Objective: Our goal was to determine if pairing transcranial direct current stimulation (tDCS) with rehabilitation for two weeks could augment adaptive plasticity offered by these residual pathways to elicit longer-lasting improvements in motor function in incomplete spinal cord injury (iSCI). Design: Longitudinal, randomized, controlled, double-blinded cohort study. Setting: Cleveland Clinic Foundation, Cleveland, Ohio, USA. Participants: Eight male subjects with chronic incomplete motor tetraplegia. Interventions: Massed practice (MP) training with or without tDCS for 2 hrs, 5 times a week. Outcome Measures: We assessed neurophysiologic and functional outcomes before, after and three months following intervention. Neurophysiologic measures were collected with transcranial magnetic stimulation (TMS). TMS measures included excitability, representational volume, area and distribution of a weaker and stronger muscle motor map. Functional assessments included a manual muscle test (MMT), upper extremity motor score (UEMS), action research arm test (ARAT) and nine hole peg test (NHPT). Results: We observed that subjects receiving training paired with tDCS had more increased strength of weak proximal (15% vs 10%), wrist (22% vs 10%) and hand (39% vs. 16%) muscles immediately and three months after intervention compared to the sham group. Our observed changes in muscle strength were related to decreases in strong muscle map volume (r=0.851), reduced weak muscle excitability (r=0.808), a more focused weak muscle motor map (r=0.675) and movement of weak muscle motor map (r=0.935). Conclusion: Overall, our results encourage the establishment of larger clinical trials to confirm the potential benefit of pairing tDCS with training to improve the effectiveness of rehabilitation interventions for individuals with SCI. Trial Registration: NCT01539109

Rotator cuff and scapular muscle strengthening exercises are an essential part of shoulder rehabilitation and sports training. Although the effect of exercise training on pain and function have been widely investigated, few studies have focused on the changes in shoulder kinematics and muscle activity after exercise training. Therefore, the purpose of the present study was to investigate the effect of rotator cuff and scapular strengthening exercises on shoulder kinematics and the activation of rotator cuff and scapular muscles in healthy subjects. Thirty‐six healthy subjects were recruited and randomly assigned into either a training or control group. Subjects in the training group were trained with rotator cuff and scapular strengthening exercises for 4 weeks. Scapular kinematics and shoulder muscle activity during arm elevation were measured before and after exercise training. After the 4‐week training protocol, there was an increase in strength and a decrease in upper trapezius activation in the training group, which is consistent with previous studies. However, no difference was found in scapular kinematics and activation of rotator cuff muscles between the control and training groups after the training protocol. Although the exercise protocol resulted in strength gains for the rotator cuff, these gains did not transfer to an increase in muscle activation during motion. These results demonstrate the difficulty in changing activation patterns of the rotator cuff muscles. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2079–2088, 2016.

Kinesio taping has been used to improve sensorimotor control performance. In this study, we explored the effect of Kinesio taping with different tensions on hand force control, joint proprioception, reaction time and brain activity. This was an observational study with a single-group, repeated-measures design. Twenty-four healthy participants (12 women) randomly assigned to three wrist/finger flexor taping conditions: (1) taping with 20% additional tension (taping20), (2) taping with neutral tension (tapingN), and (3) without taping (control). Grip force and wrist joint proprioceptive senses, reaction time, and force control performance were recorded in each of the taping conditions. An EEG of the bilateral sensorimotor cortex and an EMG of the right finger flexors were recorded to investigate changes in brain activity and functional connectivity between the brain and muscles (coherence). Our results indicated that taping significantly improved the joint position sense for participants with an error >3° (control vs. tapingN vs. taping20: 4.1° ± 1.04° vs. 2.6° ± 0.97° vs. 2.1° ± 0.91°; p = 0.001). In addition, Kinesio taping-induced improvements in force control were moderately correlated with decreases in the EEG beta band power. In conclusion, Kinesio taping could improve the joint proprioceptive sense, and taping-induced improvement in force control is likely due to neural desynchronization in motor cortex.