Modulation of the cutaneous silent period in the upper-limb with whole-body instability

poster abstractThe silent period (CSP) induced by cutaneous electrical stimulation of the digits has been shown to be task-dependent, at least in the grasping muscles of the hand. However, it is unknown if the CSP is adaptable throughout muscles of the entire upper limb, in particular when the task requirements are substantially altered. The purpose of the present study was to examine the characteristics of the CSP in several upper limb muscles when introducing increased whole-body instability. The CSP was evoked in 10 healthy individuals with electrical stimulation of digit II of the right hand when the subjects were seated, standing, or standing on a wobble board while maintaining a background elbow extension contraction with the triceps brachii of ~5% of maximal voluntary contraction (MVC) strength. The first excitatory response (E1), first inhibitory response (CSP), and second excitatory response (E2) were quantified as the percent increase from baseline and by their individual durations. The results showed that the level of CSP suppression significantly decreased (52.3 ± 7.7% to 66.2 ± 13.2% of baseline, p = 0.019) and there was a trend for the CSP duration to decrease (p = 0.053) in the triceps brachii during the wobble board task. For the wobble board task the amount of cutaneous afferent inhibition of EMG activity in the triceps brachii decreased; which is proposed to be due to differential weighting of cutaneous feedback relative to the corticospinal drive, most likely due to presynaptic inhibition, to meet the demands of the unstable task

Differential processing of nociceptive input within upper limb muscles

The cutaneous silent period is an inhibitory evoked response that demonstrates a wide variety of responses in muscles of the human upper limb. Classically, the cutaneous silent period results in a characteristic muscle pattern of extensor inhibition and flexor facilitation within the upper limb, in the presence of nociceptive input. The aims of the current study were: 1) to primarily investigate the presence and characteristics of the cutaneous silent period response across multiple extensor and flexor muscles of the upper limb, and 2) to secondarily investigate the influence of stimulation site on this nociceptive reflex response. It was hypothesized that the cutaneous silent period would be present in all muscles, regardless of role (flexion/extension) or the stimulation site. Twenty-two healthy, university-age adults (14 males; 8 females; 23 ± 5 yrs) participated in the study. Testing consisted of three different stimulation sites (Digit II, V, and II+III nociceptive stimulation) during a low intensity, sustained muscle contraction, in which, 7 upper limb muscles were monitored via surface EMG recording electrodes. Distal muscles of the upper limb presented with the earliest reflex onset times, longest reflex duration, and lowest level of EMG suppression when compared to the more proximal muscles, regardless of extensor/flexor role. Additionally, the greatest overall inhibitory influence was expressed within the distal muscles. In conclusion, the present study provides a new level of refinement within the current understanding of the spinal organization associated with nociceptive input processing and the associated motor control of the upper limb. Subsequently, these results have further implications on the impact of nociception on supraspinal processing

Greater functional aerobic capacity predicts more effective pain modulation in older adults

poster abstractEndogenous pain inhibitory and facilitory function deteriorates with age, potentially placing older adults at greater risk for chronic pain. Prior research shows that self-reported physical activity predicts endogenous pain inhibitory capacity and facilitation of pain on quantitative sensory tests (QST) in healthy adults. Purpose: To investigate whether functional aerobic capacity and lower extremity strength in older adults cross-sectionally predicts pain sensitivity, pain inhibition following isometric exercise, and facilitation of pain during heat pain temporal summation (TS) tests. Methods: 42 subjects (10 male, 32 female, age=67.5±5.1) completed the 6-minute walk test (6MWT), 30-second chair stand test, and several QSTs. QSTs included: 1) Pain ratings (0-100 scale) during the submersion of the hand in a cold water bath (CWB), 2) heat pain threshold tests, 3) the amount of pain reduction following submaximal isometric exercise, and 4) degree of pain facilitation during temporal summation tests conducted at 44, 46, and 48°C. Responses on the QSTs were analyzed using hierarchical linear regression with meters on 6MWT and number of chair stands as final predictors. Results: After controlling for demographic and psychological factors, aerobic capacity on 6MWT significantly predicted CWB pain ratings (R2 change= 22.5%, Beta= -0.491), pain facilitation during TS trials at 44°C (R2 change= 16.7%, Beta= -0.446), and the amount of pain reduction following isometric exercise (R2 change= 20.7%, Beta= 0.393). All other analyses were not significant (P>0.05). Conclusions: Older adults exhibiting greater functional aerobic capacity displayed reduced cold pain sensitivity, reduced pain facilitory function, and increased pain inhibition following exercise. These findings suggest that increased aerobic fitness in older adults may be associated with more effective endogenous modulation of pain. This study was funded by the IUPUI School of PETM Faculty Research Opportunity Grant

Determinants of Fatigue in the Biceps Brachii During Blood Flow Restriction Training

poster abstractTraining loads of 60% - 80% of maximum are traditionally recommended for increasing muscular strength. Lifting lighter loads (~20% of 1RM) with concomitant blood flow restriction (BFR) can also increase muscle strength. It is unknown if adaptation with BFR is limited to the muscle or also due to changes in the nervous system. We examined changes in the output of the motor cortex and the muscle with stimulation, when subjects perform 1.) Training with light loads, 2.) Training with light loads with BFR, and 3.) Training with moderate loads. 5 subjects completed three training sessions with the elbow flexor muscles. Maximal strength was measured before and after each training session. Voluntary activation was tested with cortical stimulation (TMS) and with electrical stimulation of the biceps during additional MVCs. Subjects trained with a block of 4 isometric contractions at 20% MVC (120s, 60s, 60s, 60s durations) or at 60% MVC (40s, 20s, 20s, 20s durations). Fatigue (% decrease in MVC after training) was similar between 20% with BFR and 60% conditions (18.6% and 16%) and less in the 20% without BFR condition (9.7%). Cortical voluntary activation decreased similarly between the 20% BFR and 60% conditions (-3.6% and -3.3%) and showed less change with 20% without BFR (-1.8%). Alternatively, with electrical stimulation of the muscle, both 20% training conditions showed a decline in voluntary activation (-3.1% and -5.15), while voluntary activation increased by 8% after the 60% condition. Similar levels of fatigue occur at different contraction intensities when BFR is applied during the lighter contraction. Both 20% with BFR and 60% loading causes deficits in cortical activation, though the limiting factor in the 20% BFR condition is a decrease in activation of the muscle directly, while in the 60% contraction it is due to an inability to drive the motorneuron pool sufficiently

The Effects of Deep Oscillation Therapy for Individuals with Lower-Leg Pain

Purpose: Lower extremity (LE) pain accounts for 13-20% of injuries in the active population. LE pain has been contributed to inflexibility and fascial restrictions. Deep oscillation therapy (DOT) has been proposed to improve range of motion and reduce pain following musculoskeletal injuries. Therefore, our objective was to determine the effectiveness of DOT on ankle dorsiflexion range of motion (ROM) and pain in individuals with and without lower-leg pain. Methods: We used a single blind, pre-post experimental study in a research laboratory. Thirty-two active participants completed this study. Sixteen individuals reporting lower-leg pain and sixteen non-painful individuals completed the study. Participants received a single session of DOT performed by one researcher to their affected limb or matched limb. The intervention parameters included a 1:1 mode and 70-80% dosage. The intervention began by stimulating the lymphatic channels at the cisterna chyli, the inguinal lymph node, and the popliteal lymph node at a frequency of 150 Hz all for a minute each. Next, the researcher treated the triceps surae complex for 11 minutes at three different frequencies. Finally, the participant was treated distal to the popliteal lymph node at 25 Hz for 5 minutes. The main outcome measures included pain using the VAS and ankle dorsiflexion ROM with the weight-bearing lunge test (WBLT). Statistical analyses included descriptive statistics and F-test comparisons between and within groups. Results: The average WBLT measures for all participants increased 0.6 cm, which not to the minimal detectable change for passive ankle dorsiflexion ROM. Significant differences from pre-post measures were identified for pain on the VAS. Conclusion: While increases in ROM were identified, the difference was not clinically important. DOT was successful in decreasing lower-leg pain

The Effects of Deep Oscillation Therapy for Individuals with Lower-Leg Pain

Purpose: Lower extremity (LE) pain accounts for 13-20% of injuries in the active population. LE pain has been contributed to inflexibility and fascial restrictions. Deep oscillation therapy (DOT) has been proposed to improve range of motion and reduce pain following musculoskeletal injuries. Therefore, our objective was to determine the effectiveness of DOT on ankle dorsiflexion range of motion (ROM) and pain in individuals with and without lower-leg pain. Methods: We used a single blind, pre-post experimental study in a research laboratory. Thirty-two active participants completed this study. Sixteen individuals reporting lower-leg pain and sixteen non-painful individuals completed the study. Participants received a single session of DOT performed by one researcher to their affected limb or matched limb. The intervention parameters included a 1:1 mode and 70-80% dosage. The intervention began by stimulating the lymphatic channels at the cisterna chyli, the inguinal lymph node, and the popliteal lymph node at a frequency of 150 Hz all for a minute each. Next, the researcher treated the triceps surae complex for 11 minutes at three different frequencies. Finally, the participant was treated distal to the popliteal lymph node at 25 Hz for 5 minutes. The main outcome measures included pain using the VAS and ankle dorsiflexion ROM with the weight-bearing lunge test (WBLT). Statistical analyses included descriptive statistics and F-test comparisons between and within groups. Results: The average WBLT measures for all participants increased 0.6 cm, which not to the minimal detectable change for passive ankle dorsiflexion ROM. Significant differences from pre-post measures were identified for pain on the VAS. Conclusion: While increases in ROM were identified, the difference was not clinically important. DOT was successful in decreasing lower-leg pain

Cutaneous Silent Period Characteristics are Dependent on the Organization of Upper Limb Muscles

abstractCutaneous silent periods (CSPs) are inhibitory spinal reflexes mediated by small diameter A-δ fibers, serving to protect the body from harmful stimuli (Leis et al., 1992; Kofler, 2003). Currently, CSPs are believed to only inhibit the extensor muscles of the upper limb halting motions such as reaching, while exciting flexor muscles to withdraw the limb. The present study sought to determine if CSPs could be evoked in both extensor and flexor muscles of the upper limb, thereby providing further insight into the organization of the spinal circuitry associated with this reflex. 22 subjects performed contractions with seven muscles from the hand, forearm, upper arm, and shoulder while muscle activity was recorded with electromyography. Subjects were electrically stimulated (10x perceptual threshold) with 20 individual pulses delivered to each digit II (radial nerve) and digit V (ulnar nerve) of the right hand during each contraction. Results demonstrated significant main effects (p<0.001) across muscles for the key dependent variables of the CSP: onsets (F[6,21] = 15.42, p <0.001), durations (F[6,21] = 65.39, p <0.001), and % of suppression (F[6,21] = 91, p <0.001), similarly for both nerves stimulated. Distal muscles presented with the earliest onset times, longest duration of inhibition, and largest amount of inhibition. Moving proximally, the onset times became later with duration and the amount of inhibition decreasing. Linear regressions showed that the distance of the muscle from the spinal cord (cm) was a significant predictor of the duration (digit II r2 = 0.43; digit V r2 = 0.46) and amount of inhibition (digit II r2 = 0.51; digit V r2 = 0.48). The results demonstrate the occurrence of CSPs throughout the upper limb, with the greatest inhibition of distal muscles, leading us to hypothesize that the corticospinal tract, specifically direct cortico-motorneuronal connections, are directly influenced by the inhibitory input

Body Mass Index Superior to Body Adiposity Index in Predicting Adiposity in Female Collegiate Athletes.

International Journal of Exercise Science 16(4): 1487-1498, 2023. Body mass index (BMI) is moderately correlated with %Fat and often used to assess obesity in athletes. Limited research assesses BMI as a surrogate for %Fat in female collegiate athletes. Body Adiposity Index (BAI) is an anthropometric measurement suggested to be superior to BMI at predicting adiposity but has not been well assessed within female athletic populations. This study aimed to determine if BAI is superior to other anthropometric indices to predict %Fat in female collegiate athletes and college-aged female non-athletes. Collegiate female athletes and female non-athletes were invited into the laboratory for anthropometrics and %Fat measurements via BOD POD. BAI was calculated as Hip Circumference/Height1.5 – 18. Eighty-eight female non-athletes and 72 female athletes from soccer (n = 27), softball (n = 28), and basketball (n = 17) completed the study. Using BMI, 19% of non-athletes had a false positive (FP). Sensitivity of BMI in non-athletes was 85.5%, while specificity was 73%. 16% of athletes had a FP. Sensitivity of BMI within athletes was 100%, specificity was 81%. BMI outperformed BAI in athletic (BMI: r = .725, p \u3c .001; BAI: r = .556, p \u3c .001) and nonathletic (BMI: r = .650, p \u3c .001; BAI: r = .499, p \u3c .001) groups. The strongest anthropometric predictor of %Fat within the non-athlete population was BMI (r2 = .42, p \u3c .001). Waist circumference was the strongest predictor in the athletic population (r2 = .62, p \u3c .001). BMI outperformed BAI in its ability to predict %Fat

Cortical Representation and Excitability Increases for a Thenar Muscle Mediate Improvement in Short-Term Cellular Phone Text Messaging Ability

Cortical representations expand during skilled motor learning. We studied a unique model of motor learning with cellular phone texting, where the thumbs are used exclusively to interact with the device and the prominence of use can be seen where 3200 text messages are exchanged a month in the 18-24 age demographic. The purpose of the present study was to examine the motor cortex representation and input-output (IO) recruitment curves of the abductor pollicis brevis (APB) muscle of the thumb and the ADM muscle with transcranial magnetic stimulation (TMS), relative to individuals' texting abilities and short-term texting practice. Eighteen individuals performed a functional texting task (FTT) where we scored their texting speed and accuracy. TMS was then used to examine the cortical volumes and areas of activity in the two muscles and IO curves were constructed to measure excitability. Subjects also performed a 10-min practice texting task, after which we repeated the cortical measures. There were no associations between the cortical measures and the FTT scores before practice. However, after practice the APB cortical map expanded and excitability increased, whereas the ADM map constricted. The increase in the active cortical areas in APB correlated with the improvement in the FTT score. Based on the homogenous group of subjects that were already good at texting, we conclude that the cortical representations and excitability for the thumb muscle were already enlarged and more receptive to changes with short-term practice, as noted by the increase in FTT performance after 10-min of practice

Cortical Representation and Excitability Increases for a Thenar Muscle Mediate Improvement in Short-Term Cellular Phone Text Messaging Ability

Cortical representations expand during skilled motor learning. We studied a unique model of motor learning with cellular phone texting, where the thumbs are used exclusively to interact with the device and the prominence of use can be seen where 3200 text messages are exchanged a month in the 18–24 age demographic. The purpose of the present study was to examine the motor cortex representation and input–output (IO) recruitment curves of the abductor pollicis brevis (APB) muscle of the thumb and the ADM muscle with transcranial magnetic stimulation (TMS), relative to individuals’ texting abilities and short-term texting practice. Eighteen individuals performed a functional texting task (FTT) where we scored their texting speed and accuracy. TMS was then used to examine the cortical volumes and areas of activity in the two muscles and IO curves were constructed to measure excitability. Subjects also performed a 10-min practice texting task, after which we repeated the cortical measures. There were no associations between the cortical measures and the FTT scores before practice. However, after practice the APB cortical map expanded and excitability increased, whereas the ADM map constricted. The increase in the active cortical areas in APB correlated with the improvement in the FTT score. Based on the homogenous group of subjects that were already good at texting, we conclude that the cortical representations and excitability for the thumb muscle were already enlarged and more receptive to changes with short-term practice, as noted by the increase in FTT performance after 10-min of practice