Context-dependent reduction in corticomuscular coupling for balance control in chronic stroke survivors.

Balance control is an important indicator of mobility and independence in activities of daily living. How the functional coupling between the cortex and the muscle for balance control is affected following stroke remains to be known. We investigated the changes in coupling between the cortex and leg muscles during a challenging balance task over multiple frequency bands in chronic stroke survivors. Fourteen participants with stroke and ten healthy controls performed a challenging balance task. They stood on a computerized support surface that was either fixed (low difficulty condition) or sway-referenced with varying gain (medium and high difficulty conditions). We computed corticomuscular coherence between electrodes placed over the sensorimotor area (electroencephalography) and leg muscles (electromyography) and assessed balance performance using clinical and laboratory-based tests. We found significantly lower delta frequency band coherence in stroke participants when compared with healthy controls under medium difficulty condition, but not during low and high difficulty conditions. These differences were found for most of the distal but not for proximal leg muscle groups. No differences were found at other frequency bands. Participants with stroke showed poor balance clinical scores when compared with healthy controls, but no differences were found for laboratory-based tests. The observation of effects at distal but not at proximal muscle groups suggests differences in the (re)organization of the descending connections across two muscle groups for balance control. We argue that the observed group difference in delta band coherence indicates balance context-dependent alteration in mechanisms for the detection of somatosensory modulation resulting from sway-referencing of the support surface for balance maintenance following stroke.

The Bead Maze Hand Function Test for Children.

IMPORTANCE: There is a need for a pediatric hand function test that can be used to objectively assess movement quality. We have developed a toy-based test, the Bead Maze Hand Function (BMHF) test, to quantify how well a child performs an activity. This is achieved by assessing the control of forces applied while drawing a bead over wires of different complexity. OBJECTIVE: To study the psychometric properties of the BMHF test and understand the influence of age and task complexity on test measures. DESIGN: A cross-sectional, observational study performed in a single visit. SETTING: Clinical research laboratory. PARTICIPANTS: Twenty-three participants (ages 4-15 yr) were recruited locally. They were typically developing children with no illness or conditions that affected their movement. Interventions/Assessments: Participants performed the BMHF test and the Box and Block test with both hands. OUTCOMES AND MEASURES: Total force and completion time were examined according to age and task complexity using a linear mixed-effects model. We calculated intraclass correlation coefficients to measure interrater reliability of the method and estimated concurrent validity using the Box and Block test. RESULTS: Total force and completion time decreased with age and depended on task complexity. The total force was more sensitive to task complexity. The Box and Block score was associated with BMHF completion time but not with total force. We found excellent interrater reliability. CONCLUSIONS AND RELEVANCE: A familiar toy equipped with hidden sensors provides a sensitive tool to assess a child's typical hand function. Plain-Language Summary: We developed the Bead Maze Hand Function (BMHF) test to determine how well a child performs an activity with their hands. The BMHF test is a toy equipped with hidden sensors. Twenty-three typically developing children with no illnesses or conditions that affected their hand movement participated in the study. We asked the children to perform the BMHF test with both hands. Our study found that occupational therapists can reliably use the BMHF test to assess a child's hand function.

Evaluation of a Radiation Oncology Microclerkship as a Component of Medical Student Education.

Compared to most oncologic subspecialties, radiation oncology (RO) lacks a natural pathway for incorporation into the clinical clerkships, and few students ever complete a formal rotation in RO. The feasibility, and perceived value, of a 1-day "microclerkship" exposure in RO during other related clerkships was evaluated in this study. At a single institution, the RO clerkship director partnered with clerkship directors in medical oncology, palliative care, and radiology so that every 3rd or 4th year student would spend 1 day in RO during those clerkships. Afterwards, students completed an electronic survey containing multiple choice and 5-point Likert-type questions describing their experience. Descriptive statistics are reported. Ninety-seven students completed the RO microclerkship over 2 years, and 81 completed the survey (response rate 84%). Only 8 students (10%) had ever been in a RO department previously. During the microclerkship, 73 students (90%) saw at least one new patient consultation; 77 (95%) were involved in contouring or treatment planning; 76 (94%) saw treatment delivery; and 38 (47%) saw a brachytherapy procedure. Seventy-nine students (98%) felt that the microclerkship was at least moderately valuable (mean Likert-type rating 4.01, SD 0.73). Forty students (49%) were either somewhat or much more interested in participating in a longer (2-4 week) rotation in radiation oncology (mean Likert-type rating 3.59, SD 0.83). This study demonstrated the feasibility of incorporating a 1-day RO microclerkship into other related elective clerkships. Students viewed the experience favorably and found it valuable in their education.

Dexterous Object Manipulation Requires Context-Dependent Sensorimotor Cortical Interactions in Humans.

Dexterous object manipulation is a hallmark of human evolution and a critical skill for everyday activities. A previous work has used a grasping context that predominantly elicits memory-based control of digit forces by constraining where the object should be grasped. For this "constrained" grasping context, the primary motor cortex (M1) is involved in storage and retrieval of digit forces used in previous manipulations. In contrast, when choice of digit contact points is allowed ("unconstrained" grasping), behavioral studies revealed that forces are adjusted, on a trial-to-trial basis, as a function of digit position. This suggests a role of online feedback of digit position for force control. However, despite the ubiquitous nature of unconstrained hand-object interactions in activities of daily living, the underlying neural mechanisms are unknown. Using noninvasive brain stimulation, we found the role of primary motor cortex (M1) and somatosensory cortex (S1) to be sensitive to grasping context. In constrained grasping, M1 but not S1 is involved in storing and retrieving learned digit forces and position. In contrast, in unconstrained grasping, M1 and S1 are involved in modulating digit forces to position. Our findings suggest that the relative contribution of memory and online feedback modulates sensorimotor cortical interactions for dexterous manipulation.

Clinical impact of a pharmacist + health coach chronic disease management program in a rural free clinic.

OBJECTIVES: Recent data have demonstrated benefits of pharmacist-led protocols for chronic disease state management in the primary care setting. Health coaching has also been shown to improve patient outcomes and reduce health care costs. A program was initiated in August 2017 at a rural, free clinic to provide team-based, patient-centered care management through the use of pharmacist-provider collaborative practice and health coaching for patients with chronic diseases such as diabetes, hypertension, and hyperlipidemia. METHODS: After an initial patient examination, physicians could refer patients for management by the pharmacist + health coach team. Patients continued to see their primary care provider at least yearly and as needed. The pharmacist + health coach team provided a protocol-based approach to chronic disease management, as well as health education pertaining to diet and lifestyle recommendations. In-depth medication and disease state education were provided at each visit. Motivational interviewing was also conducted at each visit. Clinical metrics were collected at baseline and analyzed routinely after program initiation, including glycosylated hemoglobin (A1c), blood pressure, and lipids. Primary objectives were to evaluate the program's impact on A1c, blood pressure, and cholesterol outcomes. RESULTS: A total of 95 patients were included in the analysis (A1c n = 37; systolic and diastolic blood pressure n = 47; total cholesterol n = 40; low-density lipoprotein [LDL] cholesterol n = 38; high-density lipoprotein cholesterol n = 40; and triglycerides n = 40). From baseline to 1 year, statistically significant improvements were observed for A1c (mean ± standard deviation, 8.55 ± 2.58 to 7.04 ± 1.12, P < 0.001), systolic blood pressure (136.79 ± 20.04 to 123.15 ± 16.81, P < 0.001), diastolic blood pressure (87.94 ± 12.28 to 78.64 ± 10.98, P < 0.001), total cholesterol (198.25 ± 52.47 to 183.55 ± 47.22, P = 0.014), and LDL cholesterol (115.74 ± 43.56 to 105.92 ± 39.27, P = 0.040). CONCLUSION: A protocol-driven collaborative practice approach to chronic disease management by a clinical pharmacist in conjunction with health coaching by a registered nurse in a low-income, rural, primary care setting improved A1c, blood pressure, total cholesterol, and LDL cholesterol.

Sensorimotor uncertainty modulates corticospinal excitability during skilled object manipulation.

Sensorimotor memory built through previous hand-object interactions allows subjects to plan grasp forces. The memory-based mechanism is particularly effective when contact points on the object do not change across multiple manipulations, thus allowing subjects to generate the same forces in a feedforward fashion. However, allowing subjects to choose where to grasp an object causes trial-to-trial variability in fingertip positioning, suggesting a decreased ability to predict where the object will be grasped. In this scenario, subjects modulate forces on a trial-to-trial basis as a function of fingertip positioning. We suggested that this fingertip force-to-position modulation could be implemented by transforming feedback of digit placement into an accurate distribution of fingertip forces. Thus, decreasing certainty of fingertip position on an object would cause a shift from predominantly memory- to feedback-based force control mechanisms. To gain further insight into these sensorimotor transformation mechanisms, we asked subjects to grasp and lift an object with an asymmetrical center of mass while preventing it from tilting. To isolate the effect of digit placement uncertainty, we designed two experimental conditions that differed in terms of predictability of fingertip position but had similar average fingertip positioning and force distribution. We measured corticospinal excitability to probe possible changes in sensorimotor processing associated with digit placement uncertainty. We found a differential effect of sensorimotor uncertainty after but not before object contact. Our results suggest that sensorimotor integration is rapidly tuned after object contact based on different processing demands for memory versus feedback mechanisms underlying the control of manipulative forces. NEW & NOTEWORTHY The relative contribution of predictive and feedback mechanisms for scaling digit forces to position during dexterous manipulation depends on the predictability of where the object will be grasped. We found that corticospinal excitability shortly after contact was sensitive to digit position predictability. This supports the proposition that distinct sensorimotor integration processes are engaged, depending on the role of feedback about digit placement versus sensorimotor memory in controlling manipulative forces.

Effects of speed and direction of perturbation on electroencephalographic and balance responses.

The modulation of perturbation-evoked potential (PEP) N1 as a function of different biomechanical characteristics of perturbation has been investigated before. However, it remains unknown whether the PEP N1 modulation contributes to the shaping of the functional postural response. To improve this understanding, we examined the modulation of functional postural response in relation to the PEP N1 response in ten healthy young subjects during unpredictable perturbations to their upright stance-translations of the support surface in a forward or backward direction at two different amplitudes of constant speed. Using independent components from the fronto-central region, obtained from subject-specific head models created from the MRI, our results show that the latency of onset of the functional postural response after the PEP N1 response was faster for forward than backward perturbations at a constant speed but was not affected by the speed of perturbation. Further, our results reinforce some of the previous findings that suggested that the N1 peak amplitude and peak latency are both modulated by the speed of perturbation but not by the direction of the perturbation. Our results improve the understanding of the relation between characteristics of perturbation and the neurophysiology of reactive balance control and may have implications for the design of brain-machine interfaces for populations with a higher risk of falls.

Role of human premotor dorsal region in learning a conditional visuomotor task.

Conditional learning is an important component of our everyday activities (e.g., handling a phone or sorting work files) and requires identification of the arbitrary stimulus, accurate selection of the motor response, monitoring of the response, and storing in memory of the stimulus-response association for future recall. Learning this type of conditional visuomotor task appears to engage the premotor dorsal region (PMd). However, the extent to which PMd might be involved in specific or all processes of conditional learning is not well understood. Using transcranial magnetic stimulation (TMS), we demonstrate the role of human PMd in specific stages of learning of a novel conditional visuomotor task that required subjects to identify object center of mass using a color cue and to apply appropriate torque on the object at lift onset to minimize tilt. TMS over PMd, but not vertex, increased error in torque exerted on the object during the learning trials. Analyses of digit position and forces further revealed that the slowing in conditional visuomotor learning resulted from impaired monitoring of the object orientation during lift, rather than stimulus identification, thus compromising the ability to accurately reduce performance error across trials. Importantly, TMS over PMd did not alter production of torque based on the recall of learned color-torque associations. We conclude that the role of PMd for conditional learning is highly sensitive to the stage of learning visuomotor associations. NEW & NOTEWORTHY: Conditional learning involves stimulus identification, motor response selection, response monitoring, memory encoding, and recall of the learned association. Premotor dorsal (PMd) has been implicated for conditional learning. However, the extent to which PMd might be involved in specific or all stages of conditional learning is not well understood. The novel finding of our study is that PMd appears to be involved with monitoring motor responses, a sensorimotor integration stage essential for conditional learning.

Corticospinal excitability underlying digit force planning for grasping in humans.

Control of digit forces for grasping relies on sensorimotor memory gained from prior experience with the same or similar objects and on online sensory feedback. However, little is known about neural mechanisms underlying digit force planning. We addressed this question by quantifying the temporal evolution of corticospinal excitability (CSE) using single-pulse transcranial magnetic stimulation (TMS) during two reach-to-grasp tasks. These tasks differed in terms of the magnitude of force exerted on the same points on the object to isolate digit force planning from reach and grasp planning. We also addressed the role of intracortical circuitry within primary motor cortex (M1) by quantifying the balance between short intracortical inhibition and facilitation using paired-pulse TMS on the same tasks. Eighteen right-handed subjects were visually cued to plan digit placement at predetermined locations on the object and subsequently to exert either negligible force ("low-force" task, LF) or 10% of their maximum pinch force ("high-force" task, HF) on the object. We found that the HF task elicited significantly smaller CSE than the LF task, but only when the TMS pulse coincided with the signal to initiate the reach. This force planning-related CSE modulation was specific to the muscles involved in the performance of both tasks. Interestingly, digit force planning did not result in modulation of M1 intracortical inhibitory and facilitatory circuitry. Our findings suggest that planning of digit forces reflected by CSE modulation starts well before object contact and appears to be driven by inputs from frontoparietal areas other than M1.

Regeneration of axons in injured spinal cord by activation of bone morphogenetic protein/Smad1 signaling pathway in adult neurons.

Axon growth potential is highest in young neurons but diminishes with age, thus becoming a significant obstacle to axonal regeneration after injury in maturity. The mechanism for the decline is incompletely understood, and no effective clinical treatment is available to rekindle innate growth capability. Here, we show that Smad1-dependent bone morphogenetic protein (BMP) signaling is developmentally regulated and governs axonal growth in dorsal root ganglion (DRG) neurons. Down-regulation of the pathway contributes to the age-related decline of the axon growth potential. Reactivating Smad1 selectively in adult DRG neurons results in sensory axon regeneration in a mouse model of spinal cord injury (SCI). Smad1 signaling can be effectively manipulated by an adeno-associated virus (AAV) vector encoding BMP4 delivered by a clinically applicable and minimally invasive technique, an approach devoid of unwanted abnormalities in mechanosensation or pain perception. Importantly, transected axons are able to regenerate even when the AAV treatment is delivered after SCI, thus mimicking a clinically relevant scenario. Together, our results identify a therapeutic target to promote axonal regeneration after SCI.

Transfer of learning between hands to handle a novel object in old age.

Transferring information about object weight between hands for use in scaling prehension forces likely depends on the integrity of the structures linking the two sides of the brain. It is unknown whether healthy older adults, who demonstrate a modest decline in this connectivity, transfer fingertip force scaling for object weight between hands. In the present study, healthy older and young adults performed two tasks: gripping and lifting an object, and a ballistic finger abduction movement. For the grip and lift task, participants practiced lifting a novel object using a precision pinch grip with the right hand (RH) and then did so again with the left hand (LH). For the ballistic task, participants were trained to maximally accelerate the right index finger by abducting it. On the grip and lift task, all participants appeared to overestimate the object weight during the 1st RH lift, followed by a progressive reduction on successive lifts. This adaptation was transferred to the LH in both groups on their first lift and remained stable over subsequent lifts. In contrast, the training-induced peak abduction acceleration on the ballistic task transferred poorly to the LH in older with considerably better transfer in young adults. We conclude that the memory representations scaling the lift force for the grip and lift task generalized to the untrained hand, while the greater acceleration that was acquired during practice of the ballistic task showed an incomplete transfer to the opposite hand. These differences may indicate task-dependent interhemispheric transfer of learning in old age.

Lateralized Neural Entropy modulates with Grip Force during Precision Grasping.

When holding a coffee mug filled to the brim, we strive to avoid spilling the coffee. This ability relies on the neural processes underlying the control of finger forces on a moment-to-moment basis. The brain activity lateralized to the contralateral hemisphere averaged over a trial and across the trials is known to be associated with the magnitude of grip force applied on an object. However, the mechanistic involvement of the variability in neural signals during grip force control remains unclear. In this study, we examined the dependence of neural variability over the frontal, central, and parietal regions assessed using noninvasive electroencephalography (EEG) on grip force magnitude during an isometric force control task. We hypothesized laterally specific modulation in EEG variability with higher magnitude of the grip force exerted during grip force control. We utilized an existing EEG dataset (64 channel) comprised of healthy young adults, who performed an isometric force control task while receiving visual feedback of the force applied. The force magnitude to be exerted on the instrumented object was cued to participants during the task, and varied pseudorandomly among 5, 10, and 15% of their maximum voluntary contraction (MVC) across the trials. We quantified neural variability via sample entropy (sequence-dependent measure) and standard deviation (sequence-independent measure) of the temporal EEG signal over the frontal, central, and parietal electrodes. The EEG sample entropy over the central electrodes showed lateralized, nonlinear, localized, modulation with force magnitude. Similar modulation was not observed over frontal or parietal EEG activity, nor for standard deviation in the EEG activity. Our findings highlight specificity in neural control of grip forces by demonstrating the modulation in sequence-dependent but not sequence-independent component of EEG variability. This modulation appeared to be lateralized, spatially constrained, and functionally dependent on the grip force magnitude. We discuss the relevance of these findings in scenarios where a finer precision is essential to enable grasp application, such as prosthesis and associated neural signal integration, and propose directions for future studies investigating the mechanistic role of neural entropy in grip force control.

Task-dependent Alteration in Delta Band Corticomuscular Coherence during Standing in Chronic Stroke Survivors.

Balance control is an important indicator of mobility and independence in activities of daily living. How the changes in functional integrity of corticospinal tract due to stroke affects the maintenance of upright stance remains to be known. We investigated the changes in functional coupling between the cortex and lower limb muscles during a challenging balance task over multiple frequency bands in chronic stroke survivors. Eleven stroke patients and nine healthy controls performed a challenging balance task. They stood on a computerized platform with/without somatosensory input distortion created by sway-referencing the support surface, thereby varying the difficulty levels of the task. We computed corticomuscular coherence between Cz (electroencephalography) and leg muscles and assessed balance performance using Berg Balance scale (BBS), Timed-up and go (TUG) and center of pressure (COP) measures. We found lower delta frequency band coherence in stroke patients when compared with healthy controls under medium difficulty condition for distal but not proximal leg muscles. For both groups, we found similar coherence at other frequency bands. On BBS and TUG, stroke patients showed poor balance. However, similar group differences were not consistently observed across COP measures. The presence of distal versus proximal effect suggests differences in the (re)organization of the corticospinal connections across the two muscles groups for balance control. We argue that the observed group difference in the delta coherence might be due to altered mechanisms for the detection of somatosensory modulation resulting from sway-referencing of the support platform for balance control.

Effects of simulated hypo-gravity on lower limb kinematic and electromyographic variables during anti-gravitational treadmill walking.

Introduction: This study investigated kinematic and EMG changes in gait across simulated gravitational unloading levels between 100% and 20% of normal body weight. This study sought to identify if each level of unloading elicited consistent changes-particular to that percentage of normal body weight-or if the changes seen with unloading could be influenced by the previous level(s) of unloading. Methods: 15 healthy adult participants (26.3 ± 2.5 years; 53% female) walked in an Alter-G anti-gravity treadmill unloading system (mean speed: 1.49 ±0.37 mph) for 1 min each at 100%, 80%, 60%, 40% and 20% of normal body weight, before loading back to 100% in reverse order. Lower-body kinematic data were captured by inertial measurement units, and EMG data were collected from the rectus femoris, biceps femoris, medial gastrocnemius, and anterior tibialis. Data were compared across like levels of load using repeated measures ANOVA and statistical parametric mapping. Difference waveforms for adjacent levels were created to examine the rate of change between different unloading levels. Results: This study found hip, knee, and ankle kinematics as well as activity in the rectus femoris, and medial gastrocnemius were significantly different at the same level of unloading, having arrived from a higher, or lower level of unloading. There were no significant changes in the kinematic difference waveforms, however the waveform representing the change in EMG between 100% and 80% load was significantly different from all other levels. Discussion: This study found that body weight unloading from 100% to 20% elicited distinct responses in the medial gastrocnemius, as well as partly in the rectus femoris. Hip, knee, and ankle kinematics were also affected differentially by loading and unloading, especially at 40% of normal body weight. These findings suggest the previous level of gravitational load is an important factor to consider in determining kinematic and EMG responses to the current level during loading and unloading below standard g. Similarly, the rate of change in kinematics from 100% to 20% appears to be linear, while the rate of change in EMG was non-linear. This is of particular interest, as it suggests that kinematic and EMG measures decouple with unloading and may react to unloading uniquely.

Assessment of Biomechanical Predictors of Occurrence of Low-Amplitude N1 Potentials Evoked by Naturally Occurring Postural Instabilities.

Naturally occurring postural instabilities that occur while standing and walking elicit specific cortical responses in the fronto-central regions (N1 potentials) followed by corrective balance responses to prevent falling. However, no framework could simultaneously track different biomechanical parameters preceding N1s, predict N1s, and assess their predictive power. Here, we propose a framework and show its utility by examining cortical activity (through electroencephalography [EEG]), ground reaction forces, and head acceleration in the anterior-posterior (AP) direction. Ten healthy young adults carried out a balance task of standing on a support surface with or without sway referencing in the AP direction, amplifying, or dampening natural body sway. Using independent components from the fronto-central cortical region obtained from subject-specific head models, we first robustly validated a prior approach on identifying low-amplitude N1 potentials before early signs of balance corrections. Then, a machine learning algorithm was used to evaluate different biomechanical parameters obtained before N1 potentials, to predict the occurrence of N1s. When different biomechanical parameters were directly compared, the time to boundary (TTB) was found to be the best predictor of the occurrence of upcoming low-amplitude N1 potentials during a balance task. Based on these findings, we confirm that the spatio-temporal characteristics of the center of pressure (COP) might serve as an essential parameter that can facilitate the early detection of postural instability in a balance task. Extending our framework to identify such biomarkers in dynamic situations like walking might improve the implementation of corrective balance responses through brain-machine-interfaces to reduce falls in the elderly.

Effects of aging on conditional visuomotor learning for grasping and lifting eccentrically weighted objects.

Explicit knowledge of object center of mass or CM location fails to guide anticipatory scaling of digit forces necessary for dexterous manipulation. We previously showed that allowing young adults to choose where to grasp the object entailed an ability to use arbitrary color cues about object CM location to gradually minimize object tilt across several trials. This conditional learning was achieved through accurate anticipatory modulation of digit position using the color cues. However, it remains unknown how aging affects the ability to use explicit color cues about object CM location to modulate digit placement for dexterous manipulation. We instructed healthy older and young adults to learn a manipulation task using arbitrary color cues about object CM location. Subjects were required to exert clockwise, counterclockwise, or no torque on the object according to the color cue and lift the object while minimizing its tilt. Older adults produced larger torque error during conditional learning trials, resulting in a slower rate of learning than young adults. Importantly, older adults showed impaired anticipatory modulation of digit position when information of the CM location was available via explicit color cues. The older adults also did not modulate their digit forces to compensate for this impairment. Interestingly, however, anticipatory modulation of digit position was intact in the same individuals when information of object CM location was implicitly conveyed from trial-to-trial. We discuss our findings in relation to age-dependent changes in processes and neural network essential for learning dexterous manipulation using arbitrary color cue about object property.NEW & NOTEWORTHY We studied whether older adults are able to predictively modulate digit position using arbitrary color cues indicating object center of mass location for dexterous manipulation. Older adults showed an impaired ability to modulate digit position using the color cues when compared with young adults. Interestingly, similar impairments were not found when same older individuals learned the task using implicit knowledge. Our findings suggest an age-related impairment specifically in the conditional learning mechanisms for dexterous manipulation.

Non-invasive Brain Stimulation of the Posterior Parietal Cortex Alters Postural Adaptation.

Effective central sensory integration of visual, vestibular, and proprioceptive information is required to promote adaptability in response to changes in the environment during postural control. Patients with a lesion in the posterior parietal cortex (PPC) have an impaired ability to form an internal representation of body position, an important factor for postural control and adaptation. Suppression of PPC excitability has also been shown to decrease postural stability in some contexts. As of yet, it is unknown whether stimulation of the PPC may influence postural adaptation. This investigation aimed to identify whether transcranial direct current stimulation (tDCS) of the bilateral PPC could modulate postural adaptation in response to a bipedal incline postural adaptation task. Using young, healthy subjects, we delivered tDCS over bilateral PPC followed by bouts of inclined stance (incline-interventions). Analysis of postural after-effects identified differences between stimulation conditions for maximum lean after-effect (LAE; p = 0.005) as well as a significant interaction between condition and measurement period for the average position (p = 0.03). We identified impaired postural adaptability following both active stimulation conditions. Results reinforce the notion that the PPC is involved in motor adaptation and extend this line of research to the realm of standing posture. The results further highlight the role of the bilateral PPC in utilizing sensory feedback to update one's internal representation of verticality and demonstrates the diffuse regions of the brain that are involved in postural control and adaptation. This information improves our understanding of the role of the cortex in postural control, highlighting the potential for the PPC as a target for sensorimotor rehabilitation.

The Posterior Parietal Cortex Is Involved in Gait Adaptation: A Bilateral Transcranial Direct Current Stimulation Study.

Gait is one of the fundamental behaviors we use to interact with the world. The functionality of the locomotor system is thus related to enriching interactions with our environment. The posterior parietal cortex (PPC) has been found to contribute to motor adaptation during both visuomotor and postural adaptation tasks. Additionally, structural or functional deficits of the PPC lead to impairments in gaits such as shortened steps and increased step width. Based on the aforementioned roles of the PPC, and the importance of gait adaptability, the current investigation sought to identify the role of the PPC in gait adaptation. To achieve this, we performed transcranial direct current stimulation (tDCS) over the bilateral PPC before performing a split-belt treadmill gait adaptation paradigm. We used three stimulation conditions in a within-subject design. tDCS was administered in a randomized and double-blinded order. Following each stimulation session, subjects first performed baseline walking with both belts running at the same speed. Then, subjects walked for 15 min on an uncoupled treadmill, with the belts being driven at a 3:1 speed ratio. Last, they returned to normal (i.e., tied-belt) walking for 5 min. Results from 15 young and healthy subjects identified that subjects required more steps to adapt to split-belt walking following the suppression of the left hemisphere PPC, contralateral to the fast belt. Furthermore, while suppression of the left hemisphere PPC did not increase the number of steps required to re-adapt to tied-belt walking, this condition did lead to increased magnitude of after-effects. Together, these findings indicate that the PPC is involved in locomotor adaptation. These results support previous literature regarding the upper body or postural adaptation and extend these findings to the realm of gait. Results highlight the PPC as a potential target for neurorehabilitation designed to improve gait adaptability.

Time-course of pain threshold after continuous theta burst stimulation of primary somatosensory cortex in pain-free subjects.

Primary somatosensory cortex (S1) is involved in pain processing and thus its suppression using neuromodulatory techniques such as continuous theta burst stimulation (cTBS) might be a potential pain management strategy in patients with neuropathic pain. cTBS over S1 is known to elevate pain threshold in young adults. However, the time course of this after-effect is unknown. Furthermore, the effect of cTBS over S1 on pain threshold might be confounded by changes in the excitability of primary motor cortex (M1), an area known to be involved in pain processing, due to spread of current. Therefore, whether S1 plays a role in pain processing independent of M1 also remains unknown. The corticospinal excitability (CSE) can provide a measure of M1 excitability because cTBS over M1 is known to reduce CSE. Here, we studied the time-course of the effects of MRI-guided cTBS over S1 on electrical pain threshold (EPT) and CSE. Ten healthy young adults received cTBS over S1 and sham stimulation in counterbalanced sessions at least 5 days apart. EPT and CSE were recorded before and following cTBS over S1. We assessed each measure once before stimulation and then every 10 min starting immediately after stimulation until 40 min. cTBS over S1 elevated EPT compared to sham stimulation with the after-effect lasting for 40 min. We observed no change in CSE following cTBS and sham stimulation. Our findings suggest that cTBS over S1 can elevate EPT for 40 min without altering M1 excitability.