Effects of Movement-Based and Cognitive Priming on Brain Function

 

 

Effects of Movement-Based and Cognitive Priming on Brain Function

Hannah Ryan

 

Background

I have been interested in research in the field of physical therapy since my first year of the UNC Doctor of Physical Therapy program. To explore my interest in research, early in the program I began observing data collection in the Human Movement Science Laboratory conducted by Michael Lewek, PT, DPT, PhD. I later received the opportunity to write a manuscript with Dr. Lewek’s guidance and direction. This manuscript was later accepted to the Journal of Neurologic Physical Therapy.  Ultimately, my plan is to pursue a PhD to conduct research in the field of neurorehabilitation. Therefore, a research-based capstone project was appealing because of the opportunity to continuing to develop my research skills.

When the capstone research opportunities were posted, the priming study under the direction of Dr. Jessica Cassidy and Dr. Michael Lewek was the perfect opportunity to learn valuable research skills within the field of neurorehabilitation. It was also an opportunity to delve into the literature about priming as it relates to motor learning. Before pursuing a PhD, I plan to work in the clinic for two to three years. The opportunity to learn more about a potential mechanism to improve motor learning for patients was appealing from a clinical perspective as well.

 

Statement of Need

Priming involves a stimulus provided before the intervention that alters the outcome of the intervention.¹  Priming interventions used in neurorehabilitation are thought to alter plasticity and improve motor learning capacity, ultimately improving the response to motor training.¹ Most studies are focused on priming interventions that involve pharmaceutical agents or transcranial magnetic stimulation (TMS).¹ However, research on more clinically feasible modes of priming, such as movement-based or cognitive priming, is currently limited. The research on clinically feasible modes of priming has not led to a sufficient understanding of the optimal method of priming, frequency, duration, and “window of opportunity” after priming in which plasticity is heightened.^1,2 Further work is required on these more “clinically feasible” modes of priming due to the low-cost, minimal extra equipment, few contraindications (compared to drugs, etc.), and minimal training required.^1,2 This project explored the effects of two forms of conservative priming including aerobic priming (movement-based priming) and action observation (cognitive priming).

Furthermore, research on motor learning outcomes and the neurophysiological effects of priming has primarily involved the upper extremity in both patient populations and unimpaired adults.^3-7 Results from recent work indicate that motor learning outcomes may be different for the lower extremity following clinically feasible modes of priming such as aerobic priming.⁸ This work is necessary to begin to elucidate the neurophysiological underpinnings of priming related to the lower extremity. Finally, most studies have measured neurological changes using TMS, but our study using EEG will allowed for a more detailed picture of the changes that result from priming to better guide clinical decision making in the future.

Priming interventions may have important implications for patient populations in the field of neurorehabilitation.   For example, motor relearning is a major focus of rehabilitation for individuals post-stroke in order to maximize independence and quality of life.³ Therefore, it is important to determine if priming interventions alter neural plasticity to improve motor learning for patients. Importantly, this work begins to establish a baseline that will lead to future work on patient populations.

 

Purpose

This project aimed to establish a baseline understanding of the effects of cognitive priming (action observation) and movement-based priming (aerobic) on electroencephalogram (EEG) changes associated with motor learning in unimpaired subjects. The ultimate goal of this project was to establish baseline information of the response of unimpaired subjects to guide future research utilizing these priming modes on individuals post-stroke.

 

Products

This handout was created to provide information to patients about clinically relevant forms of priming that they could encounter in the clinic. An abstract on preliminary findings from 4 subjects was accepted to the Human Movement Science Research Symposium for a poster presentation. The symposium was cancelled due to Covid-19. Instead of a poster, a presentation was created to provide an overview of this project and our findings. It was presented to the Cassidy Plasticity Lab group via Zoom. Finally, it was important to write a manuscript to report the findings of this study. The manuscript will be submitted for publication to a peer-reviewed journal in the future.

 

Evaluation

During the fall semester, feedback was received by Dr. Lewek at regular meetings to address any issues with the implementation and progress of subject recruitment and data collection. Feedback was received by Dr. Jessica Cassidy throughout the development of each product, especially during the writing of the manuscript through the review function on Microsoft Word and meetings every one to two weeks. The materials were also sent to Calvin Wang, PT, DPT to receive suggestions that were incorporated into the final products.

 

Self-reflection

Looking back, I am deeply appreciative of this opportunity to improve my research skills. I had previous involvement with different stages of research projects; however, this opportunity enabled me to be involved at each stage of the process, from the IRB submission to the completion of the manuscript. From designing the data collection sheets to the extensive data processing, I learned the importance of attention to detail involved with research. I also gained a more comprehensive understanding of the research process and the work required to produce a manuscript to share results with the scientific community.

A few barriers were met at various stages during this research experience, but these barriers were opportunities to learn. The IRB process delayed the start of our data collection, but this actually became an opportunity to learn more about EEG and become more confident and skilled in its administration. Additionally, messy EEG data led to the exclusion of some subjects for the data analysis. Therefore, it would have been beneficial to collect data on a few more subjects to increase the sample size used in the analysis. Despite these areas that I could have improved, I am extremely pleased with the overall implementation of every stage of this project. Completing this project alongside my classmate, Katie Fabian, required time management, effective communication, collaboration skills, and dedication. The results of this study provide preliminary information regarding conservative modes of priming that will guide future research.

 

Acknowledgments

I would like to acknowledge Jessica Cassidy, PT, DPT, PhD for her guidance, direction, and support throughout this process. I am deeply appreciative for the opportunity to learn more about her area of expertise (EEG) throughout this process. Jessica was an excellent teacher and provided extensive information and guidance on setting up the EEG for data collection, processing the data, analyzing the results, and writing the manuscript. I would like to also acknowledge Michael Lewek, PT, DPT, PhD for providing his lab to conduct the study.  His support during the subject recruitment and data collection phase is greatly appreciated. Under the direction of both Dr. Lewek and Dr. Cassidy, I gained a greater understanding of the complete research process including IRB writing, subject recruitment, data collection, data processing, data analysis, and manuscript writing.  Both Jessica and Mike were available and willing to answer questions and offer guidance throughout this process. I would also like to thank Calvin Wang, PT, DPT for his feedback and support throughout this process as a committee member. It was through his encouragement that we developed a patient-friendly handout describing priming and how/why it might be used during a treatment session.

I would also like to extend a sincere thank you to my classmate, Katie Fabian, SPT. She has been an incredibly dependable and insightful research partner during each step of this process. Together, we were able to recruit 17 participants and collect data at 3 sessions for each participant in the fall semester alone. Katie has unique strengths that significantly improved the efficiency and quality of our work. I am thankful that I had the opportunity to work with someone who shares the same passion for neurologic physical therapy.

The completion of this project in a timely manner would also not have been possible without the help of the Cassidy Plasticity Lab members including Jasper Mark, Jingles Jeangilles, Ramis Chowdhury, Hrishika Muthukrishnan, and Eric Zheng. These individuals provided valuable assistance with data collection and spent countless hours processing EEG data. It is also important to thank Sara Galante, SPT for doing an excellent job creating and editing the cognitive priming videos in a timely and dependable manner. I would also like to acknowledge the DPT students who participated in treadmill walking for the purposes of our cognitive priming video. Our final products would not have been possible without all of the aforementioned individuals, and I am deeply grateful for their time and expertise.

 

References

1. Stoykov ME, Madhavan S. Motor priming in neurorehabilitation. J Neurol Phys Ther. 2015;39(1):33-42.
2. Stoykov ME, Corcos DM, Madhavan S. Movement-Based Priming: Clinical Applications and Neural Mechanisms. J Mot Behav. 2017;49(1):88-97.
3. Stinear CM, Petoe MA, Anwar S, Barber PA, Byblow WD. Bilateral priming accelerates recovery of upper limb function after stroke: a randomized controlled trial. Stroke. 2014;45(1):205-210.
4. Stinear CM, Barber PA, Coxon JP, Fleming MK, Byblow WD. Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Brain. 2008;131(Pt 5):1381-1390.
5. Hsieh YW, Wu CY, Wang WE, et al. Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial. Clin Rehabil. 2017;31(2):225-233.
6. Statton MA, Encarnacion M, Celnik P, Bastian AJ. A Single Bout of Moderate Aerobic Exercise Improves Motor Skill Acquisition. PloS one. 2015;10(10):e0141393.
7. Franceschini M, Ceravolo MG, Agosti M, et al. Clinical Relevance of Action Observation in Upper-Limb Stroke Rehabilitation:A Possible Role in Recovery of Functional Dexterity. A Randomized Clinical Trial. Neurorehabilitation and neural repair. 2012;26(5):456-462.
8. Charalambous CC, Alcantara CC, French MA, et al. A single exercise bout and locomotor learning after stroke: physiological, behavioural, and computational outcomes. J Physiol. 2018;596(10):1999-2016.
9. Kang N, Summers JJ, Cauraugh JH. Transcranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016;87(4):345-355.