TENS stimulation can increase cortical excitability and increase GABAnergic
activity. Motor task showed synergistic effect on TENS induced increment of cortical
excitability and increment of GABAnergic activity. Lower hemodynamic response of
prefrontal cortex in retention test indicated TENS reduced high level cortex process
demand in acquainted motor task. However, there was no significant different of motor
performance with or without TENS intervention.
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FIGURES
Figure 1. Randomized Crossed-over designed in this study. Subjects were randomized
into 4 testing conditions. Subjects received another trials of sham stimulation or TENS
intervention with 1 week interval.
Figure 2. The figure shows experimental procedure of this study. NIRS and SRTT
measurement only delivered in Motor-TENS trial and Motor-Sham trial. Intermittent
TENS intervention was concurrently measurement Prefrontal cortical hemodynamic
response.
Figure 3.Motor-TENS and Stimulus-TENS showed significant increment of MEP size
Motor-TENS showed the superior excitatory response. However, there was no
significant different of MEP size change in Motor-Sham and Stimulus-Sham.
Figure 4 Motor-Sham and Motor-TENS showed significant declined of ICI. There was
no significant different of ICI in Stimulus-Sham and Stimulus-TENS. Motor-TENS got
significant lower ICI than Motor-Sham indicated that TENS increase suppression
induced by ICI.
P< 0.037*
P< 0.032*
Figure 5 Significant decrease of ICF in Motor-TENS and Stimulus-TENS. However,
there was no significant difference between Motor-TENS, Motor-Sham,
Stimulus-Sham and Stimulus-TENS in immediate effect or follow up measurements.
Indicated that poor evidence of ICF decrease after TENS intervention.
Figure 6. This figure showed hemodynamic response during motor practice. Change of
hemoglobin difference means cerebral oxygenation status which implicated level of
hemodynamic response. Prefrontal hemodynamic response significantly increase in
intermittent of TENS intervention and motor practice. Following significant decrease
activation in retention task in Motor-TENS trial indicated the TENS reduce higher
level cortical demand. Motor-TENS got significant lower of [Hbdiff] in follow up 30
mins
P< 0.030*
Figure 7. There was no significant different of reaction time of Motor-TENS and
Motor-Sham in all practice trials. A trend of reduce decrease reaction time was found
in Motor-TENS during concurrent TENS with motor execution.
Figure 8. In transfer task (random number trials) showed no significant different
between Motor-TENS and Motor-Sham in immediate effect and follow up. Both group
showed decrease of reaction time after practice.
TABLES
Basic Data/Group Motor-TENS/Sham Stimulus-TENS/Sham Independent t test
Gender (F:M) 12:13 13:10
Age 22.4±1.7 21.9±1.5 P= 0.309
Table1. The basic data of participant. No significant different of sex and age between
two groups
Table 2 The baseline of all outcome measurements. There was no significant different
of MT, MEP, ICI, ICF between four testing trials. In motor related outcome
measurements, there was also no significant different of initial prefrontal activation
([Hbdiff]), RT in block sequence practice and RT in random number practice between
Motor-TENS and Motor-Sham.
Neurophysiological
Measurement Motor-TENS Motor-Sham Stimulus-TENS Stimulus-Sham Independent t Test
MT (%) 54.52±8.0 53.6±8.0 56.7±11.5 56.4±10.2 >0.05
Table 3 This table showed the results of MEP. Significant increase MEP size was
found in Motor-TENS and Stimulus-TENS. There was no significant difference in
Motor-Sham and Stimulus-Sham. Between trials comparison showed MEP amplitude
of Motor-TENS significant higher than Motor-Sham in follow up 60 mins. Besides,
Motor-TENS 0.42±0.22 0.55±0.24 0.59±0.25 0.66±0.24 >0.001*
Motor-Sham 0.46±0.22 0.47±0.22 0.49±0.21 0.48±0.21 0.236
Stimulus-TENS 0.37±0.20 0.48±0.25 0.52±0.30 0.51±0.31 >0.001*
Stimulus-Sham 0.44±0.20 0.45±0.22 0.43±0.21 0.44±0.21 0.484
Between group comparison (Wilcoxon sign rank test; p value)
Motor-TENS/Motor-Sham 0.753 0.189 0.076 0.001*
Stimulus-TENS/Stimulus-Sham 0.089 0.715 0.144 0.543
Motor-TENS/Stimulus-TENS 0.447 0.346 0.362 0.048*
Motor-TENS/Stimulus-Sham 0.784 0.073 0.021* 0.003*
Table 4. This table showed the results of ICI. Significant increase suppression induced
by ICI was found in Motor-TENS and Motor-Sham. Between trials comparison
showed Motor-TENS significant increase more ICI suppression than motor-Sham in
follow up 60 mins. Based on these findings, TENS intervention facilitated ICI
suppression induced by motor task.
Intracortical Inhibition (%)
Baseline Immediate Effect
30 mins 60 mins Friedman’s Test (P value)
Motor-TENS 0.53±0.24 0.40±0.18 0.49±0.21 0.37±0.16 0.003*
Motor-Sham 0.56±0.21 0.53±0.18 0.43±0.16 0.46±0.15 0.041*
Stimulus-TENS 0.46±0.26 0.36±0.19 0.41±0.23 0.38±0.24 0.211
Stimulus-Sham 0.46±0.17 0.43±0.18 0.43±0.16 0.51±0.23 0.213
Between group comparison (Wilcoxon sign rank test; p value)
Motor-TENS/Motor-Sham 0.391 0.037* 0.290 0.032*
Motor-TENS/Stimulus-Sham 0.429 0.627 0.330 0.042*
Table 5. This table showed the results of ICF. Significant decreases of ICF were found
in Motor-TENS and Stimulus-TENS. Based on the results, TENS intervention decrease
amount of facilitation induced by ICF. There was no significant different between four
different trial indicated weak effect of TENS on ICF modulation.
Intracortical Facilitation (%)
Baseline Immediate Effect
30 mins 60 mins Friedman’s Test (P value)
Motor-TENS 1.45±0.30 1.24±0.35 1.28±0.25 1.18±0.18 >0.001*
Motor-Sham 1.35±0.34 1.24±0.24 1.24±0.24 1.21±0.3 0.302
Stimulus-TENS 1.48±0.45 1.26±0.35 1.24±0.28 1.21±0.24 0.004*
Stimulus-Sham 1.37±0.29 1.28±0.32 1.36±0.30 1.31±0.26 0.286
Between group comparison (Wilcoxon sign rank test; p value)
Motor-TENS/Motor-Sham 0.317 0.475 0.607 0.732
Motor-TENS/ Stimulus-Sham 0.287 0.563 0.503 0.094
Stimulus-TENS/Stimulus-Sham 0.808 0.761 0.274 0.107
Table 6. This table showed the results of prefrontal hemodynamic response.
Significant increase activation in initial learning and following decrease activation in
retention test. Between trials comparison showed Motot-TENS got significant lower of
[Hbdiff] in follow up 30 mins.
[Hbdiff]
(mmol)
Baseline Intermittent 0 min 30 mins 6o mins Friedman’s Test (P value)
Motor-TENS 3.18±1.84 4.61±3.54 2.52±3.10 1.72±1.86 2.79±2.38 0.013*
Motor-Sham 2.79±2.91 4.30±2.96 2.48±2.87 2.79±2.55 2.33±2.19 0.053
Between group comparison (Wilcoxon sign rank test; p value)
Motor-TENS/Motor-Sham 0.932 0.864 0.757 0.030* 0.493