Effects of auricular vagus nerve stimulation and electrical earlobe stimulation on motor-evoked potential changes induced by paired associative stimulation.

Paired associative stimulation (PAS) is a combination of transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). PAS can induce long-term potentiation (LTP)-like plasticity in humans, manifested as motor-evoked potential (MEP) enhancement. We have developed a variant of PAS ("high-PAS"), which consists of high-frequency PNS and high-intensity TMS and targets spinal plasticity and promotes rehabilitation after spinal cord injury (SCI). Vagus nerve stimulation (VNS) promotes LTP-like plasticity and enhances recovery in SCI and stroke in humans and animals when combined with repetitive motor training. We combined high-PAS with simultaneous noninvasive transcutaneous auricular VNS (aVNS) to determine if aVNS enhances the extent of PAS-induced MEP amplitude increase. Sixteen healthy participants were stimulated for 20 min in four different sessions (PAS, PAS + aVNS, PAS + shamVNS, and aVNS) in a randomized single-blind setup. MEPs were measured before, immediately after, and at 30, 60, and 90 min post-stimulation. Stimulation protocols with PAS significantly potentiated MEPs (p = 0.005) when compared with aVNS (p = 0.642). Although not significant, MEP enhancement observed after PAS (43.5%) is further increased by aVNS (49.7%) and electrical earlobe stimulation (63.9%). Our aVNS setup failed to significantly enhance the effect of PAS, but sham VNS revealed a trend towards enhanced plasticity. Optimization of auricular VNS stimulation setup is required for possible tests of patients with SCI.

Muscle activity during daily life in the older people.

BACKGROUND: Daily muscle activity is important for functional independence. This study examined muscle activity patterns during normal daily life and simulated daily tasks and compared muscle activity and energy consumption during active and passive transport tasks in older adults. METHODS: Nine volunteers (70 ± 6 years) were measured for quadriceps and hamstring muscle activity (EMG) during normal daily life, treadmill walking, and during passive and active transport tasks. EMG was normalized to that recorded during maximal voluntary contraction (MVC). Oxygen uptake (VO2) was measured during treadmill and transport tasks. RESULTS: During daily life the mean EMG amplitude was 5.9 ± 2.4 % of EMGMVC, activity time was 187 ± 43 min and the longest continuous inactivity periods were 20.9 ± 10.0 min. During stair ascend the peak EMG activity was 120 % of EMGMVC and the peak VO2 values were only about 70 % of VO2max. One kilometer walk consumed 3.5 times more energy than passive transport by bus, and using stairs consumed 11.7 times more energy than using an elevator. CONCLUSIONS: In daily life, older adults use only a small fraction of muscle's maximal capacity and have long continuous inactivity periods. Negotiating stairs produce significant load to neuromuscular, but not to cardiovascular system, thus providing an effective strength training stimulus.

A test of the effort equalization hypothesis in children with cerebral palsy who have an asymmetric gait.

Healthy people can walk nearly effortlessly thanks to their instinctively adaptive gait patterns that tend to minimize metabolic energy consumption. However, the economy of gait is severely impaired in many neurological disorders such as stroke or cerebral palsy (CP). Moreover, self-selected asymmetry of impaired gait does not seem to unequivocally coincide with the minimal energy cost, suggesting the presence of other adaptive origins. Here, we used hemiparetic CP gait as a model to test the hypothesis that pathological asymmetric gait patterns are chosen to equalize the relative muscle efforts between the affected and unaffected limbs. We determined the relative muscle efforts for the ankle and knee extensors by relating extensor joint moments during gait to maximum moments obtained from all-out hopping reference test. During asymmetric CP gait, the unaffected limb generated greater ankle (1.36±0.15 vs 1.17±0.16 Nm/kg, p = 0.002) and knee (0.74±0.33 vs 0.44±0.19 Nm/kg, p = 0.007) extensor moments compared with the affected limb. Similarly, the maximum moment generation capacity was greater in the unaffected limb versus the affected limb (ankle extensors: 1.81±0.39 Nm/kg vs 1.51±0.34 Nm/kg, p = 0.033; knee extensors: 1.83±0.37 Nm/kg vs 1.34±0.38 Nm/kg, p = 0.021) in our force reference test. As a consequence, no differences were found in the relative efforts between unaffected and affected limb ankle extensors (77±12% vs 80±16%, p = 0.69) and knee extensors (41±17% vs 38±23%, p = 0.54). In conclusion, asymmetric CP gait resulted in similar relative muscle efforts between affected and unaffected limbs. The tendency for effort equalization may thus be an important driver of self-selected gait asymmetry patterns, and consequently advantageous for preventing fatigue of the weaker affected side musculature.

Minimally Invasive Decompression and Physiotherapy for Lumbar Spinal Stenosis in Geriatric Patients.

Background Lumbar spinal stenosis (LSS) is the most common indication for spine surgery among the geriatric population. Although decompressive surgery is effective, older patients do not benefit as much as younger patients, and they are frequently excluded from studies assessing postoperative physiotherapy. We sought to evaluate the long-term outcomes after surgery when a novel postoperative physiotherapy regimen was included. Methods We performed a retrospective review of patients with LSS greater than 70 years old who underwent lumbar decompressive surgery by the senior author over the past five years. We evaluated patients who participated in a novel postoperative physiotherapy regimen involving four phases of rehabilitation aimed at progressively independent ambulation. The visual analog scale (VAS), lower extremity motor strength, and functional independence measure (FIM) were collected preoperatively and after physiotherapy to measure outcomes. Results Ten consecutive patients with an average age of 83 years (range: 71 - 96) met the inclusion criteria. Nine patients underwent minimally invasive laminotomies at L4-L5 and one underwent a laminotomy at L3-L4. The average follow-up time was 41.9 months. The preoperative mean VAS was 7.35, and at the end of the study, it was 1.7 (p = 0.005). Three of the four patients with preoperative motor deficits improved. The median transfer and locomotion subscores of the FIM were six preoperatively and increased to seven postoperatively. Neither of these improvements was significant. Conclusions Patients older than 70 years undergoing decompressive surgery and a novel postoperative physiotherapy regimen experienced significant reductions in pain. Independence also increased; however, this did not reach statistical significance.

Iron 'ElectriRx' man: Overground stepping in an exoskeleton combined with noninvasive spinal cord stimulation after paralysis.

We asked whether coordinated voluntary movement of the lower limbs could be regained in an individual having been completely paralyzed (>4 yr) and completely absent of vision (>15 yr) using a novel strategy - transcutaneous spinal cord stimulation at selected sites over the spinal vertebrae with just one week of training. We also asked whether this stimulation strategy could facilitate stepping assisted by an exoskeleton (EKSO, EKSO Bionics) that is designed so that the subject can voluntarily complement the work being performed by the exoskeleton. We found that spinal cord stimulation enhanced the level of effort that the subject could generate while stepping in the exoskeleton. In addition, stimulation improved the coordination patterns of the lower limb muscles resulting in a more continuous, smooth stepping motion in the exoskeleton. These stepping sessions in the presence of stimulation were accompanied by greater cardiac responses and sweating than could be attained without the stimulation. Based on the data from this case study it appears that there is considerable potential for positive synergistic effects after complete paralysis by combining the overground stepping in an exoskeleton, a novel transcutaneous spinal cord stimulation paradigm, and daily training.

Noninvasive Reactivation of Motor Descending Control after Paralysis.

The present prognosis for the recovery of voluntary control of movement in patients diagnosed as motor complete is generally poor. Herein we introduce a novel and noninvasive stimulation strategy of painless transcutaneous electrical enabling motor control and a pharmacological enabling motor control strategy to neuromodulate the physiological state of the spinal cord. This neuromodulation enabled the spinal locomotor networks of individuals with motor complete paralysis for 2-6 years American Spinal Cord Injury Association Impairment Scale (AIS) to be re-engaged and trained. We showed that locomotor-like stepping could be induced without voluntary effort within a single test session using electrical stimulation and training. We also observed significant facilitation of voluntary influence on the stepping movements in the presence of stimulation over a 4-week period in each subject. Using these strategies we transformed brain-spinal neuronal networks from a dormant to a functional state sufficiently to enable recovery of voluntary movement in five out of five subjects. Pharmacological intervention combined with stimulation and training resulted in further improvement in voluntary motor control of stepping-like movements in all subjects. We also observed on-command selective activation of the gastrocnemius and soleus muscles when attempting to plantarflex. At the end of 18 weeks of weekly interventions the mean changes in the amplitude of voluntarily controlled movement without stimulation was as high as occurred when combined with electrical stimulation. Additionally, spinally evoked motor potentials were readily modulated in the presence of voluntary effort, providing electrophysiological evidence of the re-establishment of functional connectivity among neural networks between the brain and the spinal cord.

Muscle inactivity and activity patterns after sedentary time--targeted randomized controlled trial.

PURPOSE: Interventions targeting sedentary time are needed. We used detailed EMG recordings to study the short-term effectiveness of simple sedentary time-targeted tailored counseling on the total physical activity spectrum. METHODS: This cluster randomized controlled trial was conducted between 2011 and 2013 (InPact, ISRCTN28668090), and short-term effectiveness of counseling is reported in the present study. A total of 133 office workers volunteered to participate, from which muscle activity data were analyzed from 48 (intervention, n = 24; control, n = 24). After a lecture, face-to-face tailored counseling was used to set contractually binding goals regarding breaking up sitting periods and increasing family based physical activity. Primary outcome measures were assessed 11.8 ± 1.1 h before and a maximum of 2 wk after counseling including quadriceps and hamstring muscle inactivity time, sum of the five longest muscle inactivity periods, and light muscle activity time during work, commute, and leisure time. RESULTS: Compared with those in the controls, counseling decreased the intervention group's muscle inactivity time by 32.6 ± 71.8 min from 69.1% ± 8.5% to 64.6% ± 10.9% (whole day, P < 0.05; work, P < 0.05; leisure, P < 0.05) and the sum of the five longest inactivity periods from 35.6 ± 14.8 to 29.7 ± 10.1 min (whole day, P < 0.05; leisure, P < 0.01). Concomitantly, light muscle activity time increased by 20.6 ± 52.6 min, from 22.2% ± 7.9% to 25.0% ± 9.7% (whole day, P < 0.05; work, P < 0.01; leisure, P < 0.05), and during work time, average EMG amplitude (percentage of EMG during maximal voluntary isometric contraction (MVC) (%EMG MVC)) increased from 1.6% ± 0.9% to 1.8% ± 1.0% (P < 0.05) in the intervention group compared with that in the controls. CONCLUSIONS: A simple tailored counseling was able to reduce muscle inactivity time by 33 min, which was reallocated to 21 min of light muscle activity. During work time, average EMG amplitude increased by 13%, reaching an average of 1.8% of EMG MVC. If maintained, this observed short-term effect may have health-benefiting consequences.

EMG, heart rate, and accelerometer as estimators of energy expenditure in locomotion.

PURPOSE: Precise measures of energy expenditure (EE) during everyday activities are needed. This study assessed the validity of novel shorts measuring EMG and compared this method with HR and accelerometry (ACC) when estimating EE. METHODS: Fifty-four volunteers (39.4 ± 13.9 yr) performed a maximal treadmill test (3-min loads) including walking with different speeds uphill, downhill, and on level ground and one running load. The data were categorized into all, low, and level loads. EE was measured by indirect calorimetry, whereas HR, ACC, and EMG were measured continuously. EMG from quadriceps (Q) and hamstrings (H) was measured using shorts with textile electrodes. Validity of the methods used to estimate EE was compared using Pearson correlations, regression coefficients, linear mixed models providing Akaike information criteria, and root mean squared error (RMSE) from cross-validation at the individual and population levels. RESULTS: At all loads, correlations with EE were as follows: EMG(QH), 0.94 ± 0.03; EMG(Q), 0.91 ± 0.03; EMG(H), 0.94 ± 0.03; HR, 0.96 ± 0.04; and ACC, 0.77 ± 0.10. The corresponding correlations at low loads were 0.89 ± 0.08, 0.79 ± 0.10, 0.93 ± 0.07, 0.89 ± 0.23, and 0.80 ± 0.07, and at level loads, they were 0.97 ± 0.03, 0.97 ± 0.05, 0.96 ± 0.04, 0.95 ± 0.08, and 0.99 ± 0.02, respectively. Akaike information criteria ranked the methods in accordance with the individual correlations. CONCLUSIONS: It is shown for the first time that EMG shorts can be used for EE estimations across a wide range of physical activity intensities in a heterogeneous group. Across all loads, HR is a superior method of predicting EE, whereas ACC is most accurate for level loads at the population level. At low levels of physical activity in changing terrains, thigh muscle EMG provides more accurate EE estimations than those in ACC and HR if individual calibrations are performed.

Muscle activity and inactivity periods during normal daily life.

Recent findings suggest that not only the lack of physical activity, but also prolonged times of sedentary behaviour where major locomotor muscles are inactive, significantly increase the risk of chronic diseases. The purpose of this study was to provide details of quadriceps and hamstring muscle inactivity and activity during normal daily life of ordinary people. Eighty-four volunteers (44 females, 40 males, 44.1±17.3 years, 172.3±6.1 cm, 70.1±10.2 kg) were measured during normal daily life using shorts measuring muscle electromyographic (EMG) activity (recording time 11.3±2.0 hours). EMG was normalized to isometric MVC (EMG(MVC)) during knee flexion and extension, and inactivity threshold of each muscle group was defined as 90% of EMG activity during standing (2.5±1.7% of EMG(MVC)). During normal daily life the average EMG amplitude was 4.0±2.6% and average activity burst amplitude was 5.8±3.4% of EMG(MVC) (mean duration of 1.4±1.4 s) which is below the EMG level required for walking (5 km/h corresponding to EMG level of about 10% of EMG(MVC)). Using the proposed individual inactivity threshold, thigh muscles were inactive 67.5±11.9% of the total recording time and the longest inactivity periods lasted for 13.9±7.3 min (2.5-38.3 min). Women had more activity bursts and spent more time at intensities above 40% EMG(MVC) than men (p<0.05). In conclusion, during normal daily life the locomotor muscles are inactive about 7.5 hours, and only a small fraction of muscle's maximal voluntary activation capacity is used averaging only 4% of the maximal recruitment of the thigh muscles. Some daily non-exercise activities such as stair climbing produce much higher muscle activity levels than brisk walking, and replacing sitting by standing can considerably increase cumulative daily muscle activity.