Rhythmic Arm Research Articles

Abstract 13000: Twiddler’s Syndrome - A Rare Cause of Pacemaker Malfunction

Description of Case: A 76-year-old female with a past medical history of chronic atrial fibrillation and symptomatic tachycardia and bradycardia status-post dual-chamber pacemaker with right atrial and ventricular leads who presented with dyspnea on exertion. TTE showed normal biventricular function and no significant valvular abnormalities. Upon further evaluation of her pacemaker, she was found to have a very high ventricular capture threshold suggesting RV lead failure. The patient underwent RV lead replacement. The inspection of the pacemaker pocket during the procedure showed manual dislodgement of both tie-down sleeves and the pacemaker leads required untangling. A new RV lead was subsequently placed. Upon further imaging review, displacement of the previous RV lead was evident from initial placement. In addition, the patient had previously had a history of interval diaphragmatic stimulation as well. Overall, the presentation was felt to be consistent with Twiddler’s Syndrome. Discussion: Twiddler’s or Reel Syndrome occurs when conscious or subconscious self-manipulation and spinning of the pulse generator result in lead dislodgement and loss of pacing and pacemaker malfunction. The reeling of the leads around the generator can also cause stimulation of the brachial plexus or phrenic nerve stimulation and subsequent rhythmic arm twitching or diaphragmatic pacing, respectively. It has previously been reported in cases of single- and dual-chamber ICDs, deep brain stimulators, and spinal nerve stimulators with varying presentation. The diagnosis requires clinical suspicion based on history, physical exam, imaging, or surgical inspection suggesting the displacement of leads with evidence of coiling of the wires around the pacemaker. Treatment often requires revision and focus should be maintained on patient education for both primary and secondary prevention of Twiddler’s Syndrome.

Longitudinal changes in infants' rhythmic arm movements during rattle-shaking play with mothers.

From early on, infants produce a variety of rhythmic behaviors-an ability that likely supports later social communication. However, it is unclear, how this rhythmic motor production changes with age. Here, we investigated the coupling between infants' arm movements across the first year of life in a social context of a rattle-shaking play with their mothers. Through longitudinal measurements at 4, 6, 9, and 12 months of age using wearable motion trackers placed on infants' arms, we show that infants (N = 40) are similarly motivated to attempt rattle-shaking across the first year of life. However, with age, they make more rattling movements with an increased frequency. Their left and right arm movements become more coupled during rattle-shaking, as shown by an increase in wavelet coherence. Infants produced more rattling movements when they were rattling alone than when their mothers were rattling or singing simultaneously. There were no differences between infants' individual and social rattling in between-arms coherence. Our results may help to understand rhythmic arm movements as precursors of motor social coordination.

Coupled and Synchronization Models of Rhythmic Arm Movement in Planar Plane.

Nonlinear dynamics have become a new perspective on model human movement variability; however, it is still a debate whether chaotic behavior is indeed possible to present during a rhythmic movement. This paper reports on the nonlinear dynamical behavior of coupled and synchronization models of a planar rhythmic arm movement. Two coupling schemes between a planar arm and an extended Duffing-Van der Pol (DVP) oscillator are investigated. Chaos tools, namely phase space, Poincare section, Lyapunov Exponent (LE), and heuristic approach are applied to observe the dynamical behavior of orbit solutions. For the synchronization, an orientation angle is modeled as a single well DVP oscillator implementing a Proportional Derivative (PD)-scheme. The extended DVP oscillator is used as a drive system, while the orientation angle of the planar arm is a response system. The results show that the coupled system exhibits very rich dynamical behavior where a variety of solutions from periodic, quasi-periodic, to chaotic orbits exist. An advanced coupling scheme is necessary to yield the route to chaos. By modeling the orientation angle as the single well DVP oscillator, which can synchronize with other dynamical systems, the synchronization can be achieved through the PD-scheme approach.

EMG-driven fatigue-based self-adapting admittance control of a hand rehabilitation robot

Upper-limb rehabilitation therapy sessions for post-stroke people generally contain rhythmic hand movements in a tiresome manner to rebuild the injured neural circuits. Fatigue formation causes breaks in the training and limits the therapy duration. Therefore, it is essential to establish a correlation between the patient’s muscle condition and the rehabilitation exercises to improve the physiotherapy sessions. A self-adapting control method based on online fatigue detection in rhythmic arm movements is presented. Experimental tests were performed on twenty healthy subjects to validate the method’s feasibility. Electromyography (EMG) and force signals considered the interfaces between users and the robot. In the first stage of the experiment, utilizing the frequency features from EMG signals, a neural network for fatigue detection trained; however, in the end, it substituted with a simple function as a refinement in the time-consuming aspect for the online employment. The initiation of the fatigue process is followed by reducing the admittance controller damping term based on the EMG signal processing. Trajectory tracking with the robot employs the self-adapting admittance controller (SAAC) method and the non-adapting admittance controller (NAAC). Movement accuracy and smoothness were measured and showed a better performance of the SAAC method related to the NAAC. Simulations with two different stiffness levels were performed on an upper-limb OpenSim model to study a stroke-injured arm and evaluate the proposed method’s proficiency. The metabolic cost indicated the movement’s superiority in a fatigue situation for reduced environment stiffness.

Distinct adaptation patterns between grip dynamics and arm kinematics when the body is upside-down.

In humans, practically all movements are learnt and performed in a constant gravitational field. Yet, studies on arm movements and object manipulation in parabolic flight have highlighted very fast sensorimotor adaptations to altered gravity environments. Here, we wondered if the motor adjustments observed in those altered gravity environments could also be observed on Earth in a situation where the body is upside-down. To address this question, we asked participants to perform rhythmic arm movements in two different body postures (right-side-up and upside-down) while holding an object in precision grip. Analyses of grip-load force coordination and of movement kinematics revealed distinct adaptation patterns between grip and arm control. Grip force and load force were tightly synchronized from the first movements performed in upside-down posture, reflecting a malleable allocentric grip control. In contrast, velocity profiles showed a more progressive adaptation to the upside-down posture and reflected an egocentric planning of arm kinematics. In addition to suggesting distinct mechanisms between grip dynamics and arm kinematics for adaptation to novel contexts, these results also suggest the existence of general mechanisms underlying gravity-dependent motor adaptation that can be used for fast sensorimotor coordination across different postures on Earth and, incidentally, across different gravitational conditions in parabolic flights, in human centrifuges, or in Space.NEW & NOTEWORTHY During rhythmic arm movements performed in an upside-down posture, grip control adapted very quickly, but kinematics adaptation was more progressive. Our results suggest that grip control and movement kinematics planning might operate in different reference frames. Moreover, by comparing our results with previous results from parabolic flight studies, we propose that a common mechanism underlies adaptation to unfamiliar body postures and adaptation to altered gravity.

Arm cycling increases the short-latency reflex from ankle dorsiflexor afferents to knee extensor muscles.

Low-intensity electrical stimulation of the common peroneal nerve (CPN) evokes a short latency reflex in the heteronymous knee extensor muscles (referred to as the CPN reflex). The CPN reflex is facilitated at a heel strike during walking, contributing to body weight support. However, the origin of the CPN reflex increase during walking remains unclear. We speculate that this increase originates from multiple sources due to a body of evidence suggesting the presence of neural coupling between the arms and legs. Therefore, we investigated the extent to which the CPN reflex is modulated during rhythmic arm cycling. Twenty-eight subjects sat in an armchair and were asked to perform arm cycling at a moderate cadence using a stationary ergometer while performing isometric contraction of the knee extensors, such that the CPN reflex was evoked. The CPN reflex was evoked by stimulating the CPN [0.9-2.0× the motor threshold (MT) in the tibialis anterior muscle] at the level of the neck of the fibula. The CPN-reflex amplitude was measured from the vastus lateralis (VL). The biphasic reflex response in the VL was evoked within 27-45 ms following CPN stimulation. The amplitude of the CPN reflex increased during arm cycling compared with that before cycling. The modulation of the CPN reflex during arm cycling was detected only for CPN stimulation intensity around 1.2× MT. Furthermore, CPN-reflex modulation was not observed during the isometric contraction of the arm or passive arm cycling. Our results suggest the presence of neural coupling between the CPN-reflex pathways and neural systems generating locomotive arm movement.NEW & NOTEWORTHY Whether locomotive arm movements contribute to the control of the reflex pathway from ankle dorsiflexor afferents to knee extensor muscles [common peroneal nerve (CPN)-reflex] is an unresolved issue. The CPN reflex in the stationary leg was facilitated only by arm cycling, and not by passive or isometric motor tasks. Our results suggest that the arm locomotor system modulates the reflex pathway from ankle dorsiflexor afferents to the knee extensor muscles.

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

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

Rhythmic movement and rhythmic auditory cues enhance anticipatory postural adjustment of gait initiation

The purpose of this study was to determine whether the rhythmic movements or cues enhance the anticipatory postural adjustment (APA) of gait initiation. Healthy humans initiated gait in response to an auditory start cue (third cue). A first auditory cue was given 8 s before the start cue, and a second auditory cue was given 3 s before the start cue. The participants performed the rhythmic medio-lateral weight shift (ML-WS session), rhythmic anterior-posterior weight shift (AP-WS session), or rhythmic arm swing (arm swing session) in the time between the first and second cues. In the rhythmic cues session, rhythmic auditory cues with a frequency of 1 Hz were given in this time. In the stationary session, the participants maintained stationary stance in this time. The APA and initial step movement preceded by those rhythmic movements or cues were compared with those in the stationary session. The temporal characteristics of the initial step movement of the gait initiation were not changed by the rhythmic movements or cues. The medio-lateral displacement of the APA in the ML-WS and arm swing sessions was significantly greater than that in the stationary session. The anterior–posterior displacement of the APA in the rhythmic cues and arm swing sessions was significantly greater than that in the stationary session. Taken together, the rhythmic movements and cues enhance the APA of gait initiation. The present finding may be a clue or motive for the future investigation for using rhythmic movements or cues as the preparatory activity to enlarge the small APA of gait initiation in the patients with Parkinson’s disease.

Changing coupling between the arms and legs with slow walking speeds alters regulation of somatosensory feedback

Arm swing movement is coordinated with movement of the legs during walking, where the frequency of coordination depends on walking speed. At typical speeds, arm and leg movements, respectively, are frequency locked in a 1:1 ratio but at slow speeds this changes to a 2:1 ratio. It is unknown if the changes in interlimb ratio that accompany slow walking speeds alters regulation of somatosensory feedback. To probe the neural interactions between the arms and legs, somatosensory linkages in the form of interlimb cutaneous reflexes were examined. It was hypothesized that different interlimb frequencies and walking speeds would result in changes in the modulation of cutaneous reflexes between the arms and legs. To test this hypothesis, participants walked in four combinations of walking speed (typical, slow) and interlimb coordination (1:1, and 2:1), while cutaneous reflexes and background muscle activity were evaluated with stimulation applied to the superficial peroneal nerve at the ankle and superficial radial nerve at the wrist. Results show main effects of interlimb coordination and walking speed on cutaneous reflex modulation, effects are largest in the swing phase, and a directional coupling was observed, where changes in the frequency of arm movements had a greater effect on muscle activity in the legs compared to the reverse. Task-dependent modulation was also revealed from stimulation at local and remote sources. Understanding the underlying neural mechanisms for the organization of rhythmic arm movement, and its coordination with the legs in healthy participants, can give insight into pathological walking, and will facilitate the development of effective strategies for the rehabilitation of walking.

Transcutaneous spinal cord stimulation of the cervical cord modulates lumbar networks.

It has been established that coordinated arm and leg (A&L) cycling facilitates corticospinal drive and modulation of cervico-lumbar connectivity and ultimately improves overground walking in people with incomplete spinal cord injury or stroke. This study examined the effect of noninvasive transcutaneous spinal cord stimulation (tSCS) on the modulation of cervico-lumbar connectivity. Thirteen neurologically intact adults participated in the study. The excitability of the Hoffmann (H) reflex elicited in the soleus muscle was examined under multiple conditions involving either the arms held in a static position or rhythmic arm cycling while tSCS was applied to either the cervical or lumbar cord. As expected, soleus H-reflex amplitude was significantly suppressed by 19.2% during arm cycling (without tSCS) relative to arms static (without tSCS). Interestingly, tSCS of the cervical cord with arms static significantly suppressed the soleus H-reflex (-22.9%), whereas tSCS over the lumbar cord did not suppress the soleus H-reflex (-3.8%). The combination of arm cycling with cervical or lumbar tSCS did not yield additional suppression of the soleus H-reflex beyond that obtained with arm cycling alone or cervical tSCS alone. The results demonstrate that activation of the cervical spinal cord through both rhythmic arm cycling and tonic tSCS significantly modulates the activity of lumbar networks. This highlights the potential for engaging cervical spinal cord networks through tSCS during rehabilitation interventions to enhance cervico-lumbar connectivity. This connectivity is influential in facilitating improvements in walking function after neurological impairment.NEW & NOTEWORTHY This is the first study to investigate the modulatory effects of transcutaneous spinal cord stimulation (tSCS) on cervico-lumbar connectivity. We report that both rhythmic activation of the cervical spinal cord through arm cycling and tonic activation of the cervical cord through tSCS significantly modulate the activity of lumbar networks. This suggests that engaging cervical spinal cord networks through tSCS during locomotor retraining interventions may not only enhance cervico-lumbar connectivity but also further improve walking capacity.

Prior physical synchrony enhances rapport and inter-brain synchronization during subsequent educational communication

Physical synchrony has been suggested to have positive effects on not only concurrent but also subsequent communication, but the underlying neural processes are unclear. Using functional near-infrared spectroscopy (fNIRS) hyperscanning, we tested the effects of preceding physical synchrony on subsequent dyadic teaching-learning communication. Thirty-two pairs of participants performed two experimental sessions. In each session, they underwent a rhythmic arm movement block with synchronous or asynchronous conditions, and then taught/learned unknown words to/from each other according to a given scenario. Neural activities in their medial and left lateral prefrontal cortex (PFC) were measured and inter-brain synchronization (IBS) during the teaching-learning blocks was evaluated. Participants rated their subjective rapport during the teaching-learning blocks, and took a word memory test. The analyses revealed that (1) prior physical synchrony enhanced teacher-learner rapport; (2) prior physical synchrony also enhanced IBS in the lateral PFC; and (3) IBS changes correlated positively with rapport changes. Physical synchrony did however not affect word memory performance. These results suggest that IBS can be useful to measure the effects of social-bonding facilitation activities for educational communication.

Complementary spatial and timing control in rhythmic arm movements.

Volitional rhythmic motor behaviors such as limb cycling and locomotion exhibit spatial and timing regularity. Such rhythmic movements are executed in the presence of exogenous visual and nonvisual cues, and previous studies have shown the pivotal role that vision plays in guiding spatial and temporal regulation. However, the influence of nonvisual information conveyed through auditory or touch sensory pathways, and its effect on control, remains poorly understood. To characterize the function of nonvisual feedback in rhythmic arm control, we designed a paddle juggling task in which volunteers bounced a ball off a rigid elastic surface to a target height in virtual reality by moving a physical handle with the right hand. Feedback was delivered at two key phases of movement: visual feedback at ball peaks only and simultaneous audio and haptic feedback at ball-paddle collisions. In contrast to previous work, we limited visual feedback to the minimum required for jugglers to assess spatial accuracy, and we independently perturbed the spatial dimensions and the timing of feedback. By separately perturbing this information, we evoked dissociable effects on spatial accuracy and timing, confirming that juggling, and potentially other rhythmic tasks, involves two complementary processes with distinct dynamics: spatial error correction and feedback timing synchronization. Moreover, we show evidence that audio and haptic feedback provide sufficient information for the brain to control the timing synchronization process by acting as a metronome-like cue that triggers hand movement. NEW & NOTEWORTHY Vision contains rich information for control of rhythmic arm movements; less is known, however, about the role of nonvisual feedback (touch and sound). Using a virtual ball bouncing task allowing independent real-time manipulation of spatial location and timing of cues, we show their dissociable roles in regulating motor behavior. We confirm that visual feedback is used to correct spatial error and provide new evidence that nonvisual event cues act to reset the timing of arm movements.

Synergistic influences of sensory and central stimuli on non-voluntary rhythmic arm movements

In recent years, neuromodulation of the cervical spinal circuitry has become an area of interest for investigating rhythmogenesis of the human spinal cord and interaction between cervical and lumbosacral circuitries, given the involvement of rhythmic arm muscle activity in many locomotor tasks. We have previously shown that arm muscle vibrostimulation can elicit non-voluntary upper limb oscillations in unloading body conditions. Here we investigated the excitability of the cervical spinal circuitry by applying different peripheral and central stimuli in healthy humans. The rationale for applying combined stimuli is that the efficiency of only one stimulus is generally limited. We found that low-intensity electrical stimulation of the superficial arm median nerve can evoke rhythmic arm movements. Furthermore, the movements were enhanced by additional peripheral stimuli (e.g., arm muscle vibration, head turns or passive rhythmic leg movements). Finally, low-frequency transcranial magnetic stimulation of the motor cortex significantly facilitated rhythmogenesis. The findings are discussed in the general framework of a brain-spinal interface for developing adaptive central pattern generator-modulating therapies.

Dexterous Manipulation During Rhythmic Arm Movements in Mars, Moon, and Micro-Gravity.

Predicting the consequences of one’s own movements can be challenging when confronted with completely novel environmental dynamics, such as microgravity in space. The absence of gravitational force disrupts internal models of the central nervous system (CNS) that have been tuned to the dynamics of a constant 1-g environment since birth. In the context of object manipulation, inadequate internal models produce prediction uncertainty evidenced by increases in the grip force (GF) safety margin that ensures a stable grip during unpredicted load perturbations. This margin decreases with practice in a novel environment. However, it is not clear how the CNS might react to a reduced, but non-zero, gravitational field, and if adaptation to reduced gravity might be beneficial for subsequent microgravity exposure. That is, we wondered if a transfer of learning can occur across various reduced-gravity environments. In this study, we investigated the kinematics and dynamics of vertical arm oscillations during parabolic flight maneuvers that simulate Mars gravity, Moon gravity, and microgravity, in that order. While the ratio of and the correlation between GF and load force (LF) evolved progressively with practice in Mars gravity, these parameters stabilized much quicker to subsequently presented Moon and microgravity conditions. These data suggest that prior short-term adaptation to one reduced-gravity field facilitates the CNS’s ability to update its internal model during exposure to other reduced gravity fields.

Effects of integrating rhythmic arm swing into robot-assisted walking in patients with subacute stroke: a randomized controlled pilot study.

This study aimed to identify the effects of rhythmic arm swing during robot-assisted walking training on balance, gait, motor function, and activities of daily living among patients with subacute stroke. Twenty patients with subacute stroke were recruited, and thereafter randomly allocated to either the experimental group that performed the robot-assisted walking training with rhythmic arm swing, or the control group that performed the training in arm fixation. In total, 30 training sessions were carried out. The outcome measures included the 10-m walk test, Berg balance scale, timed up-and-go test, fall index that was measured using the Tetrax system, motor function test of Fugl-Meyer assessment, and modified Barthel index. The patients of both groups showed significant improvement in all parameters after the intervention (P<0.05). The Berg balance scale, Fugl-Meyer assessment, and modified Barthel index scores at post-test appeared to be significantly higher for the experimental group than for the control group (P<0.05). These findings indicate that more favorable effects from robot-assisted walking training in patients with subacute stroke may be obtained by the use of rhythmic arm swing.

Waacking: A Shift from Gay Refusal to Gender Refusal

The medium of dance is most often valued in Western society for its artistry and great skill of movement. However, the beauty of this medium often overshadows its ability to create pointed, and often political, messages through the body’s kinesthetic movement in physical space. As embodied expression through time and space, dance must be understood as an art form that actively seeks to create meaning (Hellensleben 2010), a fact that is acutely evident in the dance form known as Waacking. Born out of improvisation-based techniques, Waacking originated in gay, Black and Latino underground disco clubs of 1970’s Los Angeles. The gestures of Waacking were inspired by classical Hollywood glamour actresses, culminating in the distinctive fast, rhythmic arm whipping typical of this dance style. Yet, it is the more performative elements of the dance that holds one’s interest by including components of large locomotion, dramatic gesture and facial expression, and a compelling narrative. This expressive style of movement resulted in Waacking becoming a catalyst for gay refusal, functioning as a method for gay men to express themselves and fully explore their identity. Through an analysis of personal experience and online videos in dialogue with the methodologies of embodiment, phenomenology, and performativity, I will explore how Waacking has shifted from a form of gay refusal to a form of gender refusal, allowing there to be a renegotiation of gender standards through the catalyst of black queer kinesthetics and gender kinesthetics.

Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation.

Training locomotor central pattern-generating networks (CPGs) through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5 wk of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Clinical function tests assessed walking, balance, and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion, and muscle activation. "Normalization" of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during the swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflex amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. NEW & NOTEWORTHY It has been suggested but not tested that training the arms may influence rehabilitation of walking due to activation of interneuronal patterning networks after stroke. We show that arm cycling training improves strength, clinical function, coordination of muscle activity during walking, and neurological connectivity between the arms and the legs. The arms can, in fact, give the legs a helping hand in rehabilitation of walking after stroke.

Modulation of corticospinal input to the legs by arm and leg cycling in people with incomplete spinal cord injury.

The spinal cervico-lumbar interaction during rhythmic movements in humans has recently been studied; however, the role of arm movements in modulating the corticospinal drive to the legs is not well understood. The goals of this study were to investigate the effect of active rhythmic arm movements on the corticospinal drive to the legs (study 1) and assess the effect of simultaneous arm and leg training on the corticospinal pathway after incomplete spinal cord injury (iSCI) (study 2). In study 1, neurologically intact (NI) participants or participants with iSCI performed combinations of stationary and rhythmic cycling of the arms and legs while motor evoked potentials (MEPs) were recorded from the vastus lateralis (VL) muscle. In the NI group, arm cycling alone could facilitate the VL MEP amplitude, suggesting that dynamic arm movements strongly modulate the corticospinal pathway to the legs. No significant difference in VL MEP between conditions was found in participants with iSCI. In study 2, participants with iSCI underwent 12 wk of electrical stimulation-assisted cycling training: one group performed simultaneous arm and leg (A&L) cycling and the other legs-only cycling. MEPs in the tibialis anterior (TA) muscle were compared before and after training. After training, only the A&L group had a significantly larger TA MEP, suggesting increased excitability in the corticospinal pathway. The findings demonstrate the importance of arm movements in modulating the corticospinal drive to the legs and suggest that active engagement of the arms in lower limb rehabilitation may produce better neural regulation and restoration of function.NEW & NOTEWORTHY This study aimed to demonstrate the importance of arm movements in modulating the corticospinal drive to the legs. It provides direct evidence in humans that active movement of the arms could facilitate corticospinal transmission to the legs and, for the first time, shows that facilitation is absent after spinal cord injury. Active engagement of the arms in lower limb rehabilitation increased the excitability of the corticospinal pathway and may produce more effective improvement in leg function.

Spontaneous bimanual independence during parallel tapping and sawing.

The performance of complex polyrhythms—rhythms where the left and right hand move at different rates—is usually the province of highly trained individuals. However, studies in which hand movement is guided haptically show that even novices can perform polyrhythms with no or only brief training. In this study, we investigated whether novices are able to tap with one hand by matching different rates of a metronome while sawing with the other hand. This experiment was based on the assumption that saw movement is controlled consistently at a predictable rate without the need for paying primary attention to it. It would follow that consciously matching different stipulated metronome rates with the other hand would result in the spontaneous performance of polyrhythms. Six experimental conditions were randomised: single handed tapping and sawing as well as four bimanual conditions with expected ratios of 1:1 (performed with and without matching a metronome) as well as 3:4 and 4:3 (performed matching a metronome). Results showed that participants executed the saw movement at a consistent cycle duration of 0.44 [0.20] s to 0.51 [0.19] s across single and bimanual conditions, with no significant effect of the condition on the cycle duration (p = 0.315). Similarly, free tapping was executed at a cycle duration of 0.48 [0.22] s. In the bimanual conditions, we found that for a ratio of 4:3 (4 taps against 3 sawing cycles per measure), the observed and predicted ratio of 0.75 were not significantly different (p = 0.369), supporting our hypothesis of the spontaneous adoption of polyrhythms. However, for a ratio of 3:4 (3 taps against 4 sawing cycles per measure), the observed and predicted ratio differed (p = 0.016), with a trend towards synchronisation. Our findings show that bimanual independence when performing complex polyrhythms can in principle be achieved if the movement of one hand can be performed without paying much—if any—attention to it. In this paradigm, small rhythmic arm movements are possibly driven by an intrinsic timing which leads to spontaneous convergence on a cycle duration of around 0.5 s, while the movement of the other hand can be controlled consciously to occur at desired rates.

Changes in Corticospinal and Spinal Excitability to the Biceps Brachii with a Neutral vs. Pronated Handgrip Position Differ between Arm Cycling and Tonic Elbow Flexion.

The purpose of this study was to examine the influence of neutral and pronated handgrip positions on corticospinal excitability to the biceps brachii during arm cycling. Corticospinal and spinal excitability were assessed using motor evoked potentials (MEPs) elicited via transcranial magnetic stimulation (TMS) and cervicomedullary-evoked potentials (CMEPs) elicited via transmastoid electrical stimulation (TMES), respectively. Participants were seated upright in front on arm cycle ergometer. Responses were recorded from the biceps brachii at two different crank positions (6 and 12 o’clock positions relative to a clock face) while arm cycling with neutral and pronated handgrip positions. Responses were also elicited during tonic elbow flexion to compare/contrast the results to a non-rhythmic motor output. MEP and CMEP amplitudes were significantly larger at the 6 o’clock position while arm cycling with a neutral handgrip position compared to pronated (45.6 and 29.9%, respectively). There were no differences in MEP and CMEP amplitudes at the 12 o’clock position for either handgrip position. For the tonic contractions, MEPs were significantly larger with a neutral vs. pronated handgrip position (32.6% greater) while there were no difference in CMEPs. Corticospinal excitability was higher with a neutral handgrip position for both arm cycling and tonic elbow flexion. While spinal excitability was also higher with a neutral handgrip position during arm cycling, no difference was observed during tonic elbow flexion. These findings suggest that not only is corticospinal excitability to the biceps brachii modulated at both the supraspinal and spinal level, but that it is influenced differently between rhythmic arm cycling and tonic elbow flexion.