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Absence of a Transcranial Magnetic Stimulation-Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors.

ABSTRACT: Background and Purpose- Transcranial magnetic stimulation is used to measure the functional integrity of the corticomotor system via motor evoked potentials (MEPs) in stroke. The association between corticomotor mechanisms and walking recovery is still not completely understood. This study determined the association between transcranial magnetic stimulation-induced MEPs and walking outcomes and examined the contribution of the contralesional hemisphere to walking recovery. Methods- Contralateral and ipsilateral transcranial magnetic stimulation responses from the contralesional and ipsilesional hemispheres were collected from 61 chronic stroke survivors. Clinical assessments included gait speeds, 6-minute walk distance, Timed Up and Go test, Fugl Meyer lower extremity scale, and strength measurements. Results- Stroke participants were classified based on the presence (MEP+ [n=28]) or absence (MEP- [n=33]) of MEPs in the paretic tibialis anterior and rectus femoris muscles. A between-group analyses showed no significant differences for any gait variable. MEP+ group showed significantly higher Fugl Meyer lower extremity and ankle dorsiflexor strength. Ipsilateral conductivity was not significantly different between groups. Finally, in the MEP+ group, MEP parameters did not predict gait recovery. Conclusions- Our study investigated the association between walking outcomes and neurophysiological parameters of lower limb function in a large cohort of stroke survivors. We did not find an associations between transcranial magnetic stimulation-induced tibialis anterior and rectus femoris MEPs and walking speeds. Further work is required to develop more comprehensive models in stroke for predicting walking recovery.

SUBMITTER: Sivaramakrishnan A

PROVIDER: S-EPMC6245657 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Absence of a Transcranial Magnetic Stimulation-Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors.

Sivaramakrishnan Anjali A Madhavan Sangeetha S

Stroke 20180801 8

Background and Purpose- Transcranial magnetic stimulation is used to measure the functional integrity of the corticomotor system via motor evoked potentials (MEPs) in stroke. The association between corticomotor mechanisms and walking recovery is still not completely understood. This study determined the association between transcranial magnetic stimulation-induced MEPs and walking outcomes and examined the contribution of the contralesional hemisphere to walking recovery. Methods- Contralateral ...[more]

PMID: 29986928

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Project description:The neural constraints underlying hemiparetic gait dysfunction are associated with abnormal kinetic outflow and altered muscle synergy structure. Recent evidence from our lab implicates the lesioned hemisphere in mediating the expression of abnormally coupled hip adduction and knee extension synergy, suggesting a role of cortical networks in the regulation of lower limb motor outflow poststroke. The potential contribution of contralesional hemisphere (CON-H) in regulating paretic leg kinetics is unknown. The purpose of this study is to characterize the effect of CON-H activation on aberrant across-joint kinetic coupling of the ipsilateral lower-extremity muscles poststroke.Amplitude-matched adductor longus motor-evoked potentials were elicited using single pulse transcranial magnetic stimulation (TMS) of the lesioned (L-H) and CON-Hs during an isometric adductor torque matching task from 11 stroke participants. For 10 control participants, TMS of the contralateral and ipsilateral hemisphere were given during the same task. TMS-induced torques were characterized at the hip and knee joints to determine the differential regulation of abnormal kinetic synergies by each motor cortices. The TMS-induced ratio of knee extension/hip adduction torques was quantified during 40 and 20% of maximum adduction torque.For both the 40 and 20% target adduction tasks, we find that contralesional stimulation significantly reduced but did not eliminate the TMS-induced ratio of knee extension/hip adduction torques for the stroke group (p = 0.0468, p = 0.0396). In contrast, the controls did not present a significantly different TMS-evoked torque following stimulation (p = 0.923) of the hemisphere ipsilateral to the test leg.The reduced expression of abnormal across-joint kinetic coupling suggests that the CON-H may contribute an adaptive role in lower limb control poststroke. Future study of neuromodulation paradigms that leverage adaptive CON-H activation may yield clinically relevant gains in lower limb motor function poststroke.

Project description:BackgroundNormative foot kinematic and kinetic data with different walking speeds will benefit rehabilitation programs and improving gait performance. The purpose of this study was to analyze foot kinematics and kinetics differences between slow walking (SW), normal walking (NW) and fast walking (FW) of healthy subjects.MethodsA total of 10 healthy male subjects participated in this study; they were asked to carry out walks at a self-selected speed. After measuring and averaging the results of NW, the subjects were asked to perform a 25% slower and 25% faster walk, respectively. Temporal-spatial parameters, kinematics of the tibia (TB), hindfoot (HF), forefoot (FF) and hallux (HX), and ground reaction forces (GRFs) were recorded while the subjects walked at averaged speeds of 1.01 m/s (SW), 1.34 m/s (NW), and 1.68 m/s (FW).ResultsHindfoot relative to tibia (HF/TB) and forefoot relative to hindfoot (FF/HF) dorsiflexion (DF) increased in FW, while hallux relative to forefoot (HX/FF) DF decreased. Increased peak eversion (EV) and peak external rotation (ER) in HF/TB were observed in FW with decreased peak supination (SP) in FF/HF. GRFs were increased significantly with walking speed. The peak values of the knee and ankle moments in the sagittal and frontal planes significantly increased during FW compared with SW and NW.DiscussionLimited HF/TB and FF/HF motion of SW was likely compensated for increased HX/FF DF. Although small angle variation in HF/TB EV and FF/HF SP during FW may have profound effects for foot kinetics. Higher HF/TB ER contributed to the FF push-off the ground while the center of mass (COM) progresses forward in FW, therefore accompanied by higher FF/HF abduction in FW. Increased peak vertical GRF in FW may affected by decreased stance duration time, the biomechanical mechanism maybe the change in vertical COM height and increase leg stiffness. Walking speed changes accompanied with modulated sagittal plane ankle moments to alter the braking GRF during loading response. The findings of foot kinematics, GRFs, and lower limb joint moments among healthy males may set a reference to distinguish abnormal and pathological gait patterns.

Project description:Lower-limb intersegmental coordination is a complex component of human walking. Aging may result in impairments of motor control and coordination contributing to the decline in mobility inducing loss of autonomy. Investigating intersegmental coordination could therefore provide insights into age-related changes in neuromuscular control of gait. However, it is unknown whether the age-related declines in gait performance relates to intersegmental coordination. The aim of this study was to evaluate the impact of aging on the coordination of lower limb kinematics and kinetics during walking at a conformable speed. We then assessed the body kinematics and kinetics from gait analyses of 84 volunteers from 25 to 85 years old when walking was performed at their self-selected speeds. Principal Component Analysis (PCA) was used to assess lower-limb intersegmental coordination and to evaluate the planar covariation of the Shank-Thigh and Foot-Shank segments. Ankle and knee stiffness were also estimated. Age-related effects on planar covariation parameters was evaluated using multiple linear regressions (i.e., without a priori age group determination) adjusted to normalized self-selected gait velocity. Colinearity between parameters was assessed using a variation inflation factor (VIF) and those with a VIF < 5 were entered in the analysis. Normalized gait velocity significantly decreased with aging (r = -0.24; P = 0.028). Planar covariation of inter-segmental coordination was consistent across age (99.3 ± 0.24% of explained variance of PCA). Significant relationships were found between age and intersegmental foot-shank coordination, range of motion of the ankle, maximal power of the knee, and the ankle. Lower-limb coordination was modified with age, particularly the coordination between foot, and shank. Such modifications may influence the ankle motion and thus, ankle power. This observation may explain the decrease in the ankle plantar flexor strength mainly reported in the literature. We therefore hypothesize that this modification of coordination constitutes a neuromuscular adaptation of gait control accompanying a loss of ankle strength and amplitude by increasing the knee power in order to maintain gait efficiency. We propose that foot-shank coordination might represent a valid outcome measure to estimate the efficacy of rehabilitative strategies and to evaluate their efficiency in restoring lower-limb synergies during walking.

Project description:IntroductionTranscranial magnetic stimulation (TMS) is widely used to investigate central nervous system mechanisms underlying motor control. Despite thousands of TMS studies on neurophysiological underpinnings of corticomotor control, a large majority of studies have focused on distal muscles, and little is known about axial muscles (e.g., low back muscles). Yet, differences between corticomotor control of low back and distal muscles (e.g., gross vs. fine motor control) suggest differences in the neural circuits involved. This systematic review of the literature aims at detailing the organisation and neural circuitry underlying corticomotor control of low back muscles tested with TMS in healthy humans.MethodsThe literature search was performed in four databases (CINAHL, Embase, Medline (Ovid) and Web of science) up to May 2022. Included studies had to use TMS in combination with EMG recording of paraspinal muscles (between T12 and L5) in healthy participants. Weighted average was used to synthesise quantitative study results.ResultsForty-four articles met the selection criteria. TMS studies of low back muscles provided consistent evidence of contralateral and ipsilateral motor evoked potentials (with longer ipsilateral latencies) as well as of short intracortical inhibition/facilitation. However, few or no studies using other paired pulse protocols were found (e.g., long intracortical inhibition, interhemispheric inhibition). In addition, no study explored the interaction between different cortical areas using dual TMS coil protocol (e.g., between primary motor cortex and supplementary motor area).DiscussionCorticomotor control of low back muscles are distinct from hand muscles. Our main findings suggest: (i) bilateral projections from each single primary motor cortex, for which contralateral and ipsilateral tracts are probably of different nature (contra: monosynaptic; ipsi: oligo/polysynaptic) and (ii) the presence of intracortical inhibitory and excitatory circuits in M1 influencing the excitability of the contralateral corticospinal cells projecting to low back muscles. Understanding of these mechanisms are important for improving the understanding of neuromuscular function of low back muscles and to improve the management of clinical populations (e.g., low back pain, stroke).

Dataset Information

Absence of a Transcranial Magnetic Stimulation-Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors.

Publications

Absence of a Transcranial Magnetic Stimulation-Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors.

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