Should We Trust Perceived Effort for Loading Control and Resistance Exercise Prescription After ACL Reconstruction?

Context: The rating of perceived effort (RPE) is a common method used in clinical practice for monitoring, loading control, and resistance training prescription during rehabilitation after rupture and anterior cruciate ligament reconstruction (ACLR). It is suggested that the RPE results from the integration of the afferent feedback and corollary discharge in the motor and somatosensory cortex, and from the activation of brain areas related to emotions, affect, memory, and pain (eg, posterior cingulate cortex, precuneus, and prefrontal cortex). Recent studies have shown that rupture and ACLR induce neural adaptations in the brain commonly associated with the RPE. Therefore, we hypothesize that RPE could be affected because of neural adaptations induced by rupture and ACLR. Study Design: Clinical review. Level of Evidence: Level 5. Results: RPE could be directly altered by changes in the activation of motor cortex, posterior cingulate cortex, and prefrontal cortex. These neural adaptations may be induced by indirect mechanisms, such as the afferent feedback deficit, pain, and fear of movement (kinesiophobia) that patients may feel after rupture and ACLR. Conclusion: Using only RPE for monitoring, loading control, and resistance training prescription in patients who had undergone ACLR could lead to under- or overdosing resistance exercise, and therefore, impair the rehabilitation process. Strength-of-Recommendation Taxonomy: 3C.

Neurobiology of injury (compression, traction, laceration) and repair, and grading of injuries

The functioning nervous system is an integrated system including conscious and subconscious pathways in the brain and spinal cord, the peripheral nerves, and specialized target organs. Efferent and afferent feedback pathways integrate at multiple levels, and there is interplay with mood, life function, growth, and development. The peripheral nervous system provides homeostatic and pain functions, and links the virtual world of our consciousness to the physical body that senses and manipulates the world around us. Injury disconnects the central nervous system from physical reality and induces profound, time-dependent changes at all levels of the system that mostly impede functional restitution after nerve reconstruction. For surgery to optimize outcomes it must be timely, and applied with precision, neurobiological awareness, and aided by adjuvant therapies or technologies that modulate responses within the central nervous system, primary motor and sensory neurons, repair site, distal nerve stump, and target organs.

Anodal transcranial direct current stimulation increases corticospinal excitability, while performance is unchanged

Anodal transcranial direct current stimulation (a-tDCS) has been shown to improve bicycle time to fatigue (TTF) tasks at 70–80% of VO2max and downregulate rate of perceived exertion (RPE). This study aimed to investigate the effect of a-tDCS on a RPE-clamp test, a 250-kJ time trial (TT) and motor evoked potentials (MEP). Twenty participants volunteered for three trials; control, sham stimulation and a-tDCS. Transcranial magnetic stimulation was used to determine the corticospinal excitability for 12 participants pre and post sham stimulation and a-tDCS. The a-tDCS protocol consisted of 13 minutes of stimulation (2 mA) with the anode placed above the Cz. The RPE-clamp test consisted of 5 minutes ergometer bicycling at an RPE of 13 on the Borg scale, and the TT consisted of a 250 kJ (∼10 km) long bicycle ergometer test. During each test, power output, heart rate and oxygen consumption was measured, while RPE was evaluated. MEPs increased significantly by 36% (±36%) post a-tDCS, with 8.8% (±31%) post sham stimulation (p = 0.037). No significant changes were found for any parameter at the RPE-clamp or TT. The lack of improvement may be due to RPE being more controlled by afferent feedback during TT tests than during TTF tests. Based on the results of the present study, it is concluded that a-tDCS applied over Cz, does not enhance self-paced cycling performance.

Computational Modeling of Spinal Locomotor Circuitry in the Age of Molecular Genetics

Neuronal circuits in the spinal cord are essential for the control of locomotion. They integrate supraspinal commands and afferent feedback signals to produce coordinated rhythmic muscle activations necessary for stable locomotion. For several decades, computational modeling has complemented experimental studies by providing a mechanistic rationale for experimental observations and by deriving experimentally testable predictions. This symbiotic relationship between experimental and computational approaches has resulted in numerous fundamental insights. With recent advances in molecular and genetic methods, it has become possible to manipulate specific constituent elements of the spinal circuitry and relate them to locomotor behavior. This has led to computational modeling studies investigating mechanisms at the level of genetically defined neuronal populations and their interactions. We review literature on the spinal locomotor circuitry from a computational perspective. By reviewing examples leading up to and in the age of molecular genetics, we demonstrate the importance of computational modeling and its interactions with experiments. Moving forward, neuromechanical models with neuronal circuitry modeled at the level of genetically defined neuronal populations will be required to further unravel the mechanisms by which neuronal interactions lead to locomotor behavior.

A NOVEL PARADIGM FOR DEEP REINFORCEMENT LEARNING OF BIOMIMETIC SYSTEMS

Mechanisms behind neural control of movement have been an active area of research. Goal-directed movement is a common experimental setup used to understand these mechanisms and neural pathways. On the one hand, optimal feedback control theory is used to model and make quantitative predictions of the coordinated activations of the effectors, such as muscles, joints or limbs. While on the other hand, evidence shows that higher centres such as Basal Ganglia and Cerebellum are involved in activities such as reinforcement learning and error correction. In this paper, we provide a framework to build a digital twin of relevant sections of the human spinal cord using our NEUROiD platform. The digital twin is anatomically and physiologically realistic model of the spinal cord at cellular, spinal networks and system level. We then build a framework to learn the supraspinal activations necessary to perform a simple goal directed movement of the upper limb. The NEUROiD model is interfaced to an Opensim model for all the musculoskeletal simulations. We use Deep Reinforcement Learning to obtain the supraspinal activations necessary to perform the goal directed movement. As per our knowledge, this is the first time an attempt is made to learn the stimulation pattern at the spinal cord level, especially by limiting the observation space to only the afferent feedback received on the Ia, II and Ib fibers. Such a setup results in a biologically realistic constrained environment for learning. Our results show that (1) Reinforcement Learning algorithm converges naturally to the triphasic response observed during goal directed movement (2) Increasing the complexity of the goal gradually was very important to accelerate learning (3) Modulation of the afferent inputs were sufficient to execute tasks which were not explicitly learned, but were closely related to the learnt task.

Peripheral-central interplay for fatiguing unresisted repetitive movements: a study using muscle ischaemia and M1 neuromodulation

Maximal-rate rhythmic repetitive movements cannot be sustained for very long, even if unresisted. Peripheral and central mechanisms of fatigue, such as the slowing of muscle relaxation and an increase in M1-GABAb inhibition, act alongside the reduction of maximal execution rates. However, maximal muscle force appears unaffected, and it is unknown whether the increased excitability of M1 GABAergic interneurons is an adaptation to the waning of muscle contractility in these movements. Here, we observed increased M1 GABAb inhibition at the end of 30 s of a maximal-rate finger-tapping (FT) task that caused fatigue and muscle slowdown in a sample of 19 healthy participants. The former recovered a few seconds after FT ended, regardless of whether muscle ischaemia was used to keep the muscle slowed down. Therefore, the increased excitability of M1-GABAb circuits does not appear to be mediated by afferent feedback from the muscle. In the same subjects, continuous (inhibitory) and intermittent (excitatory) theta-burst stimulation (TBS) was used to modulate M1 excitability and to understand the underlying central mechanisms within the motor cortex. The effect produced by TBS on M1 excitability did not affect FT performance. We conclude that fatigue during brief, maximal-rate unresisted repetitive movements has supraspinal components, with origins upstream of the motor cortex.

Inhibitory tendon-evoked reflex is attenuated in the torque-depressed isometric steady-state following active shortening

Residual torque depression (rTD) is the reduction in steady-state isometric torque following an active shortening contraction when compared with an isometric contraction at the same muscle length and activation level. We have shown that spinal excitability increases in the rTD state, yet the mechanisms remains unknown. Percutaneous electrical tendon stimulation was used to induce tendon-evoked inhibitory reflexes. We demonstrated that in the rTD state, reduced torque contributes to a reduction in inhibitory afferent feedback, which indicates that the history-dependent properties of muscle can alter spinal excitability and the voluntary control of submaximal contractions through changes in peripheral afferent feedback. Novelty Residual force depression is a basic property of skeletal muscle, which can influence spinal and supraspinal excitability via inhibitory reflex activity. Residual force depression alters the voluntary control of force.

Affective experiences to chords are modulated by mode, meter, tempo, and subjective entrainment

Mode and tempo are known to influence affective experiences during music listening. While mode (major/minor) is associated with emotional valence (positive/negative), tempo (slow/fast) is associated with emotional arousal (calm/excited). Heart rate (HR) and respiration rate (RR) are also thought to adapt (entrain) to the tempo, leading to emotion elicitation via afferent feedback mechanisms. Here, we tested the influence of mode, tempo, and entrainment on affective experiences by recording HR, RR, and self-reported subjective entrainment and affect measures while participants ( N = 20) listened to major and minor chords embedded in slow and fast isochronous, metrical, and random sequences. Though there was no effect of tempo on HR or RR, both were faster during major and metrically random chord sequences, respectively. Slower HR positively predicted visceral entrainment (VE) ratings, the extent to which one feels one’s internal rhythms changing, and fast tempo positively predicted motor entrainment (ME) ratings, the extent to which one feels like moving. Compared to minor chords, fast major chord sequences induced more feelings of vitality (positive, high arousal), while minor sequences induced more feelings of unease (negative, high, and low arousal). Both ME and VE positively predicted pleasantness ratings and positive emotions, and negatively predicted negative emotions.