Development, explanation, and presentation of the Physical Literacy Interventions Reporting Template (PLIRT).

BACKGROUND: The physical literacy (PL) concept integrates different personal (e.g., physical, cognitive, psychological/affective, social) determinants of physical activity and has received growing attention recently. Although practical efforts increasingly adopt PL as a guiding concept, latest evidence has shown that PL interventions often lack specification of important theoretical foundations and basic delivery information. Therefore, the goal of the present study was to develop an expert-based template that supports researchers and practitioners in planning and reporting PL interventions. METHODS: The development process was informed by Moher et al.'s guidance for the development of research reporting guidelines. We composed a group of ten distinguished experts on PL. In two face-to-face meetings, the group first discussed a literature-driven draft of reporting items. In the second stage, the experts anonymously voted and commented on the items in two rounds (each leading to revisions) until consensus was reached. RESULTS: The panel recommended that stakeholders of PL initiatives should tightly interlock interventional aspects with PL theory while ensuring consistency throughout all stages of intervention development. The Physical Literacy Interventions Reporting Template (PLIRT) encompasses a total of 14 items (two additional items for mixed-methods studies) in six different sections: title (one item), background and definition (three items), assessment (one item each for quantitative and qualitative studies), design and content (five items), evaluation (one item plus one item each for quantitative and qualitative studies), discussion and conclusion (two items). CONCLUSION: The PLIRT was designed to facilitate improved transparency and interpretability in reports on PL interventions. The template has the potential to close gaps between theory and practice, thereby contributing to more holistic interventions for the fields of physical education, sport, and health.

Development of the Perceived Physical Literacy Questionnaire (PPLQ) for the adult population.

Background/objective: In physical literacy (PL) research, instruments for the adult population covering all relevant domians are currently lacking in German language. Therefore, the Perceived Physical Literacy Questionnaire (PPLQ) was developed as an assessment instrument of PL for the adult population. The purpose of this study is to describe the multistage development process leading to the aim to evaluate the psychometric properties of the PPLQ. Methods: Based on established questionnaires (subscales) operationalizing the six defined PL domains (motivation, confidence, physical competence, knowledge, understanding, and physical activity behavior), we generated a large item pool. Exploratory analyses on survey data (n = 506), compelemented through an expert panel, served to identify the best fitting items. Cognitive interviews (n = 7) and a language certification process (level A2) helped to enhance the content validity of the items. Finally, we assessed the hypothesized factor structure of the PPLQ and its convergent validity with the Physical Activity-related Health Competence (PAHCO) questionnaire in a second independent sample. Results: Valid data of 417 adults (66% women, 48 ± 16 years) entered the confirmatory factor analysis. We found empirical support for a theory-compatible 24-item version, after reducing complexity (i.e., domain subscales). Additionally, the six domains could be subsumed under an overall factor for PL (χ2247 = 450.70, χ2/df = 1.83, CFIRobust = 0.895, RMSEARobust = 0.074 [CI90 = 0.063-0.085], SRMR = 0.064). Factor loadings, composite reliability, and discriminant validity were sufficient, while acceptable convergent validity was achieved for the total PL score and three domains. Conclusion: The 24-item version of the PPLQ is appropriate for assessing PL among adults. However, some items (especially in the knowledge domain) can benefit from refinement in further studies.

Physical literacy in Europe: The current state of implementation in research, practice, and policy.

Background/objective: The holistic concept of physical literacy (PL) embraces different person-centered qualities (physical, cognitive, affective/psychological) necessary to lead physically active lifestyles. PL has recently gained increasing attention globally and Europe is no exception. However, scientific endeavors summarizing the current state of PL in Europe are lacking. Therefore, the goal of this study was to comprehensively assess and compare the implementation of PL in research, policy, and practice across the continent. Methods: We assembled a panel of experts representing 25 European countries. Employing a complementary mixed-methods design, the experts first prepared reviews about the current state of PL in their countries (categories: research, practice/policy). The reviews underwent comparative document analysis, ensuring a transnational four-eyes principle. For re-validation purposes, the representatives completed a quantitative survey with questions reflecting the inductive themes from the document analysis. Results: The document analysis resulted in ten disjunct themes (related to "concept", "research", "practice/policy", "future/prospect") and yielded a heterogenous PL situation in Europe. The implementation state was strongly linked to conceptual discussions (e.g., existence of competing approaches), linguistic issues (e.g., translations), and country-specific traditions. Despite growing scholarly attention, PL hesitantly permeates practice and policy in most countries. Nevertheless, the experts largely anticipate increasing popularity of PL for the future. Conclusion: Despite the heterogeneous situation across Europe, the analysis has uncovered similarities among the countries, such as the presence of established yet not identical concepts. Research should intensify academic activities (conceptual-linguistic elaborations, empirical work) before PL may gain further access into practical and political spheres in the long term.

Reduction in insulin degludec dosing for multiple exercise sessions improves time spent in euglycaemia in people with type 1 diabetes: A randomized crossover trial.

AIMS: To compare the time spent in specified glycaemic ranges in people with type 1 diabetes (T1D) during 5 consecutive days of moderate-intensity exercise while on either 100% or 75% of their usual insulin degludec (IDeg) dose. MATERIALS AND METHODS: Nine participants with T1D (four women, mean age 32.1 ± 9.0 years, body mass index 25.5 ± 3.8 kg/m2 , glycated haemoglobin 55 ± 7 mmol/mol (7.2% ± 0.6%) on IDeg were enrolled in the trial. Three days before the first exercise period, participants were randomized to either 100% or 75% of their usual IDeg dose. Participants exercised on a cycle ergometer for 55 minutes at a moderate intensity for 5 consecutive days. After a 4-week wash-out period, participants performed the last exercise period for 5 consecutive days with the alternate IDeg dose. Time spent in specified glycaemic ranges, area under the curve and numbers of hypoglycaemic events were compared for the 5 days on each treatment allocation using a paired Students' t test, Wilcoxon matched-pairs signed-rank test and two-way ANOVA. RESULTS: Time spent in euglycaemia over 5 days was greater for the 75% IDeg dose versus the 100% IDeg dose (4008 ± 938 minutes vs. 3566 ± 856 minutes; P = 0.04). Numbers of hypoglycaemic events (P = 0.91) and time spent in hypoglycaemia (P = 0.07) or hyperglycaemia (P = 0.38) was similar for both dosing schemes. CONCLUSIONS: A 25% reduction in usual IDeg dose around regular exercise led to more time spent in euglycaemia, with small effects on time spent in hypo- and hyperglycaemia.

Holistic physical exercise training improves physical literacy among physically inactive adults: a pilot intervention study.

BACKGROUND: Physical literacy (PL), given as a multidimensional construct, is considered a person's capacity and commitment to a physically active lifestyle. We investigated the effect of a holistic physical exercise training on PL among physically inactive adults. METHODS: A non-randomised controlled study was conducted. Thirty-one physically inactive adults in the intervention group (IG; 81% females, 44 ± 16 years) participated in a holistic physical exercise training intervention once weekly for 15 weeks. A matched, non-exercising control group (CG) consisted of 30 physically inactive adults (80% female, 45 ± 11 years). PL, compliance and sociodemographic parameters were measured. PL was evaluated by a questionnaire, covering five domains: physical activity behaviour, attitude towards a physically active lifestyle, exercise motivation, knowledge and self-confidence/self-efficacy. Data were analysed using ANCOVA models, adjusted for age, gender and BMI at baseline. RESULTS: At post-training intervention, the IG showed significant improvements in PL (p = 0.001) and in the domains physical activity behaviour (p = 0.02) and exercise self-confidence/self-efficacy (p = 0.001), with no changes overserved for the CG regarding PL and those domains. No intervention effect were found for the other three domains, i.e. attitude, knowledge and motivation. Additionally, for the IG baseline BMI was identified to be positively correlated with physical exercise-induced improvements in PL (ß = 0.51, p = 0.01). CONCLUSIONS: The results from this study are very useful for further public health activities, which aim at helping physically inactive adults to adopt a physically active lifestyle as well as for the development of further PL intervention strategies. This pilot-study was a first attempt to measure PL in inactive adults. Yet, a validated measurement tool is still not available. Further research is necessary to determine the psychometric properties for this PL questionnaire. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00013991 , date of registration: 09.02.2018, retrospectively registered.

Subjective memory impairment and cholinergic transmission: a TMS study.

Subjective memory impairment (SMI) is being increasingly recognized as a preclinical phase of Alzheimer disease (AD). Short latency afferent inhibition (SAI) is helpful in demonstrating dysfunction of central cholinergic circuits, and was reported to be abnormal in patients with AD and amnestic multiple domain mild cognitive impairment. In this study, we found normal SAI in 20 subjects with SMI. SAI could be a useful biomarker for identifying, among individuals with memory complaints, those in whom cholinergic degeneration has occurred.

Serotonergic transmission after spinal cord injury.

Changes in descending serotonergic innervation of spinal neural activity have been implicated in symptoms of paralysis, spasticity, sensory disturbances and pain following spinal cord injury (SCI). Serotonergic neurons possess an enhanced ability to regenerate or sprout after many types of injury, including SCI. Current research suggests that serotonine (5-HT) release within the ventral horn of the spinal cord plays a critical role in motor function, and activation of 5-HT receptors mediates locomotor control. 5-HT originating from the brain stem inhibits sensory afferent transmission and associated spinal reflexes; by abolishing 5-HT innervation SCI leads to a disinhibition of sensory transmission. 5-HT denervation supersensitivity is one of the key mechanisms underlying the increased motoneuron excitability that occurs after SCI, and this hyperexcitability has been demonstrated to underlie the pathogenesis of spasticity after SCI. Moreover, emerging evidence implicates serotonergic descending facilitatory pathways from the brainstem to the spinal cord in the maintenance of pathologic pain. There are functional relevant connections between the descending serotonergic system from the rostral ventromedial medulla in the brainstem, the 5-HT receptors in the spinal dorsal horn, and the descending pain facilitation after tissue and nerve injury. This narrative review focussed on the most important studies that have investigated the above-mentioned effects of impaired 5-HT-transmission in humans after SCI. We also briefly discussed the promising therapeutical approaches with serotonergic drugs, monoclonal antibodies and intraspinal cell transplantation.

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: a review.

CONTEXT: Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain. OBJECTIVE: To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy. METHODS: A MEDLINE search was performed using following terms: "Spinal cord injury", "Neuropathic pain", "Brain stimulation", "Deep brain stimulation" (DBS), "Motor cortex stimulation" (MCS), "Transcranial magnetic stimulation" (TMS), "Transcranial direct current stimulation" (tDCS), "Cranial electrotherapy stimulation" (CES). RESULTS: Invasive neurostimulation therapies, in particular DBS and epidural MCS, have shown promise as treatments for neuropathic and phantom limb pain. However, the long-term efficacy of DBS is low, while MCS has a relatively higher potential with lesser complications that DBS. Among the non-invasive techniques, there is accumulating evidence that repetitive TMS can produce analgesic effects in healthy subjects undergoing laboratory-induced pain and in chronic pain conditions of various etiologies, at least partially and transiently. Another very safe technique of non-invasive brain stimulation - tDCS - applied over the sensory-motor cortex has been reported to decrease pain sensation and increase pain threshold in healthy subjects. CES has also proved to be effective in managing some types of pain, including neuropathic pain in subjects with SCI. CONCLUSION: A number of studies have begun to use non-invasive neuromodulatory techniques therapeutically to relieve neuropathic pain and phantom phenomena in patients with SCI. However, further studies are warranted to corroborate the early findings and confirm different targets and stimulation paradigms. The utility of these protocols in combination with pharmacological approaches should also be explored.

Pelvic limb kinematics and surface electromyography of the vastus lateralis, biceps femoris, and gluteus medius muscle in dogs with hip osteoarthritis.

OBJECTIVE: To measure the activity patterns of the vastus lateralis (VL), biceps femoris, and gluteus medius (GM) muscle at a walk in sound dogs and dogs with hip osteoarthritis (OA). ANIMALS: Dogs (n = 10) with hip OA and 7 clinically sound dogs. METHODS: Self-reflective markers and a high-speed camera system were used for kinematic measurements and surface electrodes were used for the electromyography (EMG). All measurements were performed on walking dogs. Maximal, minimal, and mean values of the joint angles were evaluated, together with the surface EMG data. RESULTS: In all muscles investigated, mean activity was significantly decreased during the early swing phase in dogs with hip OA. The VL and GM muscle of the clinically worse pelvic limb had significantly higher activity than the contralateral pelvic limb during early stance. CONCLUSION: The muscles investigated were significantly affected by hip OA. This finding suggests that there is a more distinct resting phase of the muscles during swing and a higher activity during early stance.

National train-the-trainer certificate programme for improving healthcare communication in Austria.

OBJECTIVES: In Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals. METHODS: The programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated. RESULTS: 18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants' satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified. CONCLUSIONS: This programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST. PRACTICE IMPLICATIONS: Implementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.

Primary Care and Physical Literacy: A Non-Randomized Controlled Pilot Study to Combat the High Prevalence of Physically Inactive Adults in Austria.

The multidimensional concept of physical literacy is fundamental for lifelong physical activity engagement. However, physical literacy-based interventions are in their infancy, especially among adults. Therefore, the purpose of this pilot study was to assess the association of a physical literacy-based intervention with changes in self-reported physical literacy among inactive adults. A non-randomized controlled study (2 × 2 design) was conducted, comparing pre- vs. postintervention. Twenty-eight inactive healthy participants in the intervention group (89% female, 53 ± 10 years) entered a physical literacy-based intervention once weekly for 14 weeks. The non-treated control group consisted of 22 inactive adults (96% female, 50 ± 11 years). Physical literacy was evaluated with a questionnaire encompassing five domains: physical activity behavior, attitude/understanding, motivation, knowledge, and self-efficacy/confidence. ANOVA models were applied to evaluate changes by time and condition. Following the intervention, significant improvements were seen for overall physical literacy and in four out of five physical literacy domains, including physical activity behavior, attitude/understanding, knowledge, and self-efficacy/confidence (all p < 0.01, Cohen's d = 0.38-0.83). No changes by time x condition were found for motivation. The physical literacy-based intervention applied in this study may be a promising approach to help inactive adults to adopt an active lifestyle.

Kinematic motion analysis of the joints of the forelimbs and hind limbs of dogs during walking exercise regimens.

OBJECTIVE: To assess forelimbs and hind limb joint kinematics in dogs during walking on an inclined slope (uphill), on a declined slope (downhill), or over low obstacles (cavaletti) on a horizontal surface and compare findings with data acquired during unimpeded walking on a horizontal surface. ANIMALS: 8 nonlame dogs (mean +/- SD age, 3.4 +/- 2.0 years; weight, 23.6 +/- 4.6 kg). PROCEDURES: By use of 10 high-speed cameras and 10 reflecting markers located on the left forelimbs and hind limbs, joint kinematics were recorded for each dog during uphill walking, downhill walking, and walking over low obstacles or unimpeded on a horizontal surface. Each exercise was recorded 6 times (10 s/cycle); joint angulations, angle velocities and accelerations, and range of motion for shoulder, elbow, carpal, hip, stifle, and tarsal joints were calculated for comparison. RESULTS: Compared with unimpeded walking, obstacle exercise significantly increased flexion of the elbow, carpal, stifle, and tarsal joints and extension in the carpal and stifle joints. Only uphill walking caused increased hip joint flexion and decreased stifle joint flexion; downhill walking caused less flexion of the hip joint. During obstacle exercise, forward angle velocities in the elbow and stifle joints and retrograde velocity in the tarsal joint changed significantly, compared with unimpeded walking. Joint angle acceleration of the elbow joint changed significantly during all 3 evaluated exercises. CONCLUSIONS AND CLINICAL RELEVANCE: These evidence-based data indicated that each evaluated exercise, except for downhill walking, has a specific therapeutic value in physical therapy for dogs.

Efficacy of adding ramipril (VAsotop) to the combination of furosemide (Lasix) and pimobendan (VEtmedin) in dogs with mitral valve degeneration: The VALVE trial.

BACKGROUND: Triple therapy (TT) consisting of furosemide, pimobendan, and an angiotensin-converting enzyme inhibitor (ACEI) frequently is recommended for the treatment of congestive heart failure (CHF) attributable to myxomatous mitral valve disease (MMVD). However, the effect of adding an ACEI to the combination of pimobendan and furosemide (dual therapy [DT]) so far has not been evaluated prospectively. HYPOTHESIS: Triple therapy will extend survival time compared to DT in dogs with CHF secondary to MMVD. ANIMALS: Client-owned dogs presented with the first episode of CHF caused by MMVD. METHODS: Prospective, single-blinded, randomized multicenter study. One-hundred and fifty-eight dogs were recruited and prospectively randomized to receive either DT (furosemide and pimobendan) or TT (furosemide, pimobendan, and ramipril). The primary endpoint was a composite of cardiac death, euthanasia for heart failure, or treatment failure. RESULTS: Seventy-seven dogs were randomized to receive DT and 79 to receive TT. Two dogs were excluded from analysis. The primary endpoint was reached by 136 dogs (87%; 66 dogs, DT; 70 dogs, TT). Median time to reach the primary endpoint for all dogs in the study was 214 days (95% confidence interval [CI], 168-259 days). Median time to reach the primary endpoint was not significantly different between the DT group (227 days; interquartile range [IQR], 103-636 days) compared with TT group (186 days; IQR, 72-453 days; P = .42). CONCLUSIONS AND CLINICAL IMPORTANCE: Addition of the ACEI ramipril to pimobendan and furosemide did not have any beneficial effect on survival time in dogs with CHF secondary to MMVD.

MEEGIPS-A Modular EEG Investigation and Processing System for Visual and Automated Detection of High Frequency Oscillations.

High frequency oscillations (HFOs) are electroencephalographic correlates of brain activity detectable in a frequency range above 80 Hz. They co-occur with physiological processes such as saccades, movement execution, and memory formation, but are also related to pathological processes in patients with epilepsy. Localization of the seizure onset zone, and, more specifically, of the to-be resected area in patients with refractory epilepsy seems to be supported by the detection of HFOs. The visual identification of HFOs is very time consuming with approximately 8 h for 10 min and 20 channels. Therefore, automated detection of HFOs is highly warranted. So far, no software for visual marking or automated detection of HFOs meets the needs of everyday clinical practice and research. In the context of the currently available tools and for the purpose of related local HFO study activities we aimed at converging the advantages of clinical and experimental systems by designing and developing a comprehensive and extensible software framework for HFO analysis that, on the one hand, focuses on the requirements of clinical application and, on the other hand, facilitates the integration of experimental code and algorithms. The development project included the definition of use cases, specification of requirements, software design, implementation, and integration. The work comprised the engineering of component-specific requirements, component design, as well as component- and integration-tests. A functional and tested software package is the deliverable of this activity. The project MEEGIPS, a Modular EEG Investigation and Processing System for visual and automated detection of HFOs, introduces a highly user friendly software that includes five of the most prominent automated detection algorithms. Future evaluation of these, as well as implementation of further algorithms is facilitated by the modular software architecture.

High-Frequency Oscillations in the Scalp Electroencephalogram: Mission Impossible without Computational Intelligence.

High-frequency oscillations (HFOs) in the electroencephalogram (EEG) are thought to be a promising marker for epileptogenicity. A number of automated detection algorithms have been developed for reliable analysis of invasively recorded HFOs. However, invasive recordings are not widely applicable since they bear risks and costs, and the harm of the surgical intervention of implantation needs to be weighted against the informational benefits of the invasive examination. In contrast, scalp EEG is widely available at low costs and does not bear any risks. However, the detection of HFOs on the scalp represents a challenge that was taken on so far mostly via visual detection. Visual detection of HFOs is, in turn, highly time-consuming and subjective. In this review, we discuss that automated detection algorithms for detection of HFOs on the scalp are highly warranted because the available algorithms were all developed for invasively recorded EEG and do not perform satisfactorily in scalp EEG because of the low signal-to-noise ratio and numerous artefacts as well as physiological activity that obscures the tiny phenomena in the high-frequency range.

HD-EEG Based Classification of Motor-Imagery Related Activity in Patients With Spinal Cord Injury.

Brain computer interfaces (BCIs) are thought to revolutionize rehabilitation after SCI, e.g., by controlling neuroprostheses, exoskeletons, functional electrical stimulation, or a combination of these components. However, most BCI research was performed in healthy volunteers and it is unknown whether these results can be translated to patients with spinal cord injury because of neuroplasticity. We sought to examine whether high-density EEG (HD-EEG) could improve the performance of motor-imagery classification in patients with SCI. We recorded HD-EEG with 256 channels in 22 healthy controls and 7 patients with 14 recordings (4 patients had more than one recording) in an event related design. Participants were instructed acoustically to either imagine, execute, or observe foot and hand movements, or to rest. We calculated Fast Fourier Transform (FFT) and full frequency directed transfer function (ffDTF) for each condition and classified conditions pairwise with support vector machines when using only 2 channels over the sensorimotor area, full 10-20 montage, high-density montage of the sensorimotor cortex, and full HD-montage. Classification accuracies were comparable between patients and controls, with an advantage for controls for classifications that involved the foot movement condition. Full montages led to better results for both groups (p < 0.001), and classification accuracies were higher for FFT than for ffDTF (p < 0.001), for which the feature vector might be too long. However, full-montage 10-20 montage was comparable to high-density configurations. Motor-imagery driven control of neuroprostheses or BCI systems may perform as well in patients as in healthy volunteers with adequate technical configuration. We suggest the use of a whole-head montage and analysis of a broad frequency range.

High Amplitude EEG Motor Potential during Repetitive Foot Movement: Possible Use and Challenges for Futuristic BCIs That Restore Mobility after Spinal Cord Injury.

Recent advances in neuroprostheses provide us with promising ideas of how to improve the quality of life in people suffering from impaired motor functioning of upper and lower limbs. Especially for patients after spinal cord injury (SCI), futuristic devices that are controlled by thought via brain-computer interfaces (BCIs) might be of tremendous help in managing daily tasks and restoring at least some mobility. However, there are certain problems arising when trying to implement BCI technology especially in such a heterogenous patient group. A plethora of processes occurring after the injuries change the brain's structure as well as its functionality collectively referred to as neuroplasticity. These changes are very different between individuals, leading to an increasing interest to reveal the exact changes occurring after SCI. In this study we investigated event-related potentials (ERPs) derived from electroencephalography (EEG) signals recorded during the (attempted) execution and imagination of hand and foot movements in healthy subjects and patients with SCI. As ERPs and especially early components are of interest for BCI research we aimed to investigate differences between 22 healthy volunteers and 7 patients (mean age = 51.86, SD = 15.49) suffering from traumatic or non-traumatic SCI since 2-314 months (mean = 116,57, SD = 125,55). We aimed to explore differences in ERP responses as well as the general presence of component that might be of interest to further consider for incorporation into BCI research. In order to match the real-life situation of BCIs for controlling neuroprostheses, we worked on small trial numbers (<25), only. We obtained a focal potential over Pz in ten healthy participants but in none of the patients after lenient artifact rejection. The potential was characterized by a high amplitude, it correlated with the repeated movements (6 times in 6 s) and in nine subjects it significantly differed from a resting condition. Furthermore, there are strong arguments against possible confounding factors leading to the potential's appearance. This phenomenon, occurring when movements are repeatedly conducted, might represent a possible potential to be used in futuristic BCIs and further studies should try to investigate the replicability of its appearance.

Effects of intermittent theta burst stimulation on spasticity after spinal cord injury.

PURPOSE: Spasticity is a common disorder in patients with spinal cord injury (SCI). The aim of this study was to investigate whether intermittent theta burst stimulation (iTBS), a safe, non-invasive and well-tolerated protocol of excitatory repetitive transcranial magnetic stimulation (rTMS), is effective in modulating spasticity in SCI patients. METHODS: In this randomized, double-blind, crossover, sham-controlled study, ten subjects with incomplete cervical or thoracic SCI received 10 days of daily sessions of real or sham iTBS. The H/M amplitude ratio of the Soleus H reflex, the amplitude of the motor evoked potentials (MEPs) at rest and during background contraction, as well as Modified Ashworth Scale (MAS) and the Spinal Cord Injury Assessment Tool for Spasticity (SCAT) were compared before and after the stimulation protocols. RESULTS: Patients receiving real iTBS showed significant increased resting and active MEPs amplitude and a significant reduction of the H/M amplitude ratio. In these patients also the MAS and SCAT scores were significantly reduced after treatment. These changes persisted up to 1 week after the end of the iTBS treatment, and were not observed under the sham-TBS condition. CONCLUSION: These findings suggest that iTBS may be a promising therapeutic tool for the spasticity in SCI patients.

Imagine There Is No Plegia. Mental Motor Imagery Difficulties in Patients with Traumatic Spinal Cord Injury.

In rehabilitation of patients with spinal cord injury (SCI), imagination of movement is a candidate tool to promote long-term recovery or to control futuristic neuroprostheses. However, little is known about the ability of patients with spinal cord injury to perform this task. It is likely that without the ability to effectively perform the movement, the imagination of movement is also problematic. We therefore examined, whether patients with SCI experience increased difficulties in motor imagery (MI) compared to healthy controls. We examined 7 male patients with traumatic spinal cord injury (aged 23-70 years, median 53) and 20 healthy controls (aged 21-54 years, median 30). All patients had incomplete SCI, with AIS (ASIA Impairment Scale) grades of C or D. All had cervical lesions, except one who had a thoracic injury level. Duration after injury ranged from 3 to 314 months. We performed the Movement Imagery Questionnaire Revised as well as the Beck Depression Inventory in all participants. The self-assessed ability of patients to visually imagine movements ranged from 7 to 36 (Md = 30) and tended to be decreased in comparison to healthy controls (ranged 16-49, Md = 42.5; W = 326.5, p = 0.055). Also, the self-assessed ability of patients to kinesthetically imagine movements (range = 7-35, Md = 31) differed significantly from the control group (range = 23-49, Md = 41; W = 337.5, p = 0.0047). Two patients yielded tendencies for depressive mood and they also reported most problems with movement imagination. Statistical analysis however did not confirm a general relationship between depressive mood and increased difficulty in MI across both groups. Patients with spinal cord injury seem to experience difficulties in imagining movements compared to healthy controls. This result might not only have implications for training and rehabilitation programs, but also for applications like brain-computer interfaces used to control neuroprostheses, which are often based on the brain signals exhibited during the imagination of movements.

Factors Affecting Volume Changes of the Somatosensory Cortex in Patients with Spinal Cord Injury: To Be Considered for Future Neuroprosthetic Design.

Spinal cord injury (SCI) leads to severe chronic disability, but also to secondary adaptive changes upstream to the injury in the brain which are most likely induced due to the lack of afferent information. These neuroplastic changes are a potential target for innovative therapies such as neuroprostheses, e.g., by stimulation in order to evoke sensation or in order to suppress phantom limb pain. Diverging results on gray matter atrophy have been reported in patients with SCI. Detectability of atrophy seems to depend on the selection of the regions of interest, while whole-brain approaches are not sensitive enough. In this study, we discussed previous research approaches and analyzed differential atrophic changes in incomplete SCI using manual segmentation of the somatosensory cortex. Patients with incomplete SCI (ASIA C-D), with cervical (N = 5) and thoracic (N = 6) injury were included. Time since injury was ≤12 months in 7 patients, and 144, 152, 216, and 312 months in the other patients. Age at the injury was ≤26 years in 4 patients and ≥50 years in 7 patients. A sample of 12 healthy controls was included in the study. In contrast to all previous studies that used voxel-based morphometry, we performed manual segmentation of the somatosensory cortex in the postcentral gyrus from structural magnetic resonance images and normalized the calculated volumes against the sum of volumes of an automated whole-head segmentation. Volumes were smaller in patients than in controls (p = 0.011), and as a tendency, female patients had smaller volumes than male patients (p = 0.017, uncorrected). No effects of duration (subacute vs. chronic), level of lesion (cervical vs. thoracic), region (left vs. right S1), and age at onset (≤26 vs. ≥50 years) was found. Our results demonstrate volume loss of S1 in incomplete SCI and encourage further research with larger sample sizes on volumetric changes in the acute and chronic stage of SCI, in order to document the moderating effect of type and location of injury on neuroplastic changes. A better understanding of neuroplastic changes in the sensorimotor cortex after SCI and its interaction with sex is needed in order to develop efficient rehabilitative interventions and neuroprosthetic technologies.