Motor cortex excitability in chronic low back pain.

Chronic pain is associated with dysfunctional cortical excitability. Research has identified altered intracortical motor cortex excitability in Chronic Lower Back Pain (CLBP). However, research identifying the specific intracortical changes underlying CLBP has been met with inconsistent findings. In the present case-control study, we examined intracortical excitability of the primary motor cortex using transcranial magnetic stimulation (TMS) in individuals with CLBP. Twenty participants with CLBP (Mage = 54.45 years, SDage = 15.89 years) and 18 age- and gender-matched, pain-free controls (M = 53.83, SD = 16.72) were included in this study. TMS was applied to the hand motor area of the right hemisphere and motor evoked potentials (MEPs) were recorded from the first dorsal interosseous muscle of the contralateral hand. Resting motor threshold (rMT) and MEP amplitude were measured using single-pulse stimulation. Short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed using paired-pulse stimulation. Individuals with CLBP had significantly higher rMT (decreased corticospinal excitability) and lower ICF compared to controls. No significant differences were found in MEP amplitude and SICI. These findings add to the growing body of evidence that CLBP is associated with deficits in intracortical modulation involving glutamatergic mechanisms.

Differential plasticity of extensor and flexor motor cortex representations following visuomotor adaptation.

Representations within the primary motor cortex (M1) are capable of rapid functional changes following motor learning, known as use-dependent plasticity. GABAergic inhibition plays a role in use-dependent plasticity. Evidence suggests a different capacity for plasticity of distal and proximal upper limb muscle representations. However, it is unclear whether the motor cortical representations of forearm flexor and extensor muscles also have different capacities for plasticity. The current study used transcranial magnetic stimulation to investigate motor cortex excitability and inhibition of forearm flexor and extensor representations before and after performance of a visuomotor adaptation task that primarily targeted flexors and extensors separately. There was a decrease in extensor and flexor motor-evoked potential (MEP) amplitude after performing the extensor adaptation, but no change in flexor and extensor MEP amplitude after performing the flexor adaptation. There was also a decrease in motor cortical inhibition in the extensor following extensor adaptation, but no change in motor cortical inhibition in the flexor muscle following flexor adaptation or either of the non-prime mover muscles. Findings suggest that the forearm extensor motor cortical representation exhibits plastic change following adaptive motor learning, and broadly support the distinct neural control of forearm flexor and extensor muscles.

Triggering prepared actions by sudden sounds: reassessing the evidence for a single mechanism.

Loud acoustic stimuli can unintentionally elicit volitional acts when a person is in a state of readiness to execute them (the StartReact effect). It has been assumed that the same subcortical pathways and brain regions underlie all instances of the StartReact effect. They are proposed to involve the startle reflex pathways, and the eliciting mechanism is distinct from other ways in which sound can affect the motor system. We present an integrative review which shows that there is no evidence to support these assumptions. We argue that motor command generation for learned, volitional orofacial, laryngeal and distal limb movements is cortical and the StartReact effect for such movements involves transcortical pathways. In contrast, command generation for saccades, locomotor corrections and postural adjustments is subcortical and subcortical pathways are implicated in the StartReact effect for these cases. We conclude that the StartReact effect is not a special phenomenon mediated by startle reflex pathways, but rather is a particular manifestation of the excitatory effects of intense stimulation on the central nervous system.

Corticospinal excitability during imagined and observed dynamic force production tasks: effortfulness matters.

Research on motor imagery and action observation has become increasingly important in recent years particularly because of its potential benefits for movement rehabilitation and the optimization of athletic performance (Munzert et al., 2009). Motor execution, motor imagery, and action observation have been shown to rely largely on a similar neural network in motor and motor-related cortical areas (Jeannerod, 2001). Given that motor imagery is a covert stage of an action and its characteristics, it has been assumed that modifying the motor task in terms of, for example, effort will impact neural activity. With this background, the present study examined how different force requirements influence corticospinal excitability (CSE) and intracortical facilitation during motor imagery and action observation of a repetitive movement (dynamic force production). Participants were instructed to kinesthetically imagine or observe an abduction/adduction movement of the right index finger that differed in terms of force requirements. Trials were carried out with single- or paired-pulse transcranial magnetic stimulation. Surface electromyography was recorded from the first dorsal interosseous (FDI) and the abductor digiti minimi (ADM). As expected, results showed a significant main effect on mean peak-to-peak motor-evoked potential (MEP) amplitudes in FDI but no differences in MEP amplitudes in ADM muscle. Participants' mean peak-to-peak MEPs increased when the force requirements (movement effort) of the imagined or observed action were increased. This reveals an impact of the imagined and observed force requirements of repetitive movements on CSE. It is concluded that this effect might be due to stronger motor neuron recruitment for motor imagery and action observation with an additional load. That would imply that the modification of motor parameters in movements such as force requirements modulates CSE.

Abdominal Palpation Haptic Device for Colonoscopy Simulation Using Pneumatic Control.

In this paper, we describe the development of a haptic device to be used in a simulator aiming to train the skills of gastroenterology assistants in abdominal palpation during colonoscopy, as well as to train team interaction skills for the colonoscopy team. To understand the haptic feedback forces to be simulated by the haptic device, we conducted an experiment with five participants of varying BMI. The applied forces and displacements were measured and hysteresis modeling was used to characterize the experimental data. These models were used to determine the haptic feedback forces required to simulate a BMI case in response to the real-time user interactions. The pneumatic haptic device consisted of a sphygmomanometer bladder as the haptic interface and a fuzzy controller to regulate the bladder pressure. The haptic device showed good steady state and dynamic response was adequate for simulating haptic interactions. Tracking accuracy averaged 94.2 percent within 300 ms of the reference input while the user was actively applying abdominal palpation and minor repositioning.

Manual interception of moving targets in two dimensions: performance and space-time accuracy.

We report results from four experiments that examined performance of an interceptive task that restricted movement of the hand and moving target to a horizontal plane. The task required accurate control over both where and when interception takes place. Three experiments studied the effects of four independent variables: target speed, target size, manipulandum size and movement amplitude. For small amplitude movements, small, fast targets were hit harder than larger slower ones and targets were hit harder with smaller manipulanda; movement time (MT) was unaffected by target size, but was shorter when the manipulandum was smaller. For larger amplitude movements, smaller, faster targets were also hit harder, but MTs tended to be greater when targets were smaller. The results support the idea that MT and peak movement speed can be independently controlled to some degree in order to meet the accuracy demands of the task. Analysis of the task showed that spatial and temporal accuracy demands are interdependent, indicating that the spatial and temporal variable errors should covary such that increases in one are accompanied by decreases in the other. This can be tested if there is no variation in interception location; which was not the case in the first three experiments. In a final experiment variation in interception location was restricted by requiring that the target be struck through an aperture. Both spatial and temporal variable errors could be estimated. As predicted, it was found that when spatial errors were small, temporal errors were large.