Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina.
Department of Physical Therapy, School of Health Technology and Management, Stony Brook University , Stony Brook, New York.
J Neurophysiol. 2018 Dec 1;120(6):2745-2760. doi: 10.1152/jn.00362.2018. Epub 2018 Sep 12.
The activity of corticospinal pathways is important in movement control, and its plasticity is essential for motor skill learning and re-learning after central nervous system (CNS) injuries. Therefore, enhancing the corticospinal function may improve motor function recovery after CNS injuries. Operant conditioning of stimulus-induced muscle responses (e.g., reflexes) is known to induce the targeted plasticity in a targeted pathway. Thus, an operant conditioning protocol to target the corticospinal pathways may be able to enhance the corticospinal function. To test this possibility, we investigated whether operant conditioning of the tibialis anterior (TA) motor evoked potential (MEP) to transcranial magnetic stimulation can enhance corticospinal excitability in people with and without chronic incomplete spinal cord injury (SCI). The protocol consisted of 6 baseline and 24 up-conditioning/control sessions over 10 wk. In all sessions, TA MEPs were elicited at 10% above active MEP threshold while the sitting participant provided a fixed preset level of TA background electromyographic activity. During baseline sessions, MEPs were simply measured. During conditioning trials of the conditioning sessions, the participant was encouraged to increase MEP and was given immediate feedback indicating whether MEP size was above a criterion. In 5/8 participants without SCI and 9/10 with SCI, over 24 up-conditioning sessions, MEP size increased significantly to ~150% of the baseline value, whereas the silent period (SP) duration decreased by ~20%. In a control group of participants without SCI, neither MEP nor SP changed. These results indicate that MEP up-conditioning can facilitate corticospinal excitation, which is essential for enhancing motor function recovery after SCI. NEW & NOTEWORTHY We investigated whether operant conditioning of the motor evoked potential (MEP) to transcranial magnetic stimulation can systematically increase corticospinal excitability for the ankle dorsiflexor tibialis anterior (TA) in people with and without chronic incomplete spinal cord injury. We found that up-conditioning can increase the TA MEP while reducing the accompanying silent period (SP) duration. These findings suggest that MEP up-conditioning produces the facilitation of corticospinal excitation as targeted, whereas it suppresses inhibitory mechanisms reflected in SP.
皮质脊髓通路的活动对于运动控制很重要,其可塑性对于中枢神经系统 (CNS) 损伤后的运动技能学习和再学习至关重要。因此,增强皮质脊髓功能可能会改善 CNS 损伤后的运动功能恢复。刺激诱导肌肉反应(例如反射)的操作性条件反射已知可以在靶向途径中诱导靶向可塑性。因此,针对皮质脊髓通路的操作性条件反射方案可能能够增强皮质脊髓功能。为了检验这种可能性,我们研究了对胫骨前肌 (TA) 运动诱发电位 (MEP) 进行经颅磁刺激的操作性条件反射是否可以增强有无慢性不完全性脊髓损伤 (SCI) 的人的皮质脊髓兴奋性。该方案由 6 个基线和 24 个上调/对照疗程组成,持续 10 周。在所有疗程中,当坐姿参与者提供 TA 背景肌电图活动的固定预设水平时,在 10%高于主动 MEP 阈值的位置引出 TA MEP。在基线疗程中,简单地测量 MEP。在条件反射疗程的条件反射试验中,鼓励参与者增加 MEP,并立即反馈 MEP 大小是否高于标准。在无 SCI 的 5/8 名参与者和 10/10 名有 SCI 的参与者中,在 24 次上调疗程中,MEP 大小显着增加到基线值的约 150%,而静默期 (SP) 持续时间减少约 20%。在无 SCI 的对照组参与者中,MEP 和 SP 均未发生变化。这些结果表明,MEP 上调可以促进皮质脊髓兴奋,这对于增强 SCI 后的运动功能恢复至关重要。新的和值得注意的是我们研究了经颅磁刺激的运动诱发电位 (MEP) 的操作性条件反射是否可以系统地增加有无慢性不完全性脊髓损伤的人的踝背屈肌胫骨前肌 (TA) 的皮质脊髓兴奋性。我们发现,上调可以增加 TA MEP,同时减少伴随的静默期 (SP) 持续时间。这些发现表明,MEP 上调产生了针对皮质脊髓兴奋的促进作用,而抑制了 SP 中反映的抑制机制。
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