Evaluating Electrical Activity of Tibialis Anterior Muscle and Balance in Hemiparetic Patients Following Central and Peripheral Electrical Stimulation - Protocol for a Randomized, Double-blinded, Clinical Trial

2019 ◽  
pp. 1-10
Author(s):  
Aline Marina Alves Fruhauf ◽  
Fabiano Politti ◽  
Camila Cardoso da Silva ◽  
David Correa Alves ◽  
João Carlos Ferrari Corrêa ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Electrical Activity ◽  
Tibialis Anterior ◽  
Evaluation System ◽  
Primary Motor Cortex ◽  
Dynamic Balance ◽  
Stroke Survivors ◽  
Median Frequency ◽  
Peripheral Electrical Stimulation

Concomitant transcranial direct current stimulation (tDCS) is suggested to enhance the functional effects of other physical rehabilitation methods in individuals with motor impairment stemming from a chronic cerebrovascular disease. Thus, the primary aim of the proposed study is to analyze the electrical activity of the tibialis anterior (TA) muscle of the paretic limb in stroke survivors following an intervention involving the combination of tDCS over the motor cortex and peripheral electrical stimulation (PES) administered over the paretic TA. The secondary objective is to analyze the effect on dynamic balance. Methods: Thirty-six adult stroke survivors will be randomized into three groups: 1) Active tDCS + active PES; 2) Sham tDCS + active PES and 3) Active tDCS + sham PES. TDCS active will be positioned bilateral over the primary motor cortex of the damaged hemisphere (C1 or C2) and the cathode will be positioned over the primary motor cortex of the undamaged hemisphere (C1 or C2) with a current of 2 mA for 20 minutes. For sham tDCS, will follow the same standarts, however, the equipment will be switched on for only 20 seconds. PES will be administered to the paretic TA at 50 Hz for 30 minutes. Evaluations: the median frequency and root mean square (RMS) of the paretic TA will be analyzed using electromyography (EMG) and dynamic balance will be evaluated using the Mini-Balance Evaluation System (Mini-BESTest) at baseline (pre-intervention), after 10 treatment sessions at a frequency of five times a week for two weeks (post-intervention) and 30 days after the end of the interventions (follow up). Discussion: PES has proven to facilitate the conduction of sensory-motor afferences to the cerebral cortex in stroke survivors. Combining PES with tDCS, which has a direct effect on increasing cortical excitability, could favor motor acquisition and neuronal plasticity in this population.

The effect of transcranial magnetic stimulation on the excitability of the motor neuron pools of the muscles of the lower extremities

2021 ◽  
Author(s):  
S.S. Ananiev ◽  
D.A. Pavlov ◽  
R.N. Yakupov ◽  
V.A. Golodnova ◽  
M.V. Balykin
Keyword(s):  
Spinal Cord ◽  
Electrical Stimulation ◽  
Transcranial Magnetic Stimulation ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Primary Motor Cortex ◽  
Lower Extremities ◽  
Transcutaneous Electrical Stimulation ◽  
Stimulation Of

The study was conducted on 22 healthy men aged 18-23 years. The primary motor cortex innervating the lower limb was stimulated with transcranial magnetic stimulation. Using transcutaneous electrical stimulation of the spinal cord, evoked motor responses of the muscles of the lower extremities were initiated when electrodes were applied cutaneous between the spinous processes in the Th11-Th12 projection. Research protocol: Determination of the thresholds of BMO of the muscles of the lower extremities during TESCS; determination of the BMO threshold of the TA muscle in TMS; determination of the thresholds of the BMO of the muscles of the lower extremities during TESCS against the background of 80% and 90% TMS. It was found that magnetic stimulation of the motor cortex of the brain leads to an increase in the excitability of the neural structures of the lumbar thickening of the spinal cord and an improvement in neuromuscular interactions. Key words: transcranial magnetic stimulation, transcutaneous electrical stimulation of the spinal cord, neural networks, excitability, neuromuscular interactions.

Transcranial electrical stimulation through screw electrodes for intraoperative monitoring of motor evoked potentials

2004 ◽  
Vol 100 (1) ◽  
pp. 155-160 ◽  
Author(s):  
Katsushige Watanabe ◽  
Takashi Watanabe ◽  
Akio Takahashi ◽  
Nobuhito Saito ◽  
Masafumi Hirato ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Evoked Potentials ◽  
Intraoperative Monitoring ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Transcranial Electrical Stimulation ◽  
Content Type ◽  
Motor Pathways ◽  
Fine Print

✓ The feasibility of high-frequency transcranial electrical stimulation (TES) through screw electrodes placed in the skull was investigated for use in intraoperative monitoring of the motor pathways in patients who are in a state of general anesthesia during cerebral and spinal operations. Motor evoked potentials (MEPs) were elicited by TES with a train of five square-wave pulses (duration 400 µsec, intensity ≤ 200 mA, frequency 500 Hz) delivered through metal screw electrodes placed in the outer table of the skull over the primary motor cortex in 42 patients. Myogenic MEPs to anodal stimulation were recorded from the abductor pollicis brevis (APB) and tibialis anterior (TA) muscles. The mean threshold stimulation intensity was 48 ± 17 mA for the APB muscles, and 112 ± 35 mA for the TA muscles. The electrodes were firmly fixed at the site and were not dislodged by surgical manipulation throughout the operation. No adverse reactions attributable to the TES were observed. Passing current through the screw electrodes stimulates the motor cortex more effectively than conventional methods of TES. The method is safe and inexpensive, and it is convenient for intraoperative monitoring of motor pathways.

scholarly journals TMS-guided physiotherapy reduces pain and induces plasticity in the motor cortex in Chronic Knee Osteoarthritis

2018 ◽  
Vol 8 (2) ◽  
pp. 269-278
Author(s):  
Lucy Chipchase ◽  
Abrahão Fontes Baptista ◽  
Maxine Te ◽  
Simon Summers
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Knee Osteoarthritis ◽  
Vastus Lateralis ◽  
Quadriceps Strength ◽  
Vastus Medialis ◽  
Intervention Period ◽  
Knee Oa ◽  
Peripheral Electrical Stimulation ◽  
Maladaptive Plasticity

BACKGROUND: Knee osteoarthritis (OA) is associated with chronic pain, impaired function and loss of quality of life.  Brain maladaptive plasticity may be involved and prevent beneficial effects of exercises and other interventions. Neuromodulation with peripheral electrical stimulation guided by TMS mapping may specifically influence those maladaptive modifications. OBJECTIVE: To compare the cortical organization and excitability of three muscles (straight femuris, vastus lateralis and vastus medialis) in a subject with OA knee.  METHODS: This single case ABA study involved a 66 yo woman with knee OA that was considering an arthroplasty.  She was assessed for pain (VAS), function (WOMAC, ICOAP), and quadriceps strength one time a week, for 10 weeks (A – four weeks assessment; B – two weeks assessment and intervention; A – four weeks assessment). TMS mapping was performed at baseline, after the two-week intervention period and at the end of the study.  This examination initially revealed a prominent decrease in the volume of vastus medialis portion of the quadriceps muscle over the primary motor cortex (M1), which determined a peripheral electrical stimulation protocol specifically designed to increase this muscle’s excitability.  During the intervention period the participant also carried over specific exercises daily.  RESULTS: WOMAC scores, and quadriceps strength were not changed during the study period.  Improvements were seen in the three subscales of the ICOAP following the intervention. This clinical change was associated with an increase in vastus medialis and also Vastus lateralis, and a decrease in rectus femuris TMS map volumes, which were maintained until the last evaluation. CONCLUSION:  TMS mapping may guide specific interventions to counteract motor cortex maladaptive plasticity and positively influence pain and function in knee OA.

Does Transcranial Electrical Stimulation Induce Changes in Peripheral Physiology?

2017 ◽  
Vol 41 (S1) ◽  
pp. S33-S33
Author(s):  
S. Lehto
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Neuronal Excitability ◽  
Brain Activity ◽  
Brain Structures ◽  
Point Of View ◽  
Transcranial Electrical Stimulation ◽  
Dorsolateral Prefrontal ◽  
Competing Interest

Transcranial electrical stimulation (tES) is a non-invasive brain stimulation method that has evoked increasing interest during the past years. The most common form of tES, transcranial direct current stimulation (tDCS), is considered to modulate neuronal resting potentials. For example, anodal stimulation over motor cortex appears to lead to increased neuronal excitability under the stimulation electrodes. However, some recent findings suggest that the effects of tDCS extend beyond the cortical areas under the electrodes, to deeper brain structures such as the midbrain. The brain also actively regulates peripheral physiology. Thus, changes in brain activity following tES may lead to modulation of peripheral physiology. For example, tDCS targeting primary motor cortex has been observed to induce changes in peripheral glucose metabolism. Furthermore, stimulation of dorsolateral prefrontal cortex has been shown to lead to alterations in cortisol secretion and the activity of the autonomic nervous system. Unpublished findings from our group corroborate with the above observations. Nevertheless, the evidence regarding peripheral effects of tES remains limited. Investigating such possible effects may be relevant especially from the point of view of tES safety and potential therapeutic discoveries.Disclosure of interestThe author has not supplied his declaration of competing interest.

Post-Stroke Intractable Pain

2019 ◽  
pp. 173-178
Author(s):  
Innocent Njoku ◽  
Julie G. Pilitsis
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Pain Syndrome ◽  
Underlying Mechanism ◽  
Anterior Cingulate ◽  
Intractable Pain ◽  
Analgesic Effects ◽  
Diagnostic Work ◽  
Stimulation Of

Deep brain stimulation (DBS) has been used as a mode to treat chronic intractable pain by targeting the ventroposterior (VP) thalamus, the periaqueductal gray (PAG), or the anterior cingulate cortex (ACC). The exact underlying mechanism by which these targets produce an analgesic effect remains unclear, but stimulation of the thalamocortical pathways, alteration of thalamic activity, and interference of the pain relay pathway have been postulated as plausible mechanisms. Motor cortex stimulation (MCS) has also been used for the treatment of intractable pain through stimulation of the primary motor cortex. Intermittent electrical stimulation is delivered at thresholds lower than evoking a motor response but adequate enough to provide variable analgesic effects. We present a case to illustrate the diagnostic work-up, surgical technique, complications, and outcomes of (sub)cortical electrical stimulation for central pain syndrome.

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