The effect of type of afferent feedback timed with motor imagery on the induction of cortical plasticity.

A peripherally generated afferent volley that arrives at the peak negative (PN) phase during the movement related cortical potential (MRCP) induces significant plasticity at the cortical level in healthy individuals and chronic stroke patients. Transferring this type of associative brain-computer interface (BCI) intervention into the clinical setting requires that the proprioceptive input is comparable to the techniques implemented during the rehabilitation process. These consist mainly of functional electrical stimulation (FES) and passive movement induced by an actuated orthosis. In this study, we compared these two interventions (BCIFES and BCIpassive) where the afferent input was timed to arrive at the motor cortex during the PN of the MRCP. Twelve healthy participants attended two experimental sessions. They were asked to perform 30 dorsiflexion movements timed to a cue while continuous electroencephalographic (EEG) data were collected from FP1, Fz, FC1, FC2, C3, Cz, C4, CP1, CP2, and Pz, according to the standard international 10-20 system. MRCPs were extracted and the PN time calculated. Next, participants were asked to imagine the same movement 30 times while either FES (frequency: 20Hz, intensity: 8-35mAmp) or a passive ankle movement (amplitude and velocity matched to a normal gait cycle) was applied such that the first afferent inflow would coincide with the PN of the MRCP. The change in the output of the primary motor cortex (M1) was quantified by applying single transcranial magnetic stimuli to the area of M1 controlling the tibialis anterior (TA) muscle and measuring the motor evoked potential (MEP). Spinal changes were assessed pre and post by eliciting the TA stretch reflex. Both BCIFES and BCIpassive led to significant increases in the excitability of the cortical projections to TA (F(2,22)=4.44, p=0.024) without any concomitant changes at the spinal level. These effects were still present 30min after the cessation of both interventions. There was no significant main effect of intervention, F(1,11)=0.38, p=0.550, indicating that the changes in MEP occurred independently of the type of afferent inflow. An afferent volley generated from a passive movement or an electrical stimulus arrives at the somatosensory cortex at similar times. It is thus likely that the similar effects observed here are strictly due to the tight coupling in time between the afferent inflow and the PN of the MRCP. This provides further support to the associative nature of the proposed BCI system.

Convergence of ipsi- and contralateral muscle afferents on common interneurons mediating reciprocal inhibition of ankle plantarflexors in humans.

Recent studies have shown that afferents arising from muscle receptors located on one side can affect the activity of muscles on the contralateral side. In animal preparations, evidence supports that afferent pathways originating from one limb converge onto interneurons mediating disynaptic reciprocal Ia inhibition of the opposite limb. This study was designed to investigate whether this pathway is similar in humans to that described in animals. Thirteen healthy volunteers participated in one of two experiments. In experiment 1, the effects of ipsilateral posterior tibial nerve (iPTN) stimulation were assessed on the reciprocal Ia inhibition of the contralateral soleus (cSOL) motoneuronal pool (n = 8). Across all participants, iPTN stimulation intensity was 1.69 ± 0.3 × Motor Threshold (MT) and contralateral common peroneal (cCPN) stimulation intensity was 0.86 ± 0.16 × MT. iPTN and cCPN stimulation were delivered separately or in combination and changes in the ongoing electromyography (EMG) quantified. In experiment 2, the amplitude of a test SOL H-reflex elicited by contralateral PTN (cPTN) stimulation was quantified following iPTN, cCPN or iPTN + cCPN nerve stimulation (n = 5). Intensities used during the H-reflex conditioning experiment were 1.79 ± 0.4 × MT for the iPTN stimulation and 0.88 ± 0.16 × MT for cCPN stimulation. Across all participants, the onset of the cSOL EMG suppression was 42 ± 4, 44 ± 3 and 44 ± 3 ms for iPTN, cCPN and iPTN + cCPN conditions, respectively. The inhibition from the combined iPTN and cCPN stimulation was significantly greater compared to the algebraic sum of their separate effects. When conditioning the cSOL H-reflex, the ISI between the test cPTN and the iPTN or cCPN stimulus was 5.4 ± 0.5 and 2.6 ± 0.5, respectively. The combined stimulation induced a significantly greater inhibition compared to their separate effects. These data provide evidence of convergence on common inhibitory interneurons by muscle afferents activated by iPTN and cCPN stimulation during sitting. Since the inhibition elicited by cCPN stimulation is known to be mediated by the disynaptic Ia inhibitory pathway, this suggests that the crossed inhibition of cSOL motoneurones elicited by muscle afferents from the ipsilateral plantarflexor muscles is at least partly mediated by Ia inhibitory interneurons in the contralateral human spinal cord. This is similar to what has been observed in the cat.

Cortical involvement in the StartReact effect.

The rapid release of prepared movements by a loud acoustic stimulus capable of eliciting a startle response has been termed the StartReact effect (Valls-Solé et al., 1999), and premotor reaction times (PMTs) of <70 ms are often observed. Two explanations have been given for these short latency responses. The subcortical storage and triggering hypothesis suggests movements that can be prepared in advance of a "go" signal are stored and triggered from subcortical areas by a startling acoustic stimulus (SAS) without cortical involvement. Alternatively, it has been hypothesized that the SAS can trigger movements from cortical areas through a faster pathway ascending from subcortical structures. Two experiments were designed to examine the possible role of the primary motor cortex in the StartReact effect. In Experiment 1, we used suprathreshold transcranial magnetic stimulation (TMS) during the reaction time (RT) interval to induce a cortical silent period in the contralateral primary motor cortex (M1). Thirteen participants performed 20° wrist extension movements as fast as possible in response to either a control stimulus (82 dB) or SAS (124 dB). PMTs for startle trials were faster than for control trials, while TMS significantly delayed movement onset compared to No TMS or Sham TMS conditions. In Experiment 2, we examined the StartReact effect in a highly cortically represented action involving speech of a consonant-vowel (CV) syllable. Similar to previous work examining limb movements, a robust StartReact effect was found. Collectively, these experiments provide evidence for cortical (M1) involvement in the StartReact effect.