Cargando…

Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS)

Advances in our understanding of neural plasticity have prompted the emergence of neuromodulatory interventions, which modulate corticomotor excitability (CME) and hold potential for accelerating stroke recovery. Endogenous paired associative stimulation (ePAS) involves the repeated pairing of a sin...

Descripción completa

Detalles Bibliográficos
Autores principales: Alder, Gemma, Signal, Nada, Vandal, Alain C., Olsen, Sharon, Jochumsen, Mads, Niazi, Imran Khan, Taylor, Denise
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918620/
https://www.ncbi.nlm.nih.gov/pubmed/33673171
http://dx.doi.org/10.3390/brainsci11020224
_version_ 1783657965175177216
author Alder, Gemma
Signal, Nada
Vandal, Alain C.
Olsen, Sharon
Jochumsen, Mads
Niazi, Imran Khan
Taylor, Denise
author_facet Alder, Gemma
Signal, Nada
Vandal, Alain C.
Olsen, Sharon
Jochumsen, Mads
Niazi, Imran Khan
Taylor, Denise
author_sort Alder, Gemma
collection PubMed
description Advances in our understanding of neural plasticity have prompted the emergence of neuromodulatory interventions, which modulate corticomotor excitability (CME) and hold potential for accelerating stroke recovery. Endogenous paired associative stimulation (ePAS) involves the repeated pairing of a single pulse of peripheral electrical stimulation (PES) with endogenous movement-related cortical potentials (MRCPs), which are derived from electroencephalography. However, little is known about the optimal parameters for its delivery. A factorial design with repeated measures delivered four different versions of ePAS, in which PES intensities and movement type were manipulated. Linear mixed models were employed to assess interaction effects between PES intensity (suprathreshold (Hi) and motor threshold (Lo)) and movement type (Voluntary and Imagined) on CME. ePAS interventions significantly increased CME compared to control interventions, except in the case of Lo-Voluntary ePAS. There was an overall main effect for the Hi-Voluntary ePAS intervention immediately post-intervention (p = 0.002), with a sub-additive interaction effect at 30 min’ post-intervention (p = 0.042). Hi-Imagined and Lo-Imagined ePAS significantly increased CME for 30 min post-intervention (p = 0.038 and p = 0.043 respectively). The effects of the two PES intensities were not significantly different. CME was significantly greater after performing imagined movements, compared to voluntary movements, with motor threshold PES (Lo) 15 min post-intervention (p = 0.012). This study supports previous research investigating Lo-Imagined ePAS and extends those findings by illustrating that ePAS interventions that deliver suprathreshold intensities during voluntary or imagined movements (Hi-Voluntary and Hi-Imagined) also increase CME. Importantly, our findings indicate that stimulation intensity and movement type interact in ePAS interventions. Factorial designs are an efficient way to explore the effects of manipulating the parameters of neuromodulatory interventions. Further research is required to ensure that these parameters are appropriately refined to maximise intervention efficacy for people with stroke and to support translation into clinical practice.
format Online
Article
Text
id pubmed-7918620
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-79186202021-03-02 Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS) Alder, Gemma Signal, Nada Vandal, Alain C. Olsen, Sharon Jochumsen, Mads Niazi, Imran Khan Taylor, Denise Brain Sci Article Advances in our understanding of neural plasticity have prompted the emergence of neuromodulatory interventions, which modulate corticomotor excitability (CME) and hold potential for accelerating stroke recovery. Endogenous paired associative stimulation (ePAS) involves the repeated pairing of a single pulse of peripheral electrical stimulation (PES) with endogenous movement-related cortical potentials (MRCPs), which are derived from electroencephalography. However, little is known about the optimal parameters for its delivery. A factorial design with repeated measures delivered four different versions of ePAS, in which PES intensities and movement type were manipulated. Linear mixed models were employed to assess interaction effects between PES intensity (suprathreshold (Hi) and motor threshold (Lo)) and movement type (Voluntary and Imagined) on CME. ePAS interventions significantly increased CME compared to control interventions, except in the case of Lo-Voluntary ePAS. There was an overall main effect for the Hi-Voluntary ePAS intervention immediately post-intervention (p = 0.002), with a sub-additive interaction effect at 30 min’ post-intervention (p = 0.042). Hi-Imagined and Lo-Imagined ePAS significantly increased CME for 30 min post-intervention (p = 0.038 and p = 0.043 respectively). The effects of the two PES intensities were not significantly different. CME was significantly greater after performing imagined movements, compared to voluntary movements, with motor threshold PES (Lo) 15 min post-intervention (p = 0.012). This study supports previous research investigating Lo-Imagined ePAS and extends those findings by illustrating that ePAS interventions that deliver suprathreshold intensities during voluntary or imagined movements (Hi-Voluntary and Hi-Imagined) also increase CME. Importantly, our findings indicate that stimulation intensity and movement type interact in ePAS interventions. Factorial designs are an efficient way to explore the effects of manipulating the parameters of neuromodulatory interventions. Further research is required to ensure that these parameters are appropriately refined to maximise intervention efficacy for people with stroke and to support translation into clinical practice. MDPI 2021-02-12 /pmc/articles/PMC7918620/ /pubmed/33673171 http://dx.doi.org/10.3390/brainsci11020224 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Alder, Gemma
Signal, Nada
Vandal, Alain C.
Olsen, Sharon
Jochumsen, Mads
Niazi, Imran Khan
Taylor, Denise
Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS)
title Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS)
title_full Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS)
title_fullStr Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS)
title_full_unstemmed Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS)
title_short Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS)
title_sort investigating the intervention parameters of endogenous paired associative stimulation (epas)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918620/
https://www.ncbi.nlm.nih.gov/pubmed/33673171
http://dx.doi.org/10.3390/brainsci11020224
work_keys_str_mv AT aldergemma investigatingtheinterventionparametersofendogenouspairedassociativestimulationepas
AT signalnada investigatingtheinterventionparametersofendogenouspairedassociativestimulationepas
AT vandalalainc investigatingtheinterventionparametersofendogenouspairedassociativestimulationepas
AT olsensharon investigatingtheinterventionparametersofendogenouspairedassociativestimulationepas
AT jochumsenmads investigatingtheinterventionparametersofendogenouspairedassociativestimulationepas
AT niaziimrankhan investigatingtheinterventionparametersofendogenouspairedassociativestimulationepas
AT taylordenise investigatingtheinterventionparametersofendogenouspairedassociativestimulationepas