The clinical use of mirror visual feedback (MVF) was initially introduced to alleviate phantom pain, and has since been applied to the improvement of hemiparesis following stroke. However, it is not known whether MVF can restore motor function by producing plastic changes in the human primary motor cortex (M1). Here, we used transcranial magnetic stimulation to test whether M1 plasticity is a physiological substrate of MVF-induced motor behavioral improvement. MVF intervention in normal volunteers using a mirror box improved motor behavior and enhanced excitatory functions of the M1. Moreover, behavioral and physiological measures of MVFinduced changes were positively correlated with each other. Improved motor performance occurred after observation of a simple action, but not after repetitive motor training of the nontarget hand without MVF, suggesting the crucial importance of visual feedback. The beneficial effects of MVF were disrupted by continuous theta burst stimulation (cTBS) over the M1, but not the control site in the occipital cortex. However, MVF following cTBS could further improve the motor functions. Our findings indicate that M1 plasticity, especially in its excitatory connections, is an essential component of MVF-based therapies.

Repeated paired associative stimulation combining peripheral nerve stimulation and transcranial magnetic stimulation (TMS) of the primary motor cortex (M1) can produce human motor plasticity. However, previous studies used paired artificial stimuli, so that it is not known whether repetitive natural M1 activity associated with TMS can induce plasticity or not. To test this hypothesis, we developed a movement-related cortical stimulation (MRCS) protocol, in which the left M1 was stimulated by TMS at specific timing with respect to the mean expected reaction time (RT) of voluntary movement during a simple reaction time task using the right abductor pollicis brevis (APB) muscle. Seventeen normal volunteers were subjected to repeated MRCS intervention (0.2 Hz, 240 pairs). Motor function was assessed before and after MRCS. When TMS was given 50 ms before the RT of movement [MRCS(Ϫ50)], motor-evoked potential (MEP) amplitude of the right APB, but not other muscles, increased for up to 15 min post-MRCS. The RT of the right APB was also shortened. However, spinal excitability measured by F-wave did not change. When TMS was given 100 ms after the RT [MRCS(ϩ100)], MEP amplitude was decreased. These findings show that this new MRCS protocol can produce timing-dependent motor associative plasticity, which may be clinically useful.

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Patients with chronic stroke often show increased flexor hypertonia in their affected upper limbs. Although an intervention strategy targeting the extensors of the affected upper limb might thus be expected to have benefits for functional recovery, conventional repetitive motor training has limited clinical utility. Recent studies have shown that repetitive transcranial magnetic stimulation could induce motor recovery. The present study tested whether 5 Hz repetitive transcranial magnetic stimulation of the upper-limb area of the primary motor cortex, combined with extensor motor training, had a greater effect on motor recovery than either intervention alone in stroke hemiparesis. Nine patients with chronic subcortical stroke and nine age-matched healthy subjects completed the crossover study. In separate sessions, we examined the single intervention effect of repetitive wrist and finger extension exercises aided by neuromuscular stimulation, the single intervention effect of 5 Hz repetitive transcranial magnetic stimulation and the combined effect of the two interventions. The motor functions were evaluated behaviourally in patients (Experiment 1) and electrophysiologically in healthy subjects (Experiment 2), both before and after the intervention. In addition, we tested the long-term effect by repeating the combined interventions 12 times in patients (Experiment 3). The motor functions were measured again 2 weeks after the end of the repetitive intervention period. In Experiment 1, the combined intervention, but neither of the single interventions, resulted in an improvement of extensor movement (P < 0.0001) and grip power (P < 0.05), along with a reduction of flexor hypertonia (P < 0.01), in their paretic upper limbs. In Experiment 2, only the combined intervention resulted in selective plastic changes of cortico-spinal excitability (P < 0.01), motor threshold (P < 0.001) and silent period (P < 0.01) for the extensors. In Experiment 3, we also confirmed long-term beneficial effects of the combined intervention in patients. These findings indicate that combining motor training with repetitive transcranial magnetic stimulation can facilitate use-dependent plasticity and achieve functional recovery of motor impairments that cannot be attained by either intervention alone. This method could be a powerful rehabilitative approach for patients with hemiparetic stroke.

The objective of this study was to investigate the prevalence of obesity among schoolchildren in the United Arab Emirates, using the body mass index (BMI) as the indicator. The sample included 1,787 males and 2,288 females 6-16 years. Physicians and trained nurses measured height and weight, and the BMI (kg/m(2)) was calculated. The 50(th) centile of the BMI was not different from that for the US. Similarly, the height and weight of UAE children approximate the US reference data. About 8% of UAE boys and girls have BMI's >/=95(th) percentile of US reference values. Using the 85(th) percentile as the criterion, 16.5% and 16.9% of males and females, respectively, are classified as overweight. This composite figure does not differ from the expected 15% based on reference data. The data thus indicate that high levels of obesity are present among UAE children and adolescents. These findings have public health implications for this generation of UAE youth during their adult years, including heart disease and diabetes, because the rate of morbid obesity is approximately twice that expected in reference data. Am. J. Hum. Biol. 12:498-502, 2000. Copyright 2000 Wiley-Liss, Inc.

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We can recognize handwritten letters despite the variability among writers. One possible strategy is exploiting the motor memory of orthography. By using TMS, we clarified the excitatory and inhibitory neural circuits of the motor corticospinal pathway that might be activated during the observation of handwritten letters. During experiments, participants looked at the handwritten or printed single letter that appeared in a random order. The excitability of the left and right primary motor cortex (M1) was evaluated by motor-evoked potentials elicited by single-pulse TMS. Short interval intracortical inhibition (SICI) of the left M1 was evaluated using paired-pulse TMS. F waves were measured for the right ulnar nerve. We found significant reduction of corticospinal excitability only for the right hand at 300-400 msec after each letter presentation without significant changes in SICI. This suppression is likely to be of supraspinal origin, because of no significant alteration in F-wave amplitudes. These findings suggest that the recognition of handwritten letters may include the implicit knowledge of "writing" in M1. The M1 activation associated with that process, which has been shown in previous neuroimaging studies, is likely to reflect the active suppression of the corticospinal excitability.

No abstract