Intermittent hypoxia enhances voluntary activation and reduces performance fatigability during repeated lower limb contractions.

Prior research has highlighted the therapeutic benefits of acute intermittent hypoxia (AIH) in enhancing motor performance after motor incomplete spinal cord injury and in able-bodied individuals. Although studies in rodents and humans indicate that AIH may facilitate motor excitability, the relationship between excitability changes and functional performance remains unclear. In addition, discrepancies in the effects of AIH on excitability in able-bodied individuals merit further investigation.

Intermittent Hypoxia-Induced Enhancements in Corticospinal Excitability Predict Gains in Motor Learning and Metabolic Efficiency.

Acute intermittent hypoxia (AIH) enhances human motor function after incomplete spinal cord injury. Although the underlying mechanisms in humans are unknown, emerging evidence indicates that AIH facilitates corticospinal excitability to the upper limb. However, the functional relevance of this plasticity remains unexplored, and it is unclear whether similar plasticity can be induced for lower limb motor areas.

A single sequence of intermittent hypoxia does not alter stretch reflex excitability in able-bodied individuals.

Spasticity attributable to exaggerated stretch reflex pathways, particularly affecting the ankle plantar flexors, often impairs overground walking in persons with incomplete spinal cord injury. Compelling evidence from rodent models underscores how exposure to acute intermittent hypoxia (AIH) can provide a unique medium to induce spinal plasticity in key inhibitory pathways mediating stretch reflex excitability and potentially affect spasticity. In this study, we quantify the effects of a single exposure to AIH on the stretch reflex in able-bodied individuals.

Enhanced motor learning and motor savings after acute intermittent hypoxia are associated with a reduction in metabolic cost.

Breathing mild bouts of low oxygen air (i.e. acute intermittent hypoxia, AIH) has been shown to improve locomotor function in humans after a spinal cord injury.

A Wearable Mixed Reality Platform to Augment Overground Walking: A Feasibility Study.

Humans routinely modify their walking speed to adapt to functional goals and physical demands. However, damage to the central nervous system (CNS) often results in abnormal modulation of walking speed and increased risk of falls. There is considerable interest in treatment modalities that can provide safe and salient training opportunities, feedback about walking performance, and that may augment less reliable sensory feedback within the CNS after injury or disease.

Acute intermittent hypoxia as a potential adjuvant to improve walking following spinal cord injury: evidence, challenges, and future directions.

Purpose Of Review: The reacquisition and preservation of walking ability are highly valued goals in spinal cord injury (SCI) rehabilitation. Recurrent episodes of breathing low oxygen (i.e.

Daily acute intermittent hypoxia combined with walking practice enhances walking performance but not intralimb motor coordination in persons with chronic incomplete spinal cord injury.

Unlabelled: Persons living with incomplete spinal cord injuries (SCI) often struggle to regain independent walking due to deficits in walking mechanics. They often dedicate many weeks of gait training before benefits to emerge, with additional training needed for benefits to persist. Recent studies in humans with SCI found that daily bouts of breathing low oxygen (acute intermittent hypoxia, AIH) prior to locomotor training elicited persistent (weeks) improvement in overground walking speed and endurance.

Daily acute intermittent hypoxia to improve walking function in persons with subacute spinal cord injury: a randomized clinical trial study protocol.

Background: Restoring community walking remains a highly valued goal for persons recovering from traumatic incomplete spinal cord injury (SCI). Recently, studies report that brief episodes of low-oxygen breathing (acute intermittent hypoxia, AIH) may serve as an effective plasticity-inducing primer that enhances the effects of walking therapy in persons with chronic (> 1 year) SCI. More persistent walking recovery may occur following repetitive (weeks) AIH treatment involving persons with more acute SCI, but this possibility remains unknown.

Differential deficits in spatial and temporal interlimb coordination during walking in persons with incomplete spinal cord injury.

Background: Returning to community walking remains a major challenge for persons with incomplete spinal cord injury (iSCI) due, in part, to impaired interlimb coordination. Here, we examined spatial and temporal features of interlimb coordination during walking and their associations to gait deficits in persons with chronic iSCI.

Research Question: Do deficits in spatial and temporal interlimb coordination correspond differentially to clinical indicators of walking performance in persons with iSCI?

Methods: Sixteen persons with chronic iSCI and eleven able-bodied individuals participated in this study.

Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol.

Background: Despite intensive rehabilitation efforts, most stroke survivors have persistent functional disability of the paretic arm and hand. These motor impairments may be due in part to maladaptive changes in structural and functional connections between brain regions. The following early stage clinical trial study protocol describes a noninvasive brain stimulation approach to target transcallosally mediated interhemispheric connections between the ipsi- and contralesional motor cortices (iM1 and cM1) using corticocortical paired associative stimulation (ihPAS).

Variability of Leg Kinematics during Overground Walking in Persons with Chronic Incomplete Spinal Cord Injury.

Incomplete spinal cord injury (iSCI) often leads to partial disruption of spinal pathways that are important for motor control of walking. Persons with iSCI present with deficits in walking ability in part because of inconsistent leg kinematics during stepping. Although kinematic variability is important for normal walking, growing evidence indicates that excessive variability may limit walking ability and increase reliance on assistive devices (AD) after iSCI.

Contralesional Hemisphere Regulation of Transcranial Magnetic Stimulation-Induced Kinetic Coupling in the Poststroke Lower Limb.

Background: The neural constraints underlying hemiparetic gait dysfunction are associated with abnormal kinetic outflow and altered muscle synergy structure. Recent evidence from our lab implicates the lesioned hemisphere in mediating the expression of abnormally coupled hip adduction and knee extension synergy, suggesting a role of cortical networks in the regulation of lower limb motor outflow poststroke. The potential contribution of contralesional hemisphere (CON-H) in regulating paretic leg kinetics is unknown.

Evidence of impaired neuromuscular responses in the support leg to a destabilizing swing phase perturbation in hemiparetic gait.

The neuromuscular mechanisms that underlie post-stroke impairment in reactive balance control during gait are not fully understood. Previous research has described altered muscle activations in the paretic leg in response to postural perturbations from static positions. Additionally, attenuation of interlimb reflexes after stroke has been reported.

Downregulating Aberrant Motor Evoked Potential Synergies of the Lower Extremity Post Stroke During TMS of the Contralesional Hemisphere.

Background: Growing evidence demonstrates unique synergistic signatures in the lower limb (LL) post-stroke, with specific across-plane and across-joint representations. While the inhibitory role of the ipsilateral hemisphere in the upper limb (UL) has been widely reported, examination of the contralesional hemisphere (CON-H) in modulating LL expressions of synergies following stroke is lacking.

Objective: We hypothesize that stimulation of lesioned and contralesional motor cortices will differentially regulate paretic LL motor outflow.

Tuning of robotic therapy controllers for stroke gait: Using isometrically constrained EMG modular structures.

The development of EMG based controllers for automated gait orthosis is a promising intervention for post-stroke gait rehabilitation and assistive device applications. However, the integration of stroke specific modular neuromuscular patterns for the design of active gait assistance controller is largely unexplored. To this end, this work presents preliminary evidence of the associated variability between lower limb muscle activation patterns underlying discrete isometric control objectives and the analogous dynamic subtask during treadmill gait using matrix factorization algorithms.

Evaluation of lower limb cross planar kinetic connectivity signatures post-stroke.

Following stroke, aberrant three dimensional multijoint gait impairments emerge that present in kinematic asymmetries such as circumduction. A precise pattern of cross-planar coordination may underlie abnormal hemiparetic gait as several studies have underscored distinctive neural couplings between medio-lateral control and sagittal plane progression during walking. Here we investigate potential neuromechanical constraints governing abnormal multijoint coordination post-stroke.