Transient motor evoked potential suppression following a complex sensorimotor task.

OBJECTIVE: To investigate the mechanism involved in the transient suppression of the response to transcranial magnetic stimulation (TMS) following repeated performance of a complex sensorimotor training task (ST). METHODS: A total of 19 healthy subjects participated in 4 experiments, all involving performance of the grooved pegboard test (GPT). The experiments investigated the effect of the ST on corticospinal and intracortical excitability, spinal excitability and maximal pinch grip force. RESULTS: Motor evoked potential amplitude decreased significantly following the ST in both muscles tested and this was associated, but not correlated, with a decrease in the time taken to perform the GPT. There was no change in intracortical inhibition or facilitation (tested at interstimulus intervals of 3 and 10 ms, respectively). M wave amplitude was unchanged, as were F wave amplitude, latency and persistence and there was no evidence of muscle fatigue. CONCLUSIONS: The reduction in corticospinal excitability was short lasting (<10 min) and was not accompanied by changes at the spinal or peripheral level, suggesting that other intracortical circuits may be involved. SIGNIFICANCE: Repeated performance of motor tasks can result in both short- and long-term modulation of motor cortical excitability. However, the relationship between changes in corticospinal excitability and motor performance is complex and critically dependent upon task type and duration.

Best practice for arm recovery post stroke: an international application.

OBJECTIVE: To develop an evidence-based application ('app') for post-stroke upper extremity rehabilitation that can be used globally by therapists. PARTICIPANTS: Twenty-three experienced neurorehabilitation therapists, applied scientists and physicians, and 10 consultants dedicated to the provision of best practice to stroke survivors. DESIGN: This team evaluated the evidence to support the timely and appropriate provision of interventions and the most defensible outcome measures during a 4-year voluntary information gathering and assimilation effort, as a basis for the sequencing of an algorithm informed by the data and directed by changes in impairment and chronicity. OUTCOME MEASURES: The primary outcome was the formulation of a testable app that will be available for minimal user cost. The app is for a smartphone, and the comments of a focus group (audience at a World Confederation for Physical Therapy 2015 presentation, approximate n=175) during a 30-minute 'Questions and Answers' session were assessed. RESULTS: Analysis of documented, extensive input offered by the audience indicated a highly favourable disposition towards this novel tool, with provision of concrete suggestions prior to launching the final version. Suggestions centred on: inclusion of instructions; visuals and demonstrations; monitoring of adverse responses; availability of updates; autonomous use by patients; and potential to characterise practice. CONCLUSIONS: A simple, user-friendly app for decision making in the treatment of upper extremity impairments following stroke is feasible and welcomed.

Afferent stimulation facilitates performance on a novel motor task.

Training on a motor task results in performance improvements that are accompanied by increases in motor cortex excitability. Moreover, periods of afferent stimulation result in increased motor cortex excitability. There is increasing evidence to suggest that raised motor cortical excitability may facilitate movement and learning. Here we examined whether a period of electrical stimulation of hand afferents ("associative stimulation"), known to increase motor cortex excitability, facilitated the performance of a complex sensorimotor task. Three groups of nine normal subjects participated in these studies. All subjects were trained on the grooved pegboard test (GPT). Training consisted of three blocks, each of five trials, of placing pegs as quickly as possible. The time to complete each block was recorded. One group of subjects had a 1-h period of associative stimulation prior to training on the GPT. A second group received non-associative stimulation (which does not change cortical excitability) of the same hand afferents while a third group received no stimulation prior to training. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseous (FDI) and abductor digiti minimus (ADM) muscles both prior to and following stimulation and performance of the GPT. In contrast to non-associative stimulation, associative stimulation increased motor cortical excitability, as evidenced by an increase in the amplitude of MEPs evoked in the FDI, one of the stimulated muscles, but not the ADM. Training on the GPT resulted in significant improvements in the time taken to complete the task for all three groups. However, in subjects who had preconditioning associative stimulation, performance on the GPT improved more rapidly. Additionally, there was a strong trend for the improvement in the performance of the stimulated group to be greater than that of the control group. The results of the present study suggest that increased motor cortical excitability, induced by associative stimulation, may facilitate the performance of a novel complex sensorimotor task.