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Summary
Abstract
Introduction
Protocol
Resultados
Discussion
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Acknowledgements
Materials
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Neurociência

Bilaterale vurdering af den Corticospinal veje af ankel muskler ved hjælp af navigerede transkranial magnetisk Stimulation

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

Denne protokol beskriver den samtidige, bilaterale vurdering af tibialis anterior og soleus corticomotor reaktion under hvile og tonic frivillig aktivering ved hjælp af en enkelt puls transkranial magnetisk stimulation og neuronavigation system.

Abstract

Distale benmusklerne modtage neurale input fra motor kortikale områder via den corticospinal tarmkanalen, som er en af de vigtigste motor faldende pathway i mennesker og kan vurderes ved hjælp af transkranial magnetisk stimulation (TMS). På grund af distale benmusklerne rolle i opretstående postural og dynamisk opgaver, som at gå, er en voksende forskningsinteresse i vurdering og graduering af de corticospinal skrifter i forhold til funktionen af disse muskler opstået i det sidste årti. Dog har metodologiske parametre, der bruges i tidligere arbejde varieret på tværs af undersøgelser at gøre fortolkningen af resultater fra tværsnits- og tidsseriedataene undersøgelser mindre robust. Derfor vil tillade brug af en standardiseret TMS protokol specifikke for vurderingen af benmusklerne corticomotor svar (CMR) for direkte sammenligning af resultater på tværs af undersøgelser og kohorter. Formålet med dette oplæg er at præsentere en protokol, der giver fleksibilitet for at samtidig vurdere de bilaterale CMR af to vigtigste ankel antagonistiske muskler, tibialis anterior og soleus, ved hjælp af fælles puls TMS med en neuronavigation system. Denne protokol finder anvendelse, mens de undersøgte muskel er enten helt afslappet eller isometrisk indgået ved en defineret procentdel af maksimal isometrisk frivillige sammentrækning. Ved hjælp af hvert emne strukturelle Mr med neuronavigation system sikrer nøjagtig og præcis positionering af spolen over ben kortikale repræsentationer under vurdering. Givet inkonsekvensen i CMR afledt foranstaltninger, beskriver denne protokol også en standardiseret beregning af foranstaltningerne ved hjælp af automatiske algoritmer. Selv om denne protokol ikke er udført under oprejst postural eller dynamisk opgaver, kan det bruges til at vurdere bilateralt ethvert par af benmusklerne, enten antagonistiske eller synergistiske, i både neurologisk intakte og nedsat emner.

Introduction

Tibialis anterior (TA) og soleus (SOL) er anklen antagonistiske muskler placeret i den forreste og bagerste rum af underbenet, henholdsvis. Begge muskler er uniarticular, mens den vigtigste funktion af TA og SOL er at dorsiflex og plantarflex talocrural fælles, henholdsvis1. Desuden er TA mere funktionel for lang muskel udflugter og mindre vigtigt for kraft produktionen, mens SOL er en antigravitation muskel designet til at generere høje kraft med lille udflugt muskel2. Begge muskler er især relevante under oprejst postural og dynamisk opgaver (fx gående)3,4. Med hensyn til neurale kontrol få motorneuron puljer af begge muskler neurale drive fra hjernen via motoren faldende veje5,6, ud over forskellige grader af sensoriske drev.

Den vigtigste drivkraft faldende vej er den corticospinal tarmkanalen, som stammer fra de primære, premotor og supplerende motor områder og ophører i spinal motorneuron pools7,8. Hos mennesker, kan den funktionelle tilstand af denne tarmkanalen (corticomotor svar – CMR) realistisk vurderes ved hjælp af transkranial magnetisk stimulation (TMS), en ikke-invasiv brain stimulation værktøj9,10. Siden indførelsen af Handelsforanstaltningerne, og da deres funktionelle betydning under oprejst postural opgave og gå er TA CMR og SOL blevet vurderet i forskellige kohorter og opgaver11,12,13,14 ,15,16,17,18,19,20,21,22,23 ,24,25,26,27,28,29,30,31,32 .

I modsætning til vurdering af CMR i øvre ekstremiteter muskler33, fastslået ingen universelle TMS protokol blev for vurderingen af CMR i nedre-ekstremitet muskler. På grund af en forud opstillet protokol og den store metodologiske variation på tværs af de tidligere undersøgelser (f.eks. type coil, brug af neuronavigation, tonic aktivering, test side og muskel, bruge og beregning af CMR foranstaltninger, osv. ), fortolkning af resultaterne på tværs af undersøgelser og årgange kan være besværlige, kompliceret og unøjagtige. Da foranstaltningerne, der er funktionelt relevante i forskellige motoriske opgaver, vil en etableret TMS protokol specifikke at sænke ekstremitet CMR vurdering give motor neuroforskere og rehabilitering forskere at systematisk vurdere CMR i disse muskler på tværs af sessioner og forskellige kohorter.

Derfor er formålet med denne protokol til at beskrive den bilaterale vurdering af TA og SOL CMR ved hjælp af fælles puls TMS og neuronavigation system. I modsætning til tidligere arbejde, denne protokol har til formål at maksimere rigor af eksperimentelle procedurer, dataopsamling og analyse af data ved at ansætte metodologiske faktorer, der optimerer gyldighed og varigheden af forsøget, og standardisere CMR vurdering af disse to nedre ekstremiteter muskler. I betragtning af at CMR af en muskel afhænger om musklen er helt afslappet eller aktiveres delvist, beskriver denne protokol hvordan TA og SOL CMR kan vurderes under hvile og tonic frivillig aktivering (TVA). De følgende afsnit vil grundigt beskriver denne protokol. Endelig, repræsentative data præsenteres og diskuteres. Protokollen beskrevet her er afledt af der i Charalambous et al. 201832.

Protocol

Alle eksperimentelle procedurer præsenteret i denne protokol er blevet godkendt af de lokale institutionelle Review Board og er i overensstemmelse med Helsinki-erklæringen. 1. samtykke til proces og sikkerhed spørgeskemaer Forud for enhver eksperiment, forklare hvert emne aim(s) af undersøgelsen, de vigtigste eksperimentelle procedurer og eventuelle potentielle risikofaktorer forbundet med deltager i undersøgelsen. Efter at besvare eventuelle spørgsmål eller bekymringer, som f…

Representative Results

Tallene 2-4 præsentere data fra en repræsentativ neurologisk intakte 31 år gammel mandlige med højde og vægt på 178 cm og 83 kg, henholdsvis. Figur 2 præsenterer bilaterale hotspots og RMT hver ankel muskler. Bruge stedet ligger på midten af området ben i hver halvkugle (se firkanter i figur 1B), intensiteten af 45% MSO anvendtes bilateralt for hotspot jagt. Hot spot placering for hver muskel afveg mellem hjernehalvdele, men som forve…

Discussion

I betragtning af den spirende interesse i hvordan den motoriske hjernebark bidrager til den motorisk kontrol af benmusklerne under dynamisk opgaver i forskellige kohorter, er et standardiseret TMS-protokollen, der beskriver en grundig vurdering af disse muskler nødvendig. Derfor, for første gang, denne protokol giver standardiserede metodologiske procedurer på bilaterale vurdering af to ankel antagonistiske muskler, SOL og TA, under to muskel stater (resten og TVA) bruger en enkelt puls TMS med neuronavigation.

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Declarações

The authors have nothing to disclose.

Acknowledgements

Forfatterne takke Dr. Jesse C. Dean for at hjælpe med metodologiske udvikling og give feedback på et udkast af manuskriptet. Dette arbejde blev støttet af en VA karriere udvikling Award-2 RR & D N0787-W (MGB), en institutionel udvikling Award fra National Institute of General Medical Sciences af NIH under grant nummer P20-GM109040 (SAK) og P2CHD086844 (SAK). Indhold repræsenterer ikke synspunkter Department of veterananliggender eller de Forenede Staters regering.

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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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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