Outsmarting the Brain: Augmenting Motor Training with Non-invasive Brain Stimulation in Order to Facilitate Plasticity-Dependent, Functional Improvement within the Motor Cortex

Brain stimulation techniques capable of optimizing cortical plasticity may provide the key to improved therapeutic techniques and functional outcomes. The primary aim of this dissertation was to examine the potential of motor training (MT) augmented with intermittent theta burst stimulation (iTBS) and anodal transcranial direct current stimulation (a-tDCS). The secondary aim was to investigate whether the training would also be advantageous to older-adults. We hypothesized that right-handed, college-age students exposed to the treatment (n=17) would perform better short-term (directly following MT) and long-term (24 hours and 7 days following MT) on motor-skill retention tests than students receiving sham stimulation (n=14). We also hypothesized that older adults (n=9) exposed to iTBS/a-tDCS enhanced MT would demonstrate greater functional improvements than younger adults (n=16) receiving identical stimulation. iTBS and a-tDCS over the non-dominant motor cortex were used as a primer to, and in conjunction with, 20-minutes of non-dominant, upper extremity MT, respectively. The Jebsen-Taylor Hand Function Test (JTHF) was chosen as the primary outcome measure, while the Pursuit Rotor Tracking Test (PRTT), Purdue Pegboard Test (PPB), and Fitt\u27s Reciprocal Tapping Test (FRTT) were considered secondary outcome measures. Students receiving iTBS/a-tDCS enhanced MT made significantly greater improvements on the JTHF than the placebo-control group (p = .041). However, differences in improvement between the groups were primarily seen long-term (p-.045). Secondary outcome measures were not sensitive enough to detect a difference between the groups at any time point. Concerning the overall performance of older vs. younger participants, whose training was augmented by iTBS/a-tDCS, neither group improved more than the other on the JTHF (p= .1801). The older group scored better on the PRTT (p = .016) and the PPB (p = .0036) but not the FRTT. Although there was no short-term performance difference on any outcome measure, older adults made greater functional improvements than younger adults long-term on the PPB (p = .0039), PPB (p = .0008) and JTHF (p = .0384) (7 days post-treatment). Collectively, the results suggest that brain stimulation may be a useful adjunct to MT in healthy, younger and older adults. Brain stimulation may also eventually improve PT outcomes of neurologically-impaired patients

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The Literary Reputation of of the Third Earl of Shaftesbury

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Bilateral and multiple cavitation sounds during upper cervical thrust manipulation

Abstract Background The popping produced during high-velocity, low-amplitude (HVLA) thrust manipulation is a common sound; however to our knowledge, no study has previously investigated the location of cavitation sounds during manipulation of the upper cervical spine. The primary purpose was to determine which side of the spine cavitates during C1-2 rotatory HVLA thrust manipulation. Secondary aims were to calculate the average number of pops, the duration of upper cervical thrust manipulation, and the duration of a single cavitation. Methods Nineteen asymptomatic participants received two upper cervical thrust manipulations targeting the right and left C1-2 articulation, respectively. Skin mounted microphones were secured bilaterally over the transverse process of C1, and sound wave signals were recorded. Identification of the side, duration, and number of popping sounds were determined by simultaneous analysis of spectrograms with audio feedback using custom software developed in Matlab. Results Bilateral popping sounds were detected in 34 (91.9%) of 37 manipulations while unilateral popping sounds were detected in just 3 (8.1%) manipulations; that is, cavitation was significantly (P Conclusions Cavitation was significantly more likely to occur bilaterally than unilaterally during upper cervical HVLA thrust manipulation. Most subjects produced 3–4 pops during a single rotatory HVLA thrust manipulation targeting the right or left C1-2 articulation; therefore, practitioners of spinal manipulative therapy should expect multiple popping sounds when performing upper cervical thrust manipulation to the atlanto-axial joint. Furthermore, the traditional manual therapy approach of targeting a single ipsilateral or contralateral facet joint in the upper cervical spine may not be realistic.</p

Intramuscular Electrical Stimulation to Trigger Points: Insights into Mechanisms and Clinical Applications&mdash;A Scoping Review

Intramuscular electrical stimulation (IMES) is a modality used by clinicians to treat myofascial pain. Recent studies have shown positive results for the use of IMES on pain outcomes, yet studies investigating the potential mechanisms of IMES directly to trigger points (TrPs) are lacking. We performed a scoping review of the literature to summarize the current evidence from human and animal studies on the mechanisms of IMES to the TrP location, and to identify gaps in the existing literature. Electronic literature searches were conducted across five databases from inception to 15 August 2022, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Scopus and Cochrane Register of Controlled Trials. Four studies met our full criteria for inclusion in this review. Three studies assessed the effects of IMES to TrPs on human subjects with MPS, and only one study used an animal model with experimentally generated TrPs. Based on the results of the included studies, IMES within a TrP region was reported to normalize muscle blood flow, decrease endplate noise of the TrP and elicit antinociceptive effects, at least partially, through engaging supraspinal descending pain inhibitory systems. At present, no clinical implications can be determined on the use of IMES to TrPs due to the limited amount and quality of the available evidence. Further studies investigating the clinical effectiveness and also underlying mechanisms of IMES to TrPs are clearly needed