This thesis describes experiments designed to investigate the effects of neuromuscular electrical stimulation (NMES) on corticospinal (CS) excitability in humans. NMES delivered at 100 Hz was more effective for increasing CS excitability than 10-, 50-, or 200-Hz NMES. CS excitability increases occurred after 24 min of 100-Hz NMES, were strongest in the stimulated muscle, and were mediated primarily at a supraspinal level. NMES of the common peroneal nerve of the leg increased CS excitability in multiple leg muscles, whereas NMES of the median nerve of the hand increased CS excitability in only the muscle innervated by that nerve. Additionally, CS excitability for the hand increased after 40 min of relatively high intensity and frequency NMES but not after 2 h of lower intensity and frequency NMES. These results have implications for identifying optimal NMES parameters to augment CS excitability for rehabilitation after central nervous system injury.

The purpose of this thesis was to investigate the potential mechanisms and sites of neural adaptations that mediate cross-limb transfer of strength and motor learning that can occur subsequent to unilateral training. Better understanding of the mechanisms should allow therapeutic benefits of this effect to be assessed. There are two main classes of mechanisms that could contribute to cross-limb transfer. The first is described by the ??bilateral access?? hypothesis, which suggests that neural adaptations induced by training reside in bilaterally projecting motor areas that are accessible to the untrained (ipsilateral) hemisphere during task execution to facilitate performance. According to the alternative ??cross-activation?? hypothesis, activation of the untrained hemisphere during unilateral training leads to adaptations in the untrained hemisphere that cause improved performance with the opposite untrained limb. A series of studies were conducted in this research. We directly tested the cross-activation hypothesis via a reliable twitch interpolation technique involving transcranial magnetic stimulation (TMS). Four-weeks of strength training for the right wrist increased neural drive (from the untrained motor cortex) to the untrained left wrist. The data demonstrate that strength training of one limb can influence the efficacy of corticospinal pathways that project to the opposite untrained limb, consistent with the cross-activation hypothesis. To investigate the contribution of each hemisphere in cross-limb transfer, we applied repetitive TMS (rTMS) to the trained or the untrained motor cortex to disrupt brain processing after unilateral ballistic training. Learning to produce ballistic movements requires optimization of motor drive to the relevant muscles in a way that resembles high-force contractions performed during strength training. Ballistic skill transferred rapidly to the untrained hand and the improved performance was accompanied by bilateral increases in corticospinal excitability. Performance improvement in each hand was specifically suppressed by rTMS of the opposite hemisphere. Thus the motor cortex ipsilateral to the trained hand is critically altered during unilateral training; and neural adaptations within this untrained hemisphere are crucial in cross-limb transfer of ballistic skill. Overall, the data are in agreement with the cross-activation hypothesis for high-force and ballistic tasks, although they do not exclude the potential involvement of bilateral access mechanisms.

Neuromuscular electrical stimulation (NMES) has become an increasingly popular rehabilitative treatment approach for swallowing disorders (dysphagia). However, its precise effects on swallowing biomechanics and measures of swallowing neurophysiology are unclear. Clearly defined NMES treatment protocols that have been corroborated by thorough empirical research are lacking. The primary objective of this research programme was therefore to establish optimal NMES treatment parameters for the anterior hyo-mandibular (submental) musculature, a muscle group that is critically involved in the oral and pharyngeal phases of swallowing. Based on previous research, the primary hypothesis was that various NMES treatment protocols would have differential effects of either enhancing or inhibiting the excitability of corticobulbar projections to this muscle group. The research paradigm used to test this hypothesis was an evaluation of MEP amplitude and onset latency, recorded in the functional context of volitional contraction of the submental musculature (VC) and contraction of this muscle group during the pharyngeal phase of volitional swallowing (VPS, volitional pharyngeal swallow). Outcome measures were recorded before and at several time points after each NMES treatment trial. This methodology is similar to, but improved upon, research paradigms previously reported. Changes in corticobulbar excitability in response to various NMES treatment protocols were recorded in a series of experiments. Ten healthy research participants were recruited into a study that evaluated the effects of event-related NMES, whereas 15 healthy research participants were enrolled in a study that investigated the effects of non-event-related NMES. In a third cohort of 35 healthy research participants, task-dependent differences in corticobulbar excitability were evaluated during three conditions of submental muscle contraction: VC, VPS and submental muscle contraction during the pharyngeal phase of reflexive swallowing (RPS, reflexive pharyngeal swallowing). Event-related NMES induced frequency-depended changes in corticobulbar excitability. NMES administered at 80 Hz facilitated MEP amplitude, whereas NMES at 5 Hz and 20 Hz inhibited MEP amplitude. No changes were observed after NMES at 40 Hz. Maximal excitatory or inhibitory changes occurred 60 min post-treatment. Changes in MEP amplitude in response to event-related NMES were only observed when MEPs were recorded during the VC condition, whereas MEPs recorded during the VPS condition remained unaffected. Non-event-related NMES did not affect MEP amplitude in either of the muscle contraction conditions. Similarly, MEP onset latencies remained unchanged across all comparisons. MEPs were detected most consistently during the VC contraction condition. They were less frequently detected and were smaller in amplitude for the VPS condition and they were infrequently detected during pre-activation by RPS. The documented results indicate that event-related NMES has a more substantial impact on MEP amplitude than non-event-related NMES, producing excitatory and inhibitory effects. Comparison of MEPs recorded during VC, VPS and RPS suggests that different neural networks may govern the motor control of submental muscle activation during these tasks. This research programme is the first to investigate the effects of various NMES treatment protocols on the excitability of submental corticobulbar projections. It provides important new information for the use of NMES in clinical rehabilitation practices and our understanding of the neural networks governing swallowing motor control.

The purpose of this thesis was to investigate the potential mechanisms and sites of neural adaptations that mediate cross-limb transfer of strength and motor learning that can occur subsequent to unilateral training. Better understanding of the mechanisms should allow therapeutic benefits of this effect to be assessed. There are two main classes of mechanisms that could contribute to cross-limb transfer. The first is described by the ??bilateral access?? hypothesis, which suggests that neural adaptations induced by training reside in bilaterally projecting motor areas that are accessible to the untrained (ipsilateral) hemisphere during task execution to facilitate performance. According to the alternative ??cross-activation?? hypothesis, activation of the untrained hemisphere during unilateral training leads to adaptations in the untrained hemisphere that cause improved performance with the opposite untrained limb. A series of studies were conducted in this research. We directly tested the cross-activation hypothesis via a reliable twitch interpolation technique involving transcranial magnetic stimulation (TMS). Four-weeks of strength training for the right wrist increased neural drive (from the untrained motor cortex) to the untrained left wrist. The data demonstrate that strength training of one limb can influence the efficacy of corticospinal pathways that project to the opposite untrained limb, consistent with the cross-activation hypothesis. To investigate the contribution of each hemisphere in cross-limb transfer, we applied repetitive TMS (rTMS) to the trained or the untrained motor cortex to disrupt brain processing after unilateral ballistic training. Learning to produce ballistic movements requires optimization of motor drive to the relevant muscles in a way that resembles high-force contractions performed during strength training. Ballistic skill transferred rapidly to the untrained hand and the improved performance was accompanied by bilateral increases in corticospinal excitability. Performance improvement in each hand was specifically suppressed by rTMS of the opposite hemisphere. Thus the motor cortex ipsilateral to the trained hand is critically altered during unilateral training; and neural adaptations within this untrained hemisphere are crucial in cross-limb transfer of ballistic skill. Overall, the data are in agreement with the cross-activation hypothesis for high-force and ballistic tasks, although they do not exclude the potential involvement of bilateral access mechanisms.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 6 uppsatser.

Les mécanismes de neuroplasticité sont essentiels pour la mise en place et le renforcement des circuits neuronaux lors de périodes critiques du développement, et permettent au cerveau de s'adapter au cours des différentes étapes de la vie. Ces mécanismes varient avec l'âge, sont généralement plus difficile à activer chez l'adulte, et diminuent dans le cerveau âgé. La stimulation magnétique transcrânienne répétée (rTMS) est actuellement utilisée pour moduler l'excitabilité corticale et est décrite comme prometteuse dans le traitement de certains troubles neurologiques. La rTMS de faible intensité (LI-rTMS), ne déclenchant pas directement de potentiels d'action dans les neurones stimulés, a aussi montré des effets thérapeutiques, il est donc important de comprendre les effets biologiques de ces champs magnétiques d'intensités similaires à celles présentes dans les régions adjacentes à la région ciblée par la rTMS de haute intensité. Nous avons utilisé une stimulation magnétique focale de faible intensité (10 mT), ciblant le cervelet ainsi que la voie olivocérébelleuse chez la souris, afin d'aborder certaines de ces questions. Le cervelet est un modèle pertinent, en effet son développement, sa structure, son vieillissement et ses fonctions sont bien décrits, facilitant la détection d'éventuelles modifications dans cette région. Nous avons étudié les effets de LI-rTMS, in vivo ou in vitro, sur la morphologie neuronale, le comportement, et la plasticité post-lésionnelle. Dans une première étude nous avons montré que la LI-rTMS in vivo modifie les épines et la morphologie dendritique des cellules de Purkinje, ces modifications sont associées à une amélioration de la mémoire. / Neuroplasticity is essential for the establishment and strengthening of neural circuits during the critical period of development, and are required for the brain to adapt to its environment. The mechanisms of plasticity vary throughout life, are generally more difficult to induce in the adult brain, and decrease with advancing age. Repetitive transcranial magnetic stimulation (rTMS) is commonly used to modulate cortical excitability and shows promise in the treatment of some neurological disorders. Low intensity magnetic stimulation (LI-rTMS), which does not directly elicit action potentials in the stimulated neurons, have also shown some therapeutic effects, and it is important to determine the biological mechanisms underlying the effects of these low intensity magnetic fields, such as would occur in the regions surrounding the central high-intensity focus of rTMS. We have used a focal low-intensity magnetic stimulation (10mT) to address some of these issues in the mouse cerebellum and olivocerebellar path. The cerebellum model is particularly useful as its development, structure, ageing and function are well described which allows us to easily detect eventual modifications. We assessed effects of in vivo or in vitro LI-rTMS on neuronal morphology, behavior, and post-lesion plasticity. We first showed that LI-rTMS treatment in vivo alters dendritic spines and dendritic morphology, in association with improved spatial memory. These effects were age dependent. To optimize stimulation parameters in order to induce post-lesion reinnervation we used our in vitro model of post-lesion repair to systematically investigate the effects of different LI-rTMS stimulation patterns and frequencies. We showed that the pattern of stimulation is critical for allowing repair, rather than the total number of stimulation pulses. Finally, we looked for potential underlying mechanisms participating in the effects of the LI-rTMS, using mouse mutants in vivo or in vitro. We found that the cryptochromes, which have magnetoreceptor properties, must be present for the response to magnetic stimulation to be transduced into biological effects. The ensemble of our results indicate that the effects of LI-rTMS depend upon the presence of magnetoreceptors, the stimulation protocol, and the age of the animal suggesting that future therapeutic strategies must be adapted to the neuronal context in each individual person.

Em pacientes com esquizofrenia, sintomas obsessivo-compulsivos (SOC) são associados com taxas mais baixas de qualidade de vida e polifarmácia. Não há estudos controlados anteriores testando a eficácia da estimulação magnética transcraniana repetitiva (EMTr) para o tratamento de SOC nesta população. Este trabalho examinou os efeitos terapêuticos da EMTr aplicadas à Área Motora Suplementar (1 Hz, 20 min, 20 sessões) em SOC e sintomas gerais em pacientes com esquizofrenia ou transtorno esquizoafetivo, e se esta intervenção pode produzir alterações nos níveis plasmáticos do fator neurotrófico derivado do cérebro (BDNF). Inicialmente, foi realizado um relato de três casos, com o objetivo de fornecer uma evidência inicial de eficácia. Dois dos três pacientes que participaram apresentaram redução da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS), com retorno aos valores iniciais 4 semanas após o término do tratamento. Foi realizado então um estudo duplo-cego randomizado controlado por placebo para confirmação dos efeitos terapêuticos. EMTr ativa e placebo foram entregues para 12 pacientes (6 em cada grupo). Os escores da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e da Escala Breve de Avaliação Psiquiátrica (BPRS), bem como os níveis de BDNF, foram avaliados antes, depois, e 4 semanas após as intervenções. A EMTr não alterou significativamente os resultados após o tratamento e no follow-up (Y-BOCS: Χ2 = 3,172; p = 0,205; BPRS: X2 = 1.629; p = 0,443; BDNF: X2 = 2.930; p = 0,231). Parece haver uma tendência para a melhoria da pontuação BPRS 4 semanas após o tratamento no grupo ativo comparando com placebo (d de Cohen = 0,875, com 32,9% de poder estatístico). Não foram relatados efeitos colaterais. São necessários estudos futuros com amostras maiores. / In patients with schizophrenia, obsessive-compulsive symptoms (OCS) are associated with lower rates of quality of life and polypharmacy. No previous controlled studies have tested the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the treatment of OCS in this population. The present study examined the therapeutic effects of rTMS applied to the supplementary motor area (1 Hz, 20 min, 20 sessions) on OCS and general symptoms in patients with schizophrenia or schizoaffective disorder, and whether this intervention can produce changes in plasma levels of brain-derived neurotrophic factor (BDNF). Initially, there was a report of three cases with the aim of providing initial evidence of efficacy. Two patients showed a reduction on the Yale-Brown Obsessive-Compulsive Symptoms Scale (Y-BOCS) scores, with return to baseline 4 weeks after completion of treatment. Then, a double-blind randomized controlled trial was conducted. Active and sham rTMS were delivered to 12 patients (6 on each group). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Brief Psychiatric Rating Scale (BPRS) scores, as well as BDNF levels, were assessed before, after, and 4 weeks after treatment. rTMS did not significantly change the outcomes after treatment and on the follow-up (Y-BOCS: Wald’s Χ2=3.172; p=0.205; BPRS: X2=1.629; p=0.443; BDNF: X2=2.930; p=0.231). There seemed to be a trend towards improvement of BPRS scores 4 weeks after rTMS treatment comparing with sham (Cohen’s d=0.875, with 32.9% statistical power). No side effects were reported. Future studies with larger sample sizes are needed.

abstract: The human hand is a complex biological system. Humans have evolved a unique ability to use the hand for a wide range of tasks, including activities of daily living such as successfully grasping and manipulating objects, i.e., lifting a cup of coffee without spilling. Despite the ubiquitous nature of hand use in everyday activities involving object manipulations, there is currently an incomplete understanding of the cortical sensorimotor mechanisms underlying this important behavior. One critical aspect of natural object grasping is the coordination of where the fingers make contact with an object and how much force is applied following contact. Such force-to-position modulation is critical for successful manipulation. However, the neural mechanisms underlying these motor processes remain less understood, as previous experiments have utilized protocols with fixed contact points which likely rely on different neural mechanisms from those involved in grasping at unconstrained contacts. To address this gap in the motor neuroscience field, transcranial magnetic stimulation (TMS) and electroencephalography (EEG) were used to investigate the role of primary motor cortex (M1), as well as other important cortical regions in the grasping network, during the planning and execution of object grasping and manipulation. The results of virtual lesions induced by TMS and EEG revealed grasp context-specific cortical mechanisms underlying digit force-to-position coordination, as well as the spatial and temporal dynamics of cortical activity during planning and execution. Together, the present findings provide the foundation for a novel framework accounting for how the central nervous system controls dexterous manipulation. This new knowledge can potentially benefit research in neuroprosthetics and improve the efficacy of neurorehabilitation techniques for patients affected by sensorimotor impairments. / Dissertation/Thesis / Doctoral Dissertation Neuroscience 2017

abstract: The activation of the primary motor cortex (M1) is common in speech perception tasks that involve difficult listening conditions. Although the challenge of recognizing and discriminating non-native speech sounds appears to be an instantiation of listening under difficult circumstances, it is still unknown if M1 recruitment is facilitatory of second language speech perception. The purpose of this study was to investigate the role of M1 associated with speech motor centers in processing acoustic inputs in the native (L1) and second language (L2), using repetitive Transcranial Magnetic Stimulation (rTMS) to selectively alter neural activity in M1. Thirty-six healthy English/Spanish bilingual subjects participated in the experiment. The performance on a listening word-to-picture matching task was measured before and after real- and sham-rTMS to the orbicularis oris (lip muscle) associated M1. Vowel Space Area (VSA) obtained from recordings of participants reading a passage in L2 before and after real-rTMS, was calculated to determine its utility as an rTMS aftereffect measure. There was high variability in the aftereffect of the rTMS protocol to the lip muscle among the participants. Approximately 50% of participants showed an inhibitory effect of rTMS, evidenced by smaller motor evoked potentials (MEPs) area, whereas the other 50% had a facilitatory effect, with larger MEPs. This suggests that rTMS has a complex influence on M1 excitability, and relying on grand-average results can obscure important individual differences in rTMS physiological and functional outcomes. Evidence of motor support to word recognition in the L2 was found. Participants showing an inhibitory aftereffect of rTMS on M1 produced slower and less accurate responses in the L2 task, whereas those showing a facilitatory aftereffect of rTMS on M1 produced more accurate responses in L2. In contrast, no effect of rTMS was found on the L1, where accuracy and speed were very similar after sham- and real-rTMS. The L2 VSA measure was indicative of the aftereffect of rTMS to M1 associated with speech production, supporting its utility as an rTMS aftereffect measure. This result revealed an interesting and novel relation between cerebral motor cortex activation and speech measures. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2018

Em pacientes com esquizofrenia, sintomas obsessivo-compulsivos (SOC) são associados com taxas mais baixas de qualidade de vida e polifarmácia. Não há estudos controlados anteriores testando a eficácia da estimulação magnética transcraniana repetitiva (EMTr) para o tratamento de SOC nesta população. Este trabalho examinou os efeitos terapêuticos da EMTr aplicadas à Área Motora Suplementar (1 Hz, 20 min, 20 sessões) em SOC e sintomas gerais em pacientes com esquizofrenia ou transtorno esquizoafetivo, e se esta intervenção pode produzir alterações nos níveis plasmáticos do fator neurotrófico derivado do cérebro (BDNF). Inicialmente, foi realizado um relato de três casos, com o objetivo de fornecer uma evidência inicial de eficácia. Dois dos três pacientes que participaram apresentaram redução da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS), com retorno aos valores iniciais 4 semanas após o término do tratamento. Foi realizado então um estudo duplo-cego randomizado controlado por placebo para confirmação dos efeitos terapêuticos. EMTr ativa e placebo foram entregues para 12 pacientes (6 em cada grupo). Os escores da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e da Escala Breve de Avaliação Psiquiátrica (BPRS), bem como os níveis de BDNF, foram avaliados antes, depois, e 4 semanas após as intervenções. A EMTr não alterou significativamente os resultados após o tratamento e no follow-up (Y-BOCS: Χ2 = 3,172; p = 0,205; BPRS: X2 = 1.629; p = 0,443; BDNF: X2 = 2.930; p = 0,231). Parece haver uma tendência para a melhoria da pontuação BPRS 4 semanas após o tratamento no grupo ativo comparando com placebo (d de Cohen = 0,875, com 32,9% de poder estatístico). Não foram relatados efeitos colaterais. São necessários estudos futuros com amostras maiores. / In patients with schizophrenia, obsessive-compulsive symptoms (OCS) are associated with lower rates of quality of life and polypharmacy. No previous controlled studies have tested the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the treatment of OCS in this population. The present study examined the therapeutic effects of rTMS applied to the supplementary motor area (1 Hz, 20 min, 20 sessions) on OCS and general symptoms in patients with schizophrenia or schizoaffective disorder, and whether this intervention can produce changes in plasma levels of brain-derived neurotrophic factor (BDNF). Initially, there was a report of three cases with the aim of providing initial evidence of efficacy. Two patients showed a reduction on the Yale-Brown Obsessive-Compulsive Symptoms Scale (Y-BOCS) scores, with return to baseline 4 weeks after completion of treatment. Then, a double-blind randomized controlled trial was conducted. Active and sham rTMS were delivered to 12 patients (6 on each group). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Brief Psychiatric Rating Scale (BPRS) scores, as well as BDNF levels, were assessed before, after, and 4 weeks after treatment. rTMS did not significantly change the outcomes after treatment and on the follow-up (Y-BOCS: Wald’s Χ2=3.172; p=0.205; BPRS: X2=1.629; p=0.443; BDNF: X2=2.930; p=0.231). There seemed to be a trend towards improvement of BPRS scores 4 weeks after rTMS treatment comparing with sham (Cohen’s d=0.875, with 32.9% statistical power). No side effects were reported. Future studies with larger sample sizes are needed.