Wei-Peng Teo

The effects of circadian rhythmicity of salivary cortisol and testosterone on maximal isometric force, maximal dynamic force, and power output.

Teo, W, McGuigan, MR, and Newton, MJ. The effects of circadian rhythmicity of salivary cortisol and testosterone on maximal isometric force, maximal dynamic force, and power output. J Strength Cond Res 25(6): 1538-1545, 2011—The study investigated the effects of circadian rhythm of cortisol (C) and testosterone (T) on maximal force production (Fpeak) and power output (Ppeak). Twenty male university students (mean age = 23.8 ± 3.6 years, height = 177.5 ± 6.4 cm, weight = 78.9 ± 11.2 kg) performed 4 time-of-day testing sessions consisting of countermovement jumps (CMJs), squat jumps (SJ), isometric midthigh pulls (IMTPs), and a 1-repetition maximum (1RM) squat. Saliva samples were collected at 0800, 1200, 1600, and 2000 hours to assess T and C levels on each testing day. Session rate-of-perceived exertion (RPE) scores were collected after each session. The results showed that Fpeak and Ppeak presented a clear circadian rhythm in CMJ and IMTP but not in SJ. One repetition maximum squat did not display a clear circadian rhythm. Session RPE scores collected at 0800 and 2000 hours were significantly (p ≤ 0.05) higher than those obtained at 1200 and 1600 hours. Salivary T and C displayed a clear circadian rhythm with highest values at 0800 hours and lowest at 2000 hours; however, no significant correlation was found between T and C with Fpeak and Ppeak. A very strong correlation was found between Taural with Fpeak of CMJ and IMTP and Ppeak of CMJ (r = 0.86, r = 0.84 and r = 0.8, p ≤ 0.001). The study showed the existence of a circadian rhythm in Fpeak and Ppeak in CMJ and IMTP. The evidence suggests that strength and power training or testing should be scheduled later during the day. The use of Taural seemed to be a more effective indicator of physical performance than hormonal measures, and the use of session RPE should also be closely monitored because it may present a circadian rhythm.

Facilitating Effects of Transcranial Direct Current Stimulation on Motor Imagery Brain-Computer Interface With Robotic Feedback for Stroke Rehabilitation

OBJECTIVE To investigate the efficacy and effects of transcranial direct current stimulation (tDCS) on motor imagery brain-computer interface (MI-BCI) with robotic feedback for stroke rehabilitation. DESIGN A sham-controlled, randomized controlled trial. SETTING Patients recruited through a hospital stroke rehabilitation program. PARTICIPANTS Subjects (N=19) who incurred a stroke 0.8 to 4.3 years prior, with moderate to severe upper extremity functional impairment, and passed BCI screening. INTERVENTIONS Ten sessions of 20 minutes of tDCS or sham before 1 hour of MI-BCI with robotic feedback upper limb stroke rehabilitation for 2 weeks. Each rehabilitation session comprised 8 minutes of evaluation and 1 hour of therapy. MAIN OUTCOME MEASURES Upper extremity Fugl-Meyer Motor Assessment (FMMA) scores measured end-intervention at week 2 and follow-up at week 4, online BCI accuracies from the evaluation part, and laterality coefficients of the electroencephalogram (EEG) from the therapy part of the 10 rehabilitation sessions. RESULTS FMMA score improved in both groups at week 4, but no intergroup differences were found at any time points. Online accuracies of the evaluation part from the tDCS group were significantly higher than those from the sham group. The EEG laterality coefficients from the therapy part of the tDCS group were significantly higher than those of the sham group. CONCLUSIONS The results suggest a role for tDCS in facilitating motor imagery in stroke.

Is motor-imagery brain-computer interface feasible in stroke rehabilitation?

In the past 3 decades, interest has increased in brain-computer interface (BCI) technology as a tool for assisting, augmenting, and rehabilitating sensorimotor functions in clinical populations. Initially designed as an assistive device for partial or total body impairments, BCI systems have since been explored as a possible adjuvant therapy in the rehabilitation of patients who have had a stroke. In particular, BCI systems incorporating a robotic manipulanda to passively manipulate affected limbs have been studied. These systems can use a range of invasive (ie, intracranial implanted electrodes) or noninvasive neurophysiologic recording techniques (ie, electroencephalography [EEG], near-infrared spectroscopy, and magnetoencephalography) to establish communication links between the brain and the BCI system. Trials are most commonly performed on EEG-based BCI in comparison with the other techniques because of its high temporal resolution, relatively low setup costs, portability, and noninvasive nature. EEG-based BCI detects event-related desynchronization/synchronization in sensorimotor oscillatory rhythms associated with motor imagery (MI), which in turn drives the BCI. Previous evidence suggests that the process of MI preferentially activates sensorimotor regions similar to actual task performance and that repeated practice of MI can induce plasticity changes in the brain. It is therefore postulated that the combination of MI and BCI may augment rehabilitation gains in patients who have had a stroke by activating corticomotor networks via MI and providing sensory feedback from the affected limb using end-effector robots. In this review we examine the current literature surrounding the feasibility of EEG-based MI-BCI systems in stroke rehabilitation. We also discuss the limitations of using EEG-based MI-BCI in patients who have had a stroke and suggest possible solutions to overcome these limitations.

Motor cortex excitability is not differentially modulated following skill and strength training

AIM A single session of skill or strength training can modulate the primary motor cortex (M1), which manifests as increased corticospinal excitability (CSE) and decreased short-latency intra-cortical inhibition (SICI). We tested the hypothesis that both skill and strength training can propagate the neural mechanisms mediating cross-transfer and modulate the ipsilateral M1 (iM1). METHODS Transcranial magnetic stimulation (TMS) measured baseline CSE and SICI in the contralateral motor cortex (cM1) and iM1. Participants completed 4 sets of unilateral training with their dominant arm, either visuomotor tracking, metronome-paced strength training (MPST), self-paced strength training (SPST) or control. Immediately post training, TMS was repeated in both M1s. RESULTS Motor-evoked potentials (MEPs) increased and inhibition was reduced for skill and MPST training from baseline in both M1s. Self-paced strength training and control did not produce changes in CSE and SICI when compared to baseline in both M1s. After training, skill and MPST increased CSE and decreased SICI in cM1 compared to SPST and control. Skill and MPST training decreased SICI in iM1 compared to SPST and control post intervention; however, CSE in iM1 was not different across groups post training. CONCLUSION Both skill training and MPST facilitated an increase in CSE and released SICI in iM1 and cM1 compared to baseline. Our results suggest that synchronizing to an auditory or a visual cue promotes neural adaptations within the iM1, which is thought to mediate cross transfer.

Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? – A Narrative Review of the Literature

In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a treatment for motor and cognitive dysfunction is to improve neuroplasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic intervention for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders, and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation and its complimentary use with neuroimaging (e.g., fNIRS and EEG) and neuromodulation (e.g., tDCS and rTMS), more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.

Anodal transcranial direct current stimulation prolongs the cross-education of strength and corticomotor plasticity

PURPOSE This study aimed to assess the efficacy of applying anodal transcranial direct-current stimulation (a-tDCS) to the ipsilateral motor cortex (iM1) during unilateral strength training to enhance the neurophysiological and functional effects of cross-education. METHODS Twenty-four healthy volunteers were randomly allocated to perform either of the following: strength training during a-tDCS (ST + a-tDCS), strength training during sham tDCS (ST + sham), or a-tDCS during rest (a-tDCS) across 2 wk. Strength training of the right biceps brachii involved four sets of six repetitions at 80% of one-repetition maximum three times per week. Anodal tDCS was applied to the iM1 at 1.5 mA for 15 min during each strength training session. Outcome measures included one-repetition maximum strength of the untrained biceps brachii, corticomotoneuronal excitability, cross-activation, and short-interval intracortical inhibition (SICI) of the iM1 determined by transcranial magnetic stimulation. RESULTS Immediately after the final training session, there was an increase in strength for both the ST + a-tDCS (12.5%, P < 0.001) and the ST + sham group (9.4%, P = 0.007), which was accompanied by significant increases in corticomotoneuronal excitability and decreases in SICI for both groups. After a 48-h retention period, strength increase was maintained in the ST + a-tDCS (13.0%, P = 0.001) group, which was significantly greater than the ST + sham group (7.6%, P = 0.039). Similarly, increases in corticomotoneuronal excitability and decreases in SICI were maintained in the ST + a-tDCS group but not in the ST + sham group. No main effects were reported for the a-tDCS group (all P > 0.05). CONCLUSIONS The addition of a-tDCS to the iM1 during unilateral strength training prolongs the benefits of cross-education, which may have significant implications to enhancement of rehabilitation outcomes after a single-limb injury or impairment.

exergaming as a viable therapeutic tool to improve static and dynamic balance among older adults and people with idiopathic Parkinson's disease: a systematic review and meta-analysis

The use of virtual reality games (known as “exergaming”) as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson’s disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I2 statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563–1.576), postural control (SMD 0.826, 95% CI 0.481–1.170), and dynamic balance (SMD −0.808, 95% CI −1.192 to −0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI −0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534–3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more large-scale trials are needed to determine if the same is true for people with IPD.

Changes in corticomotor excitability and inhibition after exercise are influenced by hand dominance and motor demand.

Previous studies on handedness have often reported functional asymmetries in corticomotor excitability (CME) associated with voluntary movement. Recently, we have shown that the degree of post-exercise corticomotor depression (PED) and increase in short-interval cortical inhibition (SICI) after a repetitive finger movement task was less when the task was performed at a maximal voluntary rate (MVR) than when it was performed at a submaximal sustainable rate (SR). In the current study, we have compared the time course of PED and SICI in the dominant (DOM) and nondominant (NDOM) hands after an MVR and SR finger movement task to determine the influence of hand dominance and task demand. We tracked motor-evoked potential (MEP) amplitude from the first dorsal interosseous muscle of the DOM and NDOM hand for 20 min after a 10-s index finger flexion-extension task at MVR and SR. For all hand-task combinations, we report a period of PED and increased SICI lasting for up to 8 min. We find that the least demanding task, one that involved index finger movement of the DOM hand at SR, was associated with the greatest change in PED and SICI from baseline (63.6±5.7% and 79±2%, P<0.001, PED and SICI, respectively), whereas the most demanding task (MVR of the NDOM hand) was associated with the least change from baseline (PED: 88.1±3.6%, SICI: 103±2%; P<0.001). Our findings indicate that the changes in CME and inhibition associated with repetitive finger movement are influenced both by handedness and the degree of demand of the motor task and are inversely related to task demand, being smallest for an MVR task of the NDOM hand and greatest for an SR task of the DOM hand. The findings provide additional evidence for differences in neuronal processing between the dominant and nondominant hemispheres in motor control.

Lower limb progressive resistance training improves leg strength but not gait speed or balance in Parkinson's disease: A systematic review and meta-analysis

The use of progressive resistance training (PRT) to improve gait and balance in people with Parkinson’s disease (PD) is an emerging area of interest. However, the main effects of PRT on lower limb functions such as gait, balance, and leg strength in people with PD remain unclear. Therefore, the aim of the meta-analysis is to evaluate the evidence surrounding the use of PRT to improve gait and balance in people with PD. Five electronic databases, from inception to December 2014, were searched to identify the relevant studies. Data extraction was performed by two independent reviewers and methodological quality was assessed using the PEDro scale. Standardized mean differences (SMD) and 95% confidence intervals (CIs) of fixed and random effects models were used to calculate the effect sizes between experimental and control groups and I2 statistics were used to determine levels of heterogeneity. In total, seven studies were identified consisting of 172 participants (experimental n = 84; control n = 88). The pooled results showed a moderate but significant effect of PRT on leg strength (SMD 1.42, 95% CI 0.464–2.376); however, no significant effects were observed for gait speed (SMD 0.418, 95% CI −0.219 to 1.055). No significant effects were observed for balance measures included in this review. In conclusion, our results showed no discernable effect of PRT on gait and balance measures, although this is likely due to the lack of studies available. It may be suggested that PRT be performed in conjunction with balance or task-specific functional training to elicit greater lower limb functional benefits in people with PD.

Motor imagery BCI for upper limb stroke rehabilitation: An evaluation of the EEG recordings using coherence analysis

Brain-computer interface (BCI) technology has the potential as a post-stroke rehabilitation tool, and the efficacy of the technology is most often demonstrated through output peripherals such as robots, orthosis and computers. In this study, the EEG signals recorded during the course of upper limb stroke rehabilitaion using motor imagery BCI were analyzed to better understand the effect of BCI therapy for post-stroke rehabilitation. The stroke patients recruited underwent 10 sessions of 1-hour BCI with robotic feedback for 2 weeks, 5 times a week. The analysis was performed by computing the coherences of the EEG in the lesion and contralesion side of the hemisphere from each session, and the coherence index of the lesion hemisphere (0 ≤ CI ≤ 1) was computed. The coherence index represents the rate of activation of the lesion hemisphere, and the correlation with the Fugl-Meyer assessment (FMA) before and after the BCI therapy was investigated. Significant improvement in the FMA scores was reported for five of the six patients (p = 0.01). The analysis showed that the number of sessions with CI ≥ 0.5 correlated with the change in the FMA scores. This suggests that post-stroke motor recovery best results from the activation in the lesion hemisphere, which is in agreement with previous studies performed using multimodal imaging technologies.