Paired associative stimulation modulates corticomotor excitability in chronic stroke: A preliminary investigation

Palmer, Jacqueline A.; Wolf, Steven L.; Borich, Michael R.

doi:10.3233/rnn-170785

Cited by 24 publications

(34 citation statements)

References 47 publications

(77 reference statements)

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“…Interestingly, Bunday et al (2018) recently demonstrated that producing a light volitional contraction during a PAS paradigm further enhanced corticospinal excitability compared to the same PAS paradigm performed at rest in a group of individuals with incomplete spinal cord injury. Following a PAS paradigm performed at rest, our laboratory previously found that a PAS intervention could enhance corticomotor excitability in stroke survivors and that this increase in corticomotor excitability was associated with enhanced motor skill performance following PAS (Palmer et al, 2018). Importantly, compared to neurologically-intact individuals, atypical cortical network behavior has been observed in stroke survivors during active but not resting motor states in multiple instances (Murase et al, 2004; Borich et al, 2016; Palmer et al, 2016, 2017).…”

Section: Introductionmentioning

confidence: 99%

Modulatory Effects of Motor State During Paired Associative Stimulation on Motor Cortex Excitability and Motor Skill Learning

Palmer

Halter

Gray

et al. 2019

Front. Hum. Neurosci.

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Repeated pairing of electrical stimulation of a peripheral nerve with transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) representation for a target muscle can induce neuroplastic adaptations in the human brain related to motor learning. The extent to which the motor state during this form of paired associative stimulation (PAS) influences the degree and mechanisms of neuroplasticity or motor learning is unclear. Here, we investigated the effect of volitional muscle contraction during PAS on: (1) measures of general corticomotor excitability and intracortical circuit excitability; and (2) motor performance and learning. We assessed measures of corticomotor excitability using TMS and motor skill performance during a serial reaction time task (SRTT) at baseline and at 0, 30, 60 min post-PAS. Participants completed a SRTT retention test 1 week following the first two PAS sessions. Following the PAS intervention where the hand muscle maintained an active muscle contraction (PASACTIVE), there was lower short interval intracortical inhibition compared to PAS during a resting motor state (PASREST) and a sham PAS condition (PASCONTROL). SRTT performance improved within the session regardless of PAS condition. SRTT retention was greater following both PASACTIVE and PASREST after 1 week compared to PASCONTROL. These findings suggest that PAS may enhance motor learning retention and that motor state may be used to target different neural mechanisms of intracortical excitation and inhibition during PAS. This observation may be important to consider for the use of therapeutic noninvasive brain stimulation in neurologic patient populations.

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Section: Introductionmentioning

confidence: 99%

Modulatory Effects of Motor State During Paired Associative Stimulation on Motor Cortex Excitability and Motor Skill Learning

Palmer

Halter

Gray

et al. 2019

Front. Hum. Neurosci.

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“…Necessarily, in any further extension of this line of enquiry, it would be advantageous to employ a sample size sufficient to permit the stratification of participants with respect to the factors referred to above. A further shortcoming was the absence of any means of assessing potential functional consequences associated with the changes in corticospinal excitability brought about by PAS (e.g., Palmer et al, 2018 ). In light of these various limitations, it must be emphasized that the prospective applicability of these methods in the clinic has not been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

“…Paired associative stimulation (PAS) has come to prominence not only as an experimental method with which to investigate Hebbian principles of neural plasticity, but also as a therapeutic intervention with the potential to treat brain injury/disease (e.g., Jayaram and Stinear, 2008 ; Castel-Lacanal et al, 2009 ; Palmer et al, 2018 ). We have demonstrated previously ( Kennedy and Carson, 2008 ) that in young healthy individuals, elevations in the excitability of corticospinal projections to the forearm muscles brought about PAS, are modulated by the contraction of muscles ipsilateral to the site of cortical stimulation.…”

Section: Introductionmentioning

confidence: 99%

Shaping the Effects of Associative Brain Stimulation by Contractions of the Opposite Limb

Carson

Rankin

2018

Front. Psychol.

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There has been an explosion of interest in methods that may promote neural plasticity by indirectly stimulating tissue in damaged brains using transient magnetic fields or weak electrical currents. A major limitation of these approaches is that the induced variations in brain activity tend to be diffuse. Thus far it has proved extremely difficult to target pathways from the brain to specific muscles. This is a particular challenge for applications in rehabilitation. Stroke survivors often exhibit abnormal patterns of muscle activation, including diminished specificity and high levels of co-contraction. For the clinical relevance of brain stimulation to be enhanced, it is desirable that the effects can be restricted to pathways controlling muscles that are the specific targets of movement therapy. We have demonstrated previously that increases in the excitability of corticospinal projections to forearm muscles generated by paired associative stimulation (PAS), are modulated by contractions ipsilateral to the site of the cortical stimulus. The current aim was to determine whether in chronic stroke survivors, simultaneous contractions performed by the non-paretic limb increase the muscle specificity of changes in the excitability of projections to the impaired limb induced by PAS. Ten chronic stroke survivors, 13 age-equivalent and 27 younger healthy controls, completed two separate sessions/conditions. In one (PAS+CONT), isometric wrist flexion contractions of the non-impaired limb were made simultaneously with PAS. In the other (PAS), associative stimulation only was applied. In all groups, PAS alone gave rise to large increases in the excitability of projections to a wrist extensor muscle (extensor carpi radialis – ECR) that was not the target of stimulation. In marked contrast, for the stroke survivors, following combined PAS and flexion contractions of the non-impaired limb, there was no corresponding elevation in the excitability of corticospinal projections to the ECR of the paretic limb. A similar effect was present for the healthy young adults, but not expressed clearly for the age-equivalent controls. The implications of these findings with respect to the clinical deployment of non-invasive brain stimulation in movement rehabilitation are discussed.

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“…PAS has demonstrated potential as a therapeutic intervention to strengthen residual circuits after spinal cord injury and promote functional recovery (Bunday and Perez, 2012;Urbin et al, 2017;Bunday et al, 2018). Studies have also employed modified PAS protocols with mixed success in improving functional recovery after neurovascular insult, both in animals (Shin et al, 2008) and in humans (Castel-Lacanal et al, 2007;Castel-Lacanal et al, 2009;Rogers et al, 2011;Cho et al, 2016;Ferris et al, 2018;Palmer et al, 2018;Tarri et al, 2018a). PAS initially showed great promise for rehabilitation, however enthusiasm for this approach has been tempered by lack of experimental rigor and inconsistent results (Alder et al, 2019).…”

Section: Non-invasive Paired Associative Stimulation (Pas) In Humansmentioning

confidence: 99%

Paired Associative Stimulation Fails to Induce Plasticity in Freely Behaving Intact Rats

Ting

Huot-Lavoie

Éthier

2020

eNeuro

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We thank Sergiu Ftomov for manufacturing the cortical electrode arrays used for the chronic experiments, and Derek Burns for coding the MATLAB software used for closed-loop recording and stimulation. We are indebted to Chantal Mérette and Geneviève Picher for statistical consultation and discussions throughout the entire study process. We also thank Martin Deschênes and Maxime Demers for sharing laboratory space and equipment with us, and their practical advice on several key experiments, as well as Martin's and Michaël Elbaz's feedback on the manuscript. Finally, we are indebted the team in the animal facility at Centre de Recherche CERVO for their continual care of the animals used in the experiments for the duration of this study.

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Paired associative stimulation modulates corticomotor excitability in chronic stroke: A preliminary investigation

Cited by 24 publications

References 47 publications

Modulatory Effects of Motor State During Paired Associative Stimulation on Motor Cortex Excitability and Motor Skill Learning

Modulatory Effects of Motor State During Paired Associative Stimulation on Motor Cortex Excitability and Motor Skill Learning

Shaping the Effects of Associative Brain Stimulation by Contractions of the Opposite Limb

Paired Associative Stimulation Fails to Induce Plasticity in Freely Behaving Intact Rats

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