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Summary
Abstract
Introduction
Protocol
Ergebnisse
Discussion
Offenlegungen
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Bilaterale vurdering av Corticospinal veier ankel muskler med navigert Transkraniell magnetisk stimulering

Published: February 19, 2019
doi:
10.3791/58944
, , , ,
1Department of Neurology,New York University School of Medicine, 2Department of Health Sciences and Research,Medical University of South Carolina, 3Department of Physical Therapy,University of Nevada Las Vegas, 4Department of Health Professions,Medical University of South Carolina, 5Ralph H. Johnson VA Medical Center, 6Department of Psychiatry,Medical University of South Carolina, 7Division of Physical Therapy,Medical University of South Carolina

Summary

Nåværende protokollen beskriver samtidige, bilaterale vurdering av corticomotor svar tibialis fremre og soleus under hvile og tonic frivillig aktivisering benytter en enkelt puls Transkraniell magnetisk stimulering og neuronavigation system.

Abstract

Distale beinmuskulaturen mottar nevrale signaler fra motor kortikale områder via det corticospinal spor, hvilke er en av de viktigste motor synkende tursti hos mennesker og kan bli vurdert ved hjelp Transkraniell magnetisk stimulering (TMS). Gitt rollen distale beinmuskulaturen i oppreist postural og dynamisk aktiviteter, som gåing, en voksende forskningsinteresse for vurdering og modulering av corticospinal strøk i forhold til funksjonen til disse musklene har dukket opp i det siste tiåret. Imidlertid har metodologiske parametere brukes i tidligere arbeid variert over studier gjør tolkningen av resultater fra cross-sectional og longitudinelle studier mindre robust. Derfor vil en standardisert TMS-protokollen som er spesifikke for vurdering av beinmuskulaturen corticomotor svaret (CMR) tillate direkte sammenligning av resultatene på tvers av studier og kohorter. Målet med denne utredningen er å presentere en protokoll som gir fleksibilitet til å samtidig vurdere bilaterale CMR av to viktigste ankel antagonistiske muskler, tibialis fremre og soleus, enkelt puls TMS med en neuronavigation system. Nåværende protokollen gjelder mens undersøkt muskelen er helt avslappet eller isometrically kontrakt ved definerte til maksimal isometrisk frivillig sammentrekning. Hvert emne strukturelle MRI sikrer med neuronavigation-systemet nøyaktig og presis posisjonering av spolen over Ben kortikale representasjoner under vurdering. Denne protokollen gitt inkonsekvensen i CMR avledet tiltak, og beskriver også en standardisert beregning av disse tiltakene ved hjelp av automatisert algoritmene. Men denne protokollen ikke er utført under oppreist postural eller dynamisk oppgaver, kan det brukes til å vurdere bilateralt noen par beinmuskulaturen, antagonistiske eller synergistisk, i både nevrologisk intakt og svekket fag.

Introduction

Fremre tibialis (TA) og soleus (SOL) er ankelen antagonistiske muskler ligger i fremre og bakre rommet i leggen, henholdsvis. Både muskler er uniarticular, mens den viktigste funksjonen til TA og SOL er dorsiflex og plantarflex talocrural felles, henholdsvis1. Videre er TA mer funksjonell for lang muskel utflukter og mindre viktig for kraft produksjon, mens SOL er en antigravitasjon muskel designet til generere høy kraft med små turbåter av muskel2. Både muskler er særlig relevant i oppreist postural og dynamisk oppgaver (f.eks walking)3,4. Om neural kontroll får motorneuron bassengene av både muskler nevrale stasjonen fra hjernen via motoren synkende veier5,6, i tillegg til varierende grad av sensoriske stasjonen.

Hovedmotor synkende veien er det corticospinal spor, hvilke stammer fra de primære, premotor og supplerende motoriske og avsluttes i spinal motorneuron bassenger7,8. Hos mennesker, kan funksjonelle tilstanden til dette heftet (corticomotor svar – CMR) feasibly vurderes bruker Transkraniell magnetisk stimulering (TMS), en ikke-invasiv hjernen stimulering verktøyet9,10. Siden introduksjonen av TMS og deres funksjonelle betydning under oppreist postural oppgaven og gå, har CMR av TA og SOL vurdert i ulike kohorter og oppgaver11,12,13,14 ,15,16,17,18,19,20,21,22,23 ,24,25,26,27,28,29,30,31,32 .

I motsetning til vurdering av CMR i øvre ekstremitet muskler33, er ingen universell TMS-protokoll etablert for vurdering av CMR i nedre ekstremitet muskler. På grunn av mangel på en etablert protokoll og store metodologiske variasjon over de tidligere studiene (f.eks typen coil, bruk av neuronavigation, tonic aktivisering, testing side og muskler, bruk og beregning av CMR måler, osv. ), tolkningen av resultater på tvers av studier og kohorter kan tungvinte, komplisert og unøyaktig. Tiltakene er funksjonelt relevant i ulike finmotoriske oppgaver, vil en etablert TMS protokoll gjelder nedre ekstremitet CMR vurdering tillate motor nevrologer og rehabilitering forskere å systematisk vurdere CMR musklene over økter og ulike kohorter.

Målet med denne protokollen er derfor å beskrive bilaterale vurdering av TA og SOL CMR bruker enkelt puls TMS og neuronavigation system. I motsetning til tidligere arbeid mål denne protokollen å maksimere rigor av eksperimentelle prosedyrer, datainnsamling og dataanalyse ved hjelp av metodologiske faktorer som optimaliserer gyldigheten og varigheten av forsøket, og standardisere CMR vurdering av disse to nedre ekstremitet musklene. Gitt at CMR på en muskel, avhenger av om muskelen helt avslappet eller aktiveres delvis, beskriver denne protokollen hvordan TA og SOL CMR kan vurderes under hvile og tonic frivillig aktivering (TVA). Delene nedenfor beskriver grundig stede protokollen. Til slutt, representant dataene presentert og drøftet. Protokollen beskrevet her er avledet fra det i Charalambous et al. 201832.

Protocol

Alle eksperimentelle prosedyrer i denne protokollen er godkjent av lokale institusjonelle gjennomgang styret og er i tråd med erklæringen i Helsinki. 1. samtykke prosessen og sikkerhet spørreskjemaer Før noen forsøk, Forklar hvert emne aim(s) studien, de viktigste eksperimentelle prosedyrene og alle mulige risikofaktorer forbundet med delta i studien. Etter spørsmål eller kommentarer som fag kan ha, spør fag å anerkjenne godkjenningsprosessen og signere skjemaet samtykke.</l…

Representative Results

Tallene 2-4 presentere data fra en representant nevrologisk intakt 31 år gammel mann med høyde og vekt 178 cm og 83 kg, henholdsvis. Figur 2 viser den bilaterale aktiveringspunkt og RMT hver ankel muskler. Bruke stedet ligger på midten av skiområdet etappe i hver halvkule (se torg figur 1B), intensiteten av 45% MSO bilateralt gjelder aktiveringspunktet jakt. Aktiveringspunkt plasseringen for hver muskel differansen imellom halvkuler, men s…

Discussion

Gitt den voksende interessen i hvordan motorisk cortex bidrar til motor kontroll av beinmuskulaturen under dynamisk oppgaver i ulike kohorter, er en standardisert TMS-protokoll som beskriver grundig vurdering av disse musklene nødvendig. Nåværende protokollen gir derfor standardisert metodologiske prosedyrer for første gang, bilaterale vurdering av to ankel antagonistiske muskler, SOL og TA, under to muskel stater (resten og TVA) bruker en enkelt puls TMS med neuronavigation.

Funnene beskr…

Offenlegungen

The authors have nothing to disclose.

Acknowledgements

Forfatterne takker Dr. Jesse C. Dean for å hjelpe med metodiske utvikling og gi tilbakemelding på et utkast til manuskriptet. Dette arbeidet ble støttet av en VA karriere Development Award-2 RR & D N0787-W (MGB), institusjonelle Development Award fra National Institute of General Medical Sciences av NIH under bevilgning nummer P20-GM109040 (SAK) og P2CHD086844 (SAK). Innholdet representerer ikke synspunktene til Department of Veterans Affairs eller myndighetene i USA.

Materials

2 Magstim stimulators (Bistim module) The Magstim Company Limited; Whitland, UK Used to elicit bilateral motor evoked potentials in tibialis anterior and soleus muscles.
Adaptive parameter estimation by sequential testing (PEST) for TMS http://www.clinicalresearcher.org/software.htm Used to determine motor thresholds.
Amplifier Motion Lab Systems; Baton Rouge, LN, USA MA-300 Used to amplify EMG data.
Data Aqcuisition Unit Motion Lab Systems; Baton Rouge, LN, USA Micro 1401 Used to aqcuire EMG data.
Double cone coil The Magstim Company Limited; Whitland, UK PN: 9902AP Used to elicit bilateral motor evoked potentials in tibialis anterior and soleus muscles.
Polaris Northen Digital Inc.; Waterloo, Ontario, Canada Used to track the reflectiive markers located on subject tracker and coil tracker.
Signal Cambridge Electronics Design Limited; Cambridge, UK version 6 Used to collect motor evoked potentials during rest and TVA.
Single double differential surface EMG electrodes Motion Lab Systems; Baton Rouge, LN, USA MA-411 Used to record EMG signals.
TMS Frameless Stereotaxy Neuronavigation Sytem Brainsight 3, Rouge Research,
Montreal, Canada		 Used to navigate coil position during TMS assessment.
Walker boot Mountainside Medical Equipment, Marcy, NY Used to stabilize ankle joint.
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Tags

Keyword Extraction: Navigated Transcranial Magnetic StimulationCorticospinal PathwaysAnkle MusclesBilateral AssessmentMotor-evoked PotentialsLower ExtremityTibialis AnteriorStrokeMotor ControlGaitNeuronavigationMRIMontreal Neurological Institute AtlasSkin ModelLeg Motor AreaMotor MappingElectrodesTibialis AnteriorLateral Soleus
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Charalambous, C. C., Liang, J. N., Kautz, S. A., George, M. S., Bowden, M. G. Bilateral Assessment of the Corticospinal Pathways of the Ankle Muscles Using Navigated Transcranial Magnetic Stimulation. J. Vis. Exp. (144), e58944, doi:10.3791/58944 (2019).
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