Understanding the impact: an investigation into the National Brain Injury Awareness Week and public interest regarding concussion in Australia.

OBJECTIVES: The purpose of this study is to analyze the relationship between the occurrence of the National Brain Injury Awareness Week and public interest in the concussion topic in Australia through an analysis of Internet search activity data from Google Trends. STUDY DESIGN: Online retrospective observational study. METHODS: For the keyword "concussion", the search interest rate over a period of 10 years between August 2012 and August 2022 within Australia has been analyzed using the Google Trends tool. The rising related topics that contributed to the months with the highest search interest were extracted for each year and a trendline analysis was performed to capture temporal patterns. RESULTS: There was a significant difference in the average search interest between the month of August, when the Brain Injury Awareness Week is annually held, and the rest of the year (d = 0.09, p = 0.017). Also, May and August were the two months with the overall highest search interests (mean ± SD: 73.3 ± 5.16 and mean ± SD: 70.1 ± 5.49, respectively). Trendline analysis showed a positive slope of 0.3081 with R2 = 0.4462 for search interests of concussion over the 10-year period. CONCLUSIONS: The data suggest that there is a growing interest and potential awareness of concussion in Australia that seems highly limited to the context of sports such as football, rugby, and soccer. Major sports events, news coverage, and media exposure appear to be associated with this trend. The study highlights the importance of more investment in producing engaging media content to educate the public on concussion of different causes and improving strategies for National Brain Injury Awareness Week.

Neuromuscular electrical stimulation during maximal voluntary contraction: a Delphi survey with expert consensus.

PURPOSE: The use of electrical stimulation to assess voluntary activation of muscle/s is a popular method employed in numerous exercise science and health research settings. This Delphi study aimed to collate expert opinion and provide recommendations for best practice when using electrical stimulation during maximal voluntary contractions. METHODS: A two-round Delphi study was undertaken with 30 experts who completed a 62-item questionnaire (Round 1) comprising of open- and closed-ended questions. Consensus was assumed if ≥ 70% of experts selected the same response; such questions were removed from the subsequent Round 2 questionnaire. Responses were also removed if they failed to meet a 15% threshold. Open-ended questions were analysed and converted into closed-ended questions for Round 2. It was assumed there was no clear consensus if a question failed to achieve a ≥ 70% response in Round 2. RESULTS: A total of 16 out of 62 (25.8%) items reached consensus. Experts agreed that electrical stimulation provides a valid assessment of voluntary activation in specific circumstances, such as during maximal contraction, and this stimulation can be applied at either the muscle or the nerve. Experts recommended using doublet stimuli, self-adhesive electrodes, a familiarisation session, real-time visual or verbal feedback during the contraction, a minimum current increase of + 20% to ensure supramaximal stimulation, and manually triggering stimuli. CONCLUSION: The results of this Delphi consensus study can help researchers make informed decisions when considering technical parameters when designing studies involving electrical stimulation for the assessment of voluntary activation.

Contralateral Effects of Unilateral Strength and Skill Training: Modified Delphi Consensus to Establish Key Aspects of Cross-Education.

BACKGROUND: Cross-education refers to increased motor output (i.e., force generation, skill) of the opposite, untrained limb following a period of unilateral exercise training. Despite extensive research, several aspects of the transfer phenomenon remain controversial. METHODS: A modified two-round Delphi online survey was conducted among international experts to reach consensus on terminology, methodology, mechanisms of action, and translational potential of cross-education, and to provide a framework for future research. RESULTS: Through purposive sampling of the literature, we identified 56 noted experts in the field, of whom 32 completed the survey, and reached consensus (75% threshold) on 17 out of 27 items. CONCLUSION: Our consensus-based recommendations for future studies are that (1) the term 'cross-education' should be adopted to refer to the transfer phenomenon, also specifying if transfer of strength or skill is meant; (2) functional magnetic resonance imaging, short-interval intracortical inhibition and interhemispheric inhibition appear to be promising tools to study the mechanisms of transfer; (3) strategies which maximize cross-education, such as high-intensity training, eccentric contractions, and mirror illusion, seem worth being included in the intervention plan; (4) study protocols should be designed to include at least 13-18 sessions or 4-6 weeks to produce functionally meaningful transfer of strength, and (5) cross-education could be considered as an adjuvant treatment particularly for unilateral orthopedic conditions and sports injuries. Additionally, a clear gap in views emerged between the research field and the purely clinical field. The present consensus statement clarifies relevant aspects of cross-education including neurophysiological, neuroanatomical, and methodological characteristics of the transfer phenomenon, and provides guidance on how to improve the quality and usability of future cross-education studies.

I-wave periodicity transcranial magnetic stimulation (iTMS) on corticospinal excitability. A systematic review of the literature.

Repetitive transcranial magnetic stimulation (rTMS) is an established technique that can modulate excitability of the motor cortex and corticospinal tract, beyond the duration of the stimulation itself. More recently, a newer repetitive technique, known as I-wave periodicity TMS (iTMS) has been purported to show increases in corticospinal excitability following at least 10 min of iTMS duration. The aim of this study was to use a systematic review to search the literature from January 2000 to October 2015 with regard to corticospinal outcomes following iTMS intervention. We also rated the quality of studies and assessed the risk of bias by applying the Downs and Black checklist and the Cochrane Collaboration Risk of Bias Tool respectively. From an initial yield of 144, 11 studies were included. Studies were found to be of moderate quality, however a high risk of bias was identified. Despite these issues, evidence from the studies presented in this review so far indicates that iTMS is effective in increasing corticospinal excitability. However, further studies are required from other groups to validate the findings to date. Additional research is required to reduce the variability in corticospinal excitability and also to functional outcomes along with corticospinal excitability following iTMS.

Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain.

Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P < 0.001), but no differences were detected between AKP and controls (P = 0.47). CSE appears to be greater in PT than controls and other AKP. An improved understanding of the corticospinal responses in different sources of knee pain may direct better treatment approaches.

Motor cortex excitability is not differentially modulated following skill and strength training.

AIM: A single session of skill or strength training can modulate the primary motor cortex (M1), which manifests as increased corticospinal excitability (CSE) and decreased short-latency intra-cortical inhibition (SICI). We tested the hypothesis that both skill and strength training can propagate the neural mechanisms mediating cross-transfer and modulate the ipsilateral M1 (iM1). METHODS: Transcranial magnetic stimulation (TMS) measured baseline CSE and SICI in the contralateral motor cortex (cM1) and iM1. Participants completed 4 sets of unilateral training with their dominant arm, either visuomotor tracking, metronome-paced strength training (MPST), self-paced strength training (SPST) or control. Immediately post training, TMS was repeated in both M1s. RESULTS: Motor-evoked potentials (MEPs) increased and inhibition was reduced for skill and MPST training from baseline in both M1s. Self-paced strength training and control did not produce changes in CSE and SICI when compared to baseline in both M1s. After training, skill and MPST increased CSE and decreased SICI in cM1 compared to SPST and control. Skill and MPST training decreased SICI in iM1 compared to SPST and control post intervention; however, CSE in iM1 was not different across groups post training. CONCLUSION: Both skill training and MPST facilitated an increase in CSE and released SICI in iM1 and cM1 compared to baseline. Our results suggest that synchronizing to an auditory or a visual cue promotes neural adaptations within the iM1, which is thought to mediate cross transfer.

Increased cross-education of muscle strength and reduced corticospinal inhibition following eccentric strength training.

AIM: Strength training of one limb results in a substantial increase in the strength of the untrained limb, however, it remains unknown what the corticospinal responses are following either eccentric or concentric strength training and how this relates to the cross-education of strength. The aim of this study was to determine if eccentric or concentric unilateral strength training differentially modulates corticospinal excitability, inhibition and the cross-transfer of strength. METHODS: Changes in contralateral (left limb) concentric strength, eccentric strength, motor-evoked potentials, short-interval intracortical inhibition and silent period durations were analyzed in groups of young adults who exercised the right wrist flexors with either eccentric (N=9) or concentric (N=9) contractions for 12 sessions over 4weeks. Control subjects (N=9) did not train. RESULTS: Following training, both groups exhibited a significant strength gain in the trained limb (concentric group increased concentric strength by 64% and eccentric group increased eccentric strength by 62%) and the extent of the cross-transfer of strength was 28% and 47% for the concentric and eccentric group, respectively, which was different between groups (P=0.031). Transcranial magnetic stimulation revealed that eccentric training reduced intracortical inhibition (37%), silent period duration (15-27%) and increased corticospinal excitability (51%) compared to concentric training for the untrained limb (P=0.033). There was no change in the control group. CONCLUSION: The results show that eccentric training uniquely modulates corticospinal excitability and inhibition of the untrained limb to a greater extent than concentric training. These findings suggest that unilateral eccentric contractions provide a greater stimulus in cross-education paradigms and should be an integral part of the rehabilitative process following unilateral injury to maximize the response.

Unilateral bicep curl hemodynamics: Low-pressure continuous vs high-pressure intermittent blood flow restriction.

Light-load exercise training with blood flow restriction (BFR) increases muscle strength and size. However, the hemodynamics of BFR exercise appear elevated compared with non-BFR exercise. This questions the suitability of BFR in special/clinical populations. Nevertheless, hemodynamics of standard prescription protocols for BFR and traditional heavy-load exercise have not been compared. We investigated the hemodynamics of two common BFR exercise methods and two traditional resistance exercises. Twelve young males completed four unilateral elbow flexion exercise trials in a balanced, randomized crossover design: (a) heavy load [HL; 80% one-repetition maximum (1-RM)]; (b) light load (LL; 20% 1-RM); and two other light-load trials with BFR applied (c) continuously at 80% resting systolic blood pressure (BFR-C) or (d) intermittently at 130% resting systolic blood pressure (BFR-I). Hemodynamics were measured at baseline, during exercise, and for 60-min post-exercise. Exercising heart rate, blood pressure, cardiac output, and rate-pressure product were significantly greater for HL and BFR-I compared with LL. The magnitude of hemodynamic stress for BFR-C was between that of HL and LL. These data show reduced hemodynamics for continuous low-pressure BFR exercise compared with intermittent high-pressure BFR in young healthy populations. BFR remains a potentially viable method to improve muscle mass and strength in special/clinical populations.

Effects of vitamin D supplementation on neuroplasticity in older adults: a double-blinded, placebo-controlled randomised trial.

UNLABELLED: Vitamin D can improve muscle function and reduce falls, but whether it can strengthen neural connections within the brain and nervous system is not known. This 10-week randomised controlled trial indicates that treatment with 2,000 IU/day vitamin D3 does not significantly alter neuroplasticity relative to placebo in older adults. INTRODUCTION: The purpose of this study was to examine the effects of vitamin D supplementation on neuroplasticity, serum brain-derived neurotrophic factor (BDNF) and muscle strength and function in older adults. METHODS: This was a 10-week double-blinded, placebo-controlled randomised trial in which 26 older adults with 25-hydroxyvitamin D [25OHD] concentrations 25-60 nmol/L were randomised to 2,000 IU/day vitamin D3 or matched placebo. Single- and paired-pulse transcranial magnetic stimulation applied over the motor cortex was used to assess changes in motor-evoked potentials (MEPs) and short-interval intracortical inhibition (SICI), as measures of corticospinal excitability and inhibition respectively, by recording electromyography (EMG) responses to stimulation from the wrist extensors. Changes in muscle strength, stair climbing power, gait (timed-up-and-go), dynamic balance (four square step test), serum 25(OH)D and BDNF concentrations were also measured. RESULTS: After 10 weeks, mean 25(OH)D levels increased from 46 to 81 nmol/L in the vitamin D group with no change in the placebo group. The vitamin D group experienced a significant 8-11% increase in muscle strength and a reduction in cortical excitability (MEP amplitude) and SICI relative to baseline (all P < 0.05), but these changes were not significantly different from placebo. There was no effect of vitamin D on muscle power, function or BDNF. CONCLUSIONS: Daily supplementation with 2,000 IU vitamin D3 for 10 weeks had no significant effect on neuroplasticity compared to placebo, but the finding that vitamin D treatment alone was associated with a decrease in corticospinal excitability and intracortical inhibition warrants further investigation as this suggests that it may improve the efficacy of neural transmission within the corticospinal pathway.

Objectively measured muscle fatigue in Crohn's disease: correlation with self-reported fatigue and associated factors for clinical application.

BACKGROUND & AIMS: The association of fatigue with decreased physical performance and underlying mechanisms are poorly understood in Crohn's disease (CD). We aimed to measure and compare self-reported fatigue with skeletal muscle fatigue in CD subjects and healthy controls, and to identify associated factors that may be amenable to change. METHODS: Demographic and clinical data were collected and fatigue assessed using the Fatigue Impact Scale (FIS) in 27 consecutive CD patients and 22 matched healthy controls. Circulating cytokines and growth factors were measured. The rate of quadriceps muscle fatigue was assessed using an isokinetic dynamometer as the decrement of force with 30 contractions performed over a 5-minute period. RESULTS: Compared with healthy controls, CD patients reported greater levels of fatigue (mean global FIS score 45.3 vs 10.5, physical dimension score 12.3 vs 2.7 respectively; each p<0.01) and muscle fatigue (-5.2 vs -1.3 Nm min(-1); p<0.05). The two indices were correlated (r = -0.52 in CD; p<0.01). Patients with CD had lower mean serum IGF-1 levels (16.1 vs 25.4 pmol/L, p<0.01) and higher oxidative stress (TBARS assay 4.3 vs 3.9 µM, p<0.05). On multivariate analysis, low serum vitamin D, IGF-1 and magnesium, and higher IL-6 levels were associated with increased muscle fatigue (all p ≤ 0.05). CONCLUSION: Subjects with CD had more muscle fatigue than matched healthy controls and this correlated well with self-reported fatigue. Of circulating factors that were independently associated with increased muscle fatigue, vitamin D, magnesium and IGF-1 could be targeted in future studies to reduce fatigue and improve physical performance.

Corticospinal adaptations and strength maintenance in the immobilized arm following 3 weeks unilateral strength training.

Cross-education strength training has being shown to retain strength and muscle thickness in the immobilized contralateral limb. Corticospinal mechanisms have been proposed to underpin this phenomenon; however, no transcranial magnetic stimulation (TMS) data has yet been presented. This study used TMS to measure corticospinal responses following 3 weeks of unilateral arm training on the contralateral, immobilize arm. Participants (n = 28) were randomly divided into either immobilized strength training (Immob + train) immobilized no training (Immob) or control. Participants in the immobilized groups had their nondominant arm rested in a sling, 15 h/day for 3 weeks. The Immob + train group completed unilateral arm curl strength training, while the Immob and control groups did not undertake training. All participants were tested for corticospinal excitability, strength, and muscle thickness of both arms. Immobilization resulted in a group x time significant reduction in strength, muscle thickness and corticospinal excitability for the untrained limb of the Immob group. Conversely, no significant change in strength, muscle thickness, or corticospinal excitability occurred in the untrained limb of the Immob + train group. These results provide the first evidence of corticospinal mechanisms, assessed by TMS, underpinning the use of unilateral strength training to retain strength and muscle thickness following immobilization of the contralateral limb.

Strength training reduces intracortical inhibition.

AIM: Paired-pulse transcranial magnetic stimulation was used to investigate the influence of 4 weeks of heavy load squat strength training on corticospinal excitability and short-interval intracortical inhibition (rectus femoris muscle). METHODS: Participants (n = 12) were randomly allocated to a strength training or control group. The strength training group completed 4 weeks of heavy load squat strength training. Recruitment curves were constructed to determine values for the slope of the curve, V50 and peak height. Short-interval intracortical inhibition was assessed using a subthreshold (0.7 × active motor threshold) conditioning stimulus, followed 3 ms later by a supra-threshold (1.2 × active motor threshold) test stimulus. All motor evoked responses were taken during 10% of maximal voluntary isometric contraction (MVC) torque and normalized to the maximal M-wave. RESULTS: The strength training group attained 87% increases in 1RM squat strength (P < 0.01), significant increases in measures of corticospinal excitability (1.2 × Motor threshold: 116%, P = 0.016; peak height of recruitment curve = 105%, P < 0.001), and a 32% reduction in short-interval intracortical inhibition (P < 0.01) following the 4-week intervention compared with control. There were no changes in any dependent variable (P > 0.05) detected in the control group. CONCLUSION: Repeated high force voluntary muscle activation in the form of short-term strength training reduces short-interval intracortical inhibition. This is consistent with studies involving skilled/complex tasks or novel movement patterns and acute studies investigating acute voluntary contractions.

Effect of heavy dynamic resistive exercise on acute upper-body power.

There is limited research to support the notion that heavy resistive exercise immediately before a power movement may acutely enhance performance. Upper-body acute power enhancement during a stretch-shorten cycle (SSC) movement has not been previously investigated. The aim of this project was to determine whether a set of 5 repetitions of 5 repetition maximum (RM) bench press preceding explosive push-ups would significantly influence indicators of power: impulse and maximum rate of force development. Subjects randomly performed either explosive push-ups only over a force platform or a set of 5RM bench press before the explosive push-ups. There were no significant differences for any of the force platform data when the explosive push-ups were preceded by a set of 5RM bench press. It appears that heavy dynamic resistive upper-body exercise on its own before an upper-body power activity is inadequate in augmenting short-term power.