a porcine model of implantable pacemakers for pediatric unilateral diaphragm paralysis, the phrenic nerve is the best target

BackgroundA frequent complication of Fontan operations is unilateral diaphragmatic paresis, which leads to hemodynamic deterioration of the Fontan circulation. A potential new therapeutic option is the unilateral diaphragmatic pacemaker. In this study, we investigated the most effective stimulation location for a potential fully implantable system in a porcine model.MethodsFive pigs (20.8 ± 0.95 kg) underwent implantation of a customized cuff electrode placed around the right phrenic nerve. A bipolar myocardial pacing electrode was sutured adjacent to the motor point and peripherally at the costophrenic angle (peripheral diaphragmatic muscle). The electrodes were stimulated 30 times per minute with a pulse duration of 200 µs and a stimulation time of 300 ms. Current intensity was the only variable changed during the experiment.ResultsEffective stimulation occurred at 0.26 ± 0.024 mA at the phrenic nerve and 7 ± 1.22 mA at the motor point, a significant difference in amperage (p = 0.005). Even with a maximum stimulation of 10 mA at the peripheral diaphragm muscle, however, no effective stimulation was observed.ConclusionThe phrenic nerve seems to be the best location for direct stimulation by a unilateral thoracic diaphragm pacemaker in terms of the required amperage level in a porcine model.

Comparison of the activation level in the sensorimotor cortex between motor point and proximal nerve bundle electrical stimulation

Objective. Neuromuscular electrical stimulation (NMES) is widely used for motor function rehabilitation in stroke survivors. Compared with the conventional motor point (MP) stimulation, the stimulation at the proximal segment of the peripheral nerve (PN) bundles has been demonstrated to have multiple advantages. However, it is not known yet whether the PN stimulation can increase the cortical activation level, which is crucial for motor function rehabilitation. Approach. The current stimuli were delivered transcutaneously at the muscle belly of the finger flexors and the proximal segment of the median and ulnar nerves, respectively for the MP and PN stimulation. The stimulation intensity was determined to elicit the same contraction levels between the two stimulation methods in 18 healthy individuals and a stroke patient. The functional near-infrared spectroscopy and the electromyogram were recorded to compare the activation pattern of the sensorimotor regions and the target muscles. Main Results. For the healthy subjects, the PN stimulation induced significantly increased concentration of the oxygenated hemoglobin in the contralateral sensorimotor areas, and enhanced the functional connectivity between brain regions compared with the MP stimulation. Meanwhile, the compound action potentials had a smaller amplitude and the H-reflex became stronger under the PN stimulation, indicating that more sensory axons were activated in the PN stimulation. For the stroke patient, the PN stimulation can elicit finger forces and induce activation of both the contralateral and ipsilateral motor cortex. Conclusions. Compared with the MP stimulation, the PN stimulation can induce more cortical activation in the contralateral sensorimotor areas possibly via involving more activities in the central pathway. Significance. This study demonstrated the potential of the PN stimulation to facilitate functional recovery via increasing the cortical activation level, which may help to improve the outcome of the NMES-based rehabilitation for motor function recovery after stroke.

Multi-scale analysis of acupuncture mechanisms for motor and sensory cortex activity based on SEEG data.

Acupuncture, a traditional Chinese therapy, is gaining attention for its impact on the brain. While existing electroencephalogram and functional magnetic resonance image research has made significant contributions, this paper utilizes stereo-electroencephalography data for a comprehensive exploration of neurophysiological effects. Employing a multi-scale approach, channel-level analysis reveals notable $\delta $-band activity changes during acupuncture. At the brain region level, acupuncture modulated connectivity between the paracentral lobule and the precentral gyrus. Whole-brain analysis indicates acupuncture's influence on network organization, and enhancing $E_{glob}$ and increased interaction between the motor and sensory cortex. Brain functional reorganization is an important basis for functional recovery or compensation after central nervous system injury. The use of acupuncture to stimulate peripheral nerve trunks, muscle motor points, acupoints, etc., in clinical practice may contribute to the reorganization of brain function. This multi-scale perspective provides diverse insights into acupuncture's effects. Remarkably, this paper pioneers the introduction of stereo-electroencephalography data, advancing our understanding of acupuncture's mechanisms and potential therapeutic benefits in clinical settings.

Synergistic difference in the effect of stretching on electromechanical delay components.

This study investigated the synergistic difference in the effect of stretching on electromechanical delay (EMD) and its components, using a simultaneous recording of electromyographic, mechanomyographic, and force signals. Twenty-six healthy men underwent plantar flexors passive stretching. Before and after stretching, the electrochemical and mechanical components of the EMD and the relaxation EMD (R-EMD) were calculated in gastrocnemius medialis (GM), lateralis (GL) and soleus (SOL) during a supramaximal motor point stimulation. Additionally, joint passive stiffness was assessed. At baseline, the mechanical components of EMD and R-EMD were longer in GM and GL than SOL (Cohen's d from 1.78 to 3.67). Stretching decreased joint passive stiffness [-22(8)%, d = -1.96] while overall lengthened the electrochemical and mechanical EMD. The mechanical R-EMD components were affected more in GM [21(2)%] and GL [22(2)%] than SOL [12(1)%], with d ranging from 0.63 to 1.81. Negative correlations between joint passive stiffness with EMD and R-EMD mechanical components were found before and after stretching in all muscles (r from -0.477 to -0.926; P from 0.007 to <0.001). These results suggest that stretching plantar flexors affected GM and GL more than SOL. Future research should calculate EMD and R-EMD to further investigate the mechanical adaptations induced by passive stretching in synergistic muscles.

Anatomical Relations of the Perforators from the Descending Lateral Femoral Circumflex Artery and Vastus Lateralis Motor Nerve Branches.

The anterolateral thigh (ALT) flap, which is nourished by perforators from the descending branch of the lateral femoral circumflex artery (P), is one of the most commonly used flaps in soft tissue reconstruction. With the growing use of ALT flaps, attention toward donor-site morbidity has increased in recent years. Damage to the motor nerve branches of the vastus lateralis muscle (N) is one of the causes of donor-site morbidity, particularly muscle weakness. This study investigated the anatomical locations of the P and N in fresh-frozen cadaveric specimens. This study included 43 cadaver limbs. A silicone rubber compound (30 mL) was injected into the femoral artery to visualize the vessel. The locations of the P and motor points of N were measured to assess the risk of N injury during ALT flap harvesting. There were one to six (mean, 2.7) P and two to seven (mean, 4) N. When the two most proximal perforators were used for flap harvesting, an average of 1.5 motor nerve branches (42%) was damaged because transection of the motor nerve branches was required for flap harvesting. In 33% of the limbs, only one motor nerve branch remained after the flap harvest. However, there were no cases where all motor nerve branches were severed. When an ALT flap with two perforators is harvested, weakness of the vastus lateralis muscle may occur in cases with a small number of motor nerve branches.

Motor Point as an Alternative to Femoral Nerve Stimulation for the Assessment of Quadriceps Muscle Inhibition in Healthy Women.

The evaluation of quadriceps muscle inhibition with the interpolated twitch technique is usually performed by stimulating the femoral nerve (FN). However, there are some problems related to the use of this stimulation site, which may be partially overcome by delivering the stimulation over the motor point (MP). This study sought to compare MP to FN stimulation at different joint angles for the evaluation of quadriceps muscle inhibition, resting peak torque, and discomfort in healthy women. Cross-sectional study. Sixteen healthy women (age: 28 [4]y; body mass: 60 [5]kg; height: 162 [5]cm) participated in this study. Supramaximal paired stimuli were delivered to the FN and to the rectus femoris MP before and during maximal voluntary contractions at different knee angles (15°, 30°, 45°, 60°, and 90° of knee flexion) to assess muscle inhibition and resting peak torque. Discomfort was also recorded for each stimulation site and knee angle. Muscle inhibition was similar between the 2 stimulation sites (P > .05) and was higher at 45° than at 90° (P = .03). MP stimulation evoked lower resting peak torque at 30° (P = .004), 60° (P = .006), and 90° (P = .006) and higher discomfort at 30° (P = .008) and 90° (P = .027) compared to FN stimulation. Despite lower resting peak torque and higher discomfort at some angles, MP stimulation provided similar muscle inhibition to FN stimulation at all knee angles and is therefore a valid method to evaluate quadriceps muscle inhibition in healthy women. MP stimulation can be used as an alternative to FN stimulation for the evaluation of quadriceps muscle inhibition with no added discomfort at the angles where muscle inhibition is the highest.

Investigating the Effects of Dry Needling on Hamstring Muscles Flexibility: A Randomized Controlled Trial

Introduction: Flexibility or the ability of a muscle to increase in length is an integral part of musculoskeletal characteristics and is essential in preventing musculoskeletal injuries and increasing functional levels. Hamstring muscles rupture is a common injury. One of the important factors in the occurrence of this injury is poor hamstring muscle flexibility, which because of its stiffened structure, has less ability to quickly increase in length. Some researchers have recently suggested that the dry needling technique could reduce the number of treatment sessions for hamstring muscle tightness and bring faster and more effective results. Accordingly, this study aims to investigate the effect of the application of dry needling through an acupuncture technique on hamstring muscle flexibility.&#x0D; Materials and Methods: The present study is a single-blinded randomized controlled trial in which 16 individuals with bilateral hamstring muscle shortness were randomly allocated into dry-needling and sham-needling groups. The sampling method was non-probability convenience. The outcome measures were the right and left active knee extension range of motion, assessed before and after the first, third, and fifth sessions of intervention. A 2-factor mixed analysis of variance was applied to determine the differences between and within the two groups.&#x0D; Results: Except for the group main effect, time main effect and interaction effect were statistically significant for the right and left active knee extension range of motion (P&lt;0.001). There were differences in behavioral patterns in groups; accordingly, in the real dry-needling group, a significant difference was detected across times. However, in the sham dry-needling group, no significant difference was observed.&#x0D; Conclusion: The application of dry needling into motor points of hamstring muscles in individuals with bilateral hamstring muscles shortness could improve flexibility and increase the range of knee extension after 3 and 5 sessions of intervention because of the therapeutic effects of the dry needling technique in improving the muscle flexibility.

Comparing the effects of electrical stimulation of antagonist at motor point and the agonist at musculotendinous junction on spasticity of biceps muscle in chronic mca stroke patients. a pilot study

Comparing the effects of electrical stimulation of antagonist at motor point and the agonist at musculotendinous junction on spasticity of biceps muscle in chronic mca stroke patients. a pilot study

DESIGNING OF A CUSTOM DEVICE FOR INVESTIGATING THE MASTICATORY AND TEMPORAL MUSCLES IN PATIENTS EXPERIENCING TMJ DYSFUNCTION

Relevance: At present, electromyography (EMG) serves as the standard method for diagnosing the condition of masticatory muscles. This technique enables the evaluation of bioelectric potentials, including bioelectric rest, average biopotential amplitude, the duration of chewing cycle and the number of chewing movements performed. In dental practice, EMG is conducted using electromyographs with electrodes attached to the skin using adhesive or electrically conductive gel. However, this installation process is often time-consuming, and the mobility of the sensors can compromise result reliability. Furthermore, when performing multiple EMG studies on a patient during different stages of treatment, there is no guarantee that the motor point will be consistently selected, leading to inaccurate data and comparisons. The aim is to develop and implement a personalized device design for performing EMG on masticatory muscles, ensuring consistent repetition of the study in clinical practice. Materials and methods: Through a comprehensive analysis of scientific literature, information sources were utilized to develop and manufacture an EMG device. Results: The technical outcome achieved includes a simplified methodology, improved sensor fixation, reduced EMG duration, and the ability to replicate the study consistently at various stages of a patient's treatment. Conclusion: The developed device and EMG methodology offer a simplified approach to obtaining accurate study results with reduced time requirements. Additionally, if repetition of the study is necessary, the obtained data would be representative.

DEVELOPMENT OF A PERSONALIZED DEVICE FOR THE STUDY OF MASTICATORY AND TEMPORAL MUSCLES IN PATIENTS WITH THE TEMPOROMANDIBULAR JOINT DYSFUNCTION.

Relevance. Currently, the gold standard for diagnosing the condition of the masticatory muscles is electromyography (EMG).&#x0D; This method allows us to evaluate the bioelectric potentials of the muscles selected for diagnosis, bioelectric rest, the average amplitude of biopotentials, the time of one chewing cycle and the number of chewing movements performed.&#x0D; In dental practice, electromyographs are used, the electrodes of which are attached to the skin in various ways: with glue or an electrically conductive gel. Installation often takes a long time; due to the mobility of the sensors the reliability of the result is reduced. In addition, when conducting several studies of EMG in a patient at various stages of treatment, there is no certainty that the motor point will be selected in a similar place, which implies that the data obtained, and their comparison are inaccurate.&#x0D; The goal is to develop and apply in clinical practice the design of a personalized device for performing EMG of masticatory muscles with the possibility of representative repetition of the study.&#x0D; Materials and methods. The analysis of information sources of scientific literature made it possible to develop and produce a device for conducting EMG.&#x0D; Results. The technical result is simplification of the methodology, improved fixation of sensors and a reduction in the time of EMG, the ability to representatively repeat the study at various stages of a patient's treatment.&#x0D; Conclusion. The developed device and method of conducting EMG allows for a simplified way to obtain an accurate result of the study with a smaller amount of time spent. If it is necessary to repeat the study, the data obtained would be representative.

Localization of the gracilis muscle motor points - key considerations for botulinum neurotoxin injection and electrical stimulation.

Muscle motor points are considered the best sites for electrode positioning in electrical stimulation and, by some researchers, for botulinum neurotoxin injections. The aim of this study is to locate the motor points in the gracilis muscle to improve muscle function maintenance and treatment of spasticity. Ninety-three gracilis muscles (49 right, 44 left), fixed in 10% formalin solution, were subjected to the research. All nerve branches running towards the muscle were precisely traced to each motor point. Specific measurements were collected. The gracilis muscle presents multiple motor points (median of 12), all of which were localized on the deep (lateral) side of the muscle belly. Generally, motor points of this muscle were spread between 15% - 40% of the reference line length. Our findings may help clinicians identify appropriate locations for electrode placement during electrical stimulation of the gracilis muscle; they also deepen our understanding of the correlation between motor points and motor end plates and improve the application of botulinum neurotoxin injections.

Motor point heatmap guide for neuromuscular electrical stimulation of the quadriceps muscle

To create an anatomical chart that indicates the probability of finding a motor point (MP) in different areas of the quadriceps muscle. On 31 healthy adults, the individual anatomy of the vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL) was determined using ultrasound. Thereafter, a 3Hz neuromuscular electrical stimulation (NMES) MP-search with a MP-pen was performed. The thigh anatomy was normalized and divided into 112 (8x14) 3x3cm areas, and the probability of finding a MP in the different areas was calculated to create a MP heat-map. The heat-map displayed the two best 3x3cm areas, over VL and VM respectively, each with a probabilitygreater than50% of finding a MP and a higher probability compared to all other areas (p<.05). RF exhibited two areas with a 29% probability of finding a MP. A higher number of MPs on the quadriceps, mean (±SD) 9.4±1, was in regression analysis found to be significantly associated with two independent factors higher physical activity level and lower body fat (R2=0.42, p=<.0001). Large inter-individual variations in location, and number of MPs were found, but the heat-map displayed areas with higher probability of finding a MP and can be used to facilitate NMES-application.

Effects on hemodynamic enhancement and discomfort of a new textile electrode integrated in a sock during calf neuromuscular electrical stimulation

PurposeTo compare fixed transverse textile electrodes (TTE) knitted into a sock versus motor point placed standard gel electrodes (MPE) on peak venous velocity (PVV) and discomfort, during calf neuromuscular electrical stimulation (calf-NMES).MethodsTen healthy participants received calf-NMES with increasing intensity until plantar flexion (measurement level I = ML I), and an additional mean 4 mA intensity (ML II), utilizing TTE and MPE. PVV was measured with Doppler ultrasound in the popliteal and femoral veins at baseline, ML I and II. Discomfort was assessed with a numerical rating scale (NRS, 0–10). Significance was set to p < 0.05.ResultsTTE and MPE both induced significant increases in PVV from baseline to ML I and significantly higher increases to ML II, in both the popliteal and femoral veins (all p < 0.001). The popliteal increases of PVV from baseline to both ML I and II were significantly higher with TTE versus MPE (p < 0.05). The femoral increases of PVV from baseline to both ML I and II were not significantly different between TTE and MPE. TTE versus MPE resulted at ML I in higher mA and NRS (p < 0.001), and at ML II in higher mA (p = 0.005) while NRS was not significantly different.ConclusionTTE integrated in a sock produces intensity-dependent increases of popliteal and femoral hemodynamics comparable to MPE, but results in more discomfort at plantar flexion due to higher current required. TTE exhibits in the popliteal vein higher increases of PVV compared to MPE.Trial registrationTrial_ID: ISRCTN49260430. Date: 11/01/2022. Retrospectively registered.

Central cord syndrome definitions, variations and limitations.

Central cord syndrome (CCS) is the most common, yet most controversial, among the different spinal cord injury (SCI) incomplete syndromes. Since its original description in 1954, many variations have been described while maintaining the core characteristic of disproportionate weakness in the upper extremities compared to the lower extremities. Several definitions have been proposed in an attempt to quantify this difference, including a widely accepted criterion of ≥10 motor points in favor of the lower extremities. Nevertheless, recent reports have recommended revisiting the terminology and criteria of CCS as existing definitions do not capture the entire essence of the syndrome. Due to methodological differences, the full extent of CCS is not known, and a large variation in prevalence has been described. This review classifies the different definitions of CCS and describes some inherent limitations, highlighting the need for universal quantifiable criteria.