Effect of three-hour ankle joint immobilization with an ankle foot orthosis on corticospinal excitability and ankle joint angle excursion during gait.

[Purpose] Ankle foot orthosis (AFO) is widely used to regain gait function after injuries and/or stroke; however, limited information is currently available on their effects. We herein examined the effects of three-hour immobilization with AFO on corticospinal excitability and ankle joint movement during gait in healthy volunteers. [Participants and Methods] The participants comprised of seven healthy volunteers. Corticospinal excitability and ankle joint excursions were evaluated before and after three hours of immobilization with left limb AFO. We measured motor evoked potentials in the tibialis anterior (TA) and gastrocnemius (Ga) muscles induced by transcranial magnetic stimulation. In a kinematic analysis, we focused on transition points, such as the timing from dorsiflexion to plantarflexion of the ankle joint and/or vice versa, during gait. [Results] Corticospinal excitability in TA and Ga both significantly decreased. During the normalized gait cycle (GC), ankle angles showed less dorsiflexion at 0% GC and 100% GC, and during loading response and mid-swing and terminal swing phases. Furthermore, less plantarflexion was observed during the initial swing phase. [Conclusion] This study showed that short-term ankle joint immobilization with AFO induces a significant decrease in corticospinal excitability and has an effect on ankle joint excursion during gait. Further studies are needed on the effects of long-term immobilization by AFO.

Transcranial direct current stimulation to dorsolateral prefrontal cortex improves performance of obstacle avoidance gait task.

We aimed to investigate the effect of dual-task interference between cognitive and obstacle avoidance walking tasks, and the effect of transcranial direct current stimulation (tDCS) on the performance of this cognitive-motor dual task. The healthy young subjects participated in a single task consisting of a three-digit subtraction task (e.g. 783 - 7) or a 15-m track with six 7.5-cm high obstacles. Then, the subjects performed two single tasks simultaneously as dual tasks, before and after sham and anodal tDCS (2 mA, 20 min) to left dorsolateral prefrontal cortex (DLPFC, the F3 region of the 10/20 electroencephalogram electrode placement system). The effect of tDCS on each outcome (number of correct answers, the clearance height above the obstacle, and foot placement position) was analyzed using repeated-measures analysis of variance. Model effects included tDCS (real, sham), time (pre-, post-tDCS), and task (single task, dual task) conditions. A significant difference in the tDCS, time, and task conditions was observed; the correct number of subtraction tasks increased, and the clearance height and the distance between the obstacle and foot decreased in front of the obstacle. Our findings suggest that dual task performance is causally related to left DLPFC activation under complicated walking tasks and tDCS over this cortical area increases overloaded its information processing capacity.

Obstacle avoidance movement-related motor cortical activity with cognitive task.

Lack of attention to obstacles on the floor or walking path may cause trip and fall accidents. The preparatory activity in the motor cortex to the perturbation associated with obstacle avoidance movements with cognitive task is still unclear. The purpose of this study was to investigate the motor cortical activity involved in the preparation and execution of concurrent obstacle avoidance movement and cognitive task. Twenty young adults were required to step over obstacles that were projected on the floor while performing a cognitive task. The electroencephalogram was recorded, and the movement-related cortical potentials (MRCP) aligned by foot dorsiflexion were evaluated. There was no significant difference in the number of contacts between the toe and the obstacle between the obstacle avoidance task and obstacle avoidance with cognitive task; however, the distance between the toe and the obstacle just before obstacle avoidance movement was significantly extended in the latter task. The amplitude and the onset of MRCP during the dual task were decreased and delayed, respectively, compared with the simple obstacle avoidance movement task. These results suggest that the young participants changed their clearance strategy to stepping over the obstacle during the concurrent motor and cognitive dual task to reduce motor cortical activity.

Mirror movement-like muscle hypertonia stroke model based on ipsilateral weight load.

In stroke patients, muscle tone on the unaffected side is often increased during voluntary tasks. This is known as a mirror movement and might be an impediment to function recovery, but its neural background is still unclear. In this study, we investigated the effect of unilateral muscle hypertonia on ipsilateral cortical activity and contralateral motor function. Fourteen right-handed healthy young subjects lifted a weight of 10% body weight with the right upper limb to increase muscle tone (weight task), while no weight lifting was set as the control 'nonweight' task. We recorded the motor-evoked potential (MEP), resting motor threshold and H-reflex from the left flexor carpi radialis muscle during both tasks. To estimate the functional effect of the weight task, subjects performed the 'Purdue pegboard test', consisting of examination for 30 seconds (peg-30) and assembly for 60 seconds (peg assembly). Left-hand grip strength was also measured. When subjects performed the weight task, the MEP amplitude increased significantly and the MT decreased significantly. There was no significant difference of H-reflex amplitude between the two tasks. No significant difference of the peg-30 score was observed between weight and nonweight tasks, but the peg assembly score was significantly lower during the weight task. Grip strength showed a significant increase during the weight task. These results indicate that the present weight load model may have the potential to advance our understanding of the mechanisms underlying mirror movements after stroke.

Time course of changes in corticospinal excitability after short-term forearm/hand immobilization.

The short-term joint immobilization induces a decrease of corticospinal excitability; however, detailed time course of the immobilization-induced central nervous system changes and their extent have not yet been clarified. To evaluate the time course of changes in corticospinal excitability during forearm/hand immobilization for 24 h and investigate the effect on muscle strength, adhesive casting tape was used to immobilize the nondominant forearm/hand. The amplitude of the motor-evoked potential of the flexor pollicis brevis muscle induced by transcranial magnetic stimulation was measured during immobilization and after cast removal. The muscle strength was evaluated after the termination of immobilization. The resting motor-evoked potential recorded from flexor pollicis brevis muscle showed a significant decrease 3 h after initiation of immobilization and gradually declined further until the end of immobilization. It then increased over 2 h after cast removal, but was still significantly below baseline. However, no significant difference from baseline was observed at 3 h. Both pinch power and integrated electromyogram were significantly reduced by immobilization, and then gradually returned to baseline after the cast was removed. These results indicate that short-term forearm/hand immobilization rapidly reduces corticospinal excitability, and this change is rapidly reversed after resumption of movement.

Correlation between changes of contralesional cortical activity and motor function recovery in patients with hemiparetic stroke.

OBJECTIVE: To investigate the correlation between changes of contralesional cortical excitability evaluated by transcranial magnetic stimulation (TMS) and functional recovery in patients with hemiparetic stroke. METHODS: Eight inpatients (mean age: 75.9±13.8 years) with mild to moderate hemiparesis were enrolled. TMS was delivered to the optimal scalp position over the contralesional (ipsilateral to the paresis) primary motor cortex (M1) to activate the unaffected flexor carpi radialis muscle (FCR) while the patient picked up a wooden block with the affected hand. The amplitude of the motor-evoked potential (MEP) was measured and then was divided by the resting MEP amplitude (MEP ratio). For evaluation of motor function, we tested grip strength (GS), performed the upper extremity motor section of the Fugl-Meyer Assessment (FMA-UE), and performed the Purdue Pegboard Test (PPT) when the patients were admitted to our hospital (T1) and 2 months after admission (T2). RESULTS: The MEP ratio was significantly decreased at the second examination. The partial correlations between the MEP ratio and FMA-UE at T1, and PPT of an affected hand at T2 were observed while controlling for the period after stroke onset as the confounding variable. CONCLUSION: The reduction of contralesional cortical hyperactivity is related to the functional recovery in part, but not related with the period after stroke onset. This suggests that enhanced reduction of contralesional M1 hyperactivity contributes to functional recovery after stroke.