Steadiness in plantar flexor muscles and its relation to postural sway in young and elderly adults

Robotic finger perturbation training improves finger postural steadiness and hand dexterity

The purpose of the study was to understand the effect of robotic finger perturbation training on steadiness in finger posture and hand dexterity in healthy young adults. A mobile robotic finger training system was designed to have the functions of high-speed mechanical response, two degrees of freedom, and adjustable loading amplitude and direction. Healthy young adults were assigned to one of the three groups: random perturbation training (RPT), constant force training (CFT), and control. Subjects in RPT and CFT performed steady posture training with their index finger using the robot in different modes: random force in RPT and constant force in CFT. After the 2-week intervention period, fluctuations of the index finger posture decreased only in RPT during steady position-matching tasks with an inertial load. Purdue pegboard test score improved also in RPT only. The relative change in finger postural fluctuations was negatively correlated with the relative change in the number of completed pegs in the pegboard test in RPT. The results indicate that finger posture training with random mechanical perturbations of varying amplitudes and directions of force is effective in improving finger postural steadiness and hand dexterity in healthy young adults.

Manual tracking impairs postural stability in older adults

Introduction

Older adults show increased postural sway and a greater risk of falls when completing activities with high cognitive demands. While dual-task approaches have clarified an association between cognitive processes and postural control, it is unclear how manual ability, which is also required for the successful completion of cognitively demanding tasks (such as putting a key into a lock), affects this relationship.

Method

Kinematic technology was used to explore the relationship between postural sway and manual control in healthy younger and older adults. Participants ( n = 82) remained standing to complete a visual-motor tracking task on a tablet computer. Root mean square tracking error measured manual performance, and a balance board measured deviations in centre of pressure as a marker of postural sway.

Results

Older adults displayed poorer manual accuracy and increased postural sway across all testing conditions.

Conclusions

Cognitive capacity can interact with multiple task demands, and in turn affect postural sway in older adults. Improving our understanding of factors that influence postural control will assist falls-prevention efforts and inform clinical practice.

Altered visual strategies and attention are related to increased force fluctuations during a pinch grip task in older adults

The purpose of the study was to determine the visual strategies used by older adults during a pinch grip task and to assess the relations between visual strategy, deficits in attention, and increased force fluctuations in older adults. Eye movements of 23 older adults (>65 yr) were monitored during a low-force pinch grip task while subjects viewed three common visual feedback displays. Performance on the Grooved Pegboard test and an attention task (which required no concurrent hand movements) was also measured. Visual strategies varied across subjects and depended on the type of visual feedback provided to the subjects. First, while viewing a high-gain compensatory feedback display (horizontal bar moving up and down with force), 9 of 23 older subjects adopted a strategy of performing saccades during the task, which resulted in 2.5 times greater force fluctuations in those that exhibited saccades compared with those who maintained fixation near the target line. Second, during pursuit feedback displays (force trace moving left to right across screen and up and down with force), all subjects exhibited multiple saccades, and increased force fluctuations were associated (r_s = 0.6; P = 0.002) with fewer saccades during the pursuit task. Also, decreased low-frequency (<4 Hz) force fluctuations and Grooved Pegboard times were significantly related (P = 0.033 and P = 0.005, respectively) with higher (i.e., better) attention z scores. Comparison of these results with our previously published results in young subjects indicates that saccadic eye movements and attention are related to force control in older adults.NEW & NOTEWORTHY The significant contributions of the study are the addition of eye movement data and an attention task to explain differences in hand motor control across different visual displays in older adults. Older participants used different visual strategies across varying feedback displays, and saccadic eye movements were related with motor performance. In addition, those older individuals with deficits in attention had impaired motor performance on two different hand motor control tasks, including the Grooved Pegboard test.

Effects of age on force steadiness: A literature review and meta-analysis

The variability of force is indicative of the biological variability inherent in the human motor system. Previous literature showed inconsistent findings of the effect of age on the variability of force and hence a systematic review was performed. Twenty studies were included in this systematic review, of which twelve provided sufficient data to determine effect sizes for the effect of age. After determining the pooled effect size, the effect of sample size on dichotomized effect sizes (significant vs. non-significant) was determined. Also, the effect of possible determinants, age difference between age groups, dominance of investigated limb, muscle group, muscle location (proximal vs. distal and upper vs. lower extremity) and target force level on effect size (categorized as small, medium, or large) were investigated. A large pooled effect size of age was found (r_total=0.67, 95% CI [0.61; 0.72]). No relation between sample size and effect size significance was found, indicative of no lack of power in the studies reviewed. No relations were found of associations between age difference, upper vs. lower extremity muscle location, and dominance and effect size. Significant relations of effect size with muscle group, proximal vs. distal muscle location and target force level were found. Also, an interaction effect of muscle group and target force level was suggested. The meta-analysis results are in line with motor unit loss as the main cause of the effect of ageing on force steadiness and this effect can partially explain decreased motor performance associated with ageing.

Comparison of muscle synergies for running between different foot strike patterns

It is well known that humans run with a fore-foot strike (FFS), a mid-foot strike (MFS) or a rear-foot strike (RFS). A modular neural control mechanism of human walking and running has been discussed in terms of muscle synergies. However, the neural control mechanisms for different foot strike patterns during running have been overlooked even though kinetic and kinematic differences between different foot strike patterns have been reported. Thus, we examined the differences in the neural control mechanisms of human running between FFS and RFS by comparing the muscle synergies extracted from each foot strike pattern during running. Muscle synergies were extracted using non-negative matrix factorization with electromyogram activity recorded bilaterally from 12 limb and trunk muscles in ten male subjects during FFS and RFS running at different speeds (5-15 km/h). Six muscle synergies were extracted from all conditions, and each synergy had a specific function and a single main peak of activity in a cycle. The six muscle synergies were similar between FFS and RFS as well as across subjects and speeds. However, some muscle weightings showed significant differences between FFS and RFS, especially the weightings of the tibialis anterior of the landing leg in synergies activated just before touchdown. The activation patterns of the synergies were also different for each foot strike pattern in terms of the timing, duration, and magnitude of the main peak of activity. These results suggest that the central nervous system controls running by sending a sequence of signals to six muscle synergies. Furthermore, a change in the foot strike pattern is accomplished by modulating the timing, duration and magnitude of the muscle synergy activity and by selectively activating other muscle synergies or subsets of the muscle synergies.

Errors in the ankle plantarflexor force production are related to the gait deficits of individuals with multiple sclerosis

BACKGROUND

Individuals with multiple sclerosis (MS) often have limited mobility that is thought to be due to the neuromuscular impairments of the ankle. Greater isometric motor control of the ankle has been associated with better standing postural balance but its relationship to mobility is less understood. The objectives of this investigation were to quantify the motor control of the ankle plantarflexors of individuals with MS during a dynamic isometric motor task, and explore the relationship between the ankle force control and gait alterations.

METHODS

Fifteen individuals with MS and 15 healthy adults participated in both a dynamic isometric ankle plantarflexion force matching task and a biomechanical gait analysis.

FINDINGS

Our results displayed that the subjects with MS had a greater amount of error in their dynamic isometric force production, were weaker, walked with altered spatiotemporal kinematics, and had reduced maximal ankle moment at toe-off than the control group. The greater amount of error in the dynamic force production was related to the decreases in strength, step length, walking velocity, and maximal ankle moment during walking.

INTERPRETATION

Altogether these results imply that errors in the ankle plantarflexion force production may be a limiting factor in the mobility of individuals with MS.

Losing touch: age-related changes in plantar skin sensitivity, lower limb cutaneous reflex strength, and postural stability in older adults

Age-related changes in the density, morphology, and physiology of plantar cutaneous receptors negatively impact the quality and quantity of balance-relevant information arising from the foot soles. Plantar perceptual sensitivity declines with age and may predict postural instability; however, alteration in lower limb cutaneous reflex strength may also explain greater instability in older adults and has yet to be investigated. We replicated the age-related decline in sensitivity by assessing monofilament and vibrotactile (30 and 250 Hz) detection thresholds near the first metatarsal head bilaterally in healthy young and older adults. We additionally applied continuous 30- and 250-Hz vibration to drive mechanically evoked reflex responses in the tibialis anterior muscle, measured via surface electromyography. To investigate potential relationships between plantar sensitivity, cutaneous reflex strength, and postural stability, we performed posturography in subjects during quiet standing without vision. Anteroposterior and mediolateral postural stability decreased with age, and increases in postural sway amplitude and frequency were significantly correlated with increases in plantar detection thresholds. With 30-Hz vibration, cutaneous reflexes were observed in 95% of young adults but in only 53% of older adults, and reflex gain, coherence, and cumulant density at 30 Hz were lower in older adults. Reflexes were not observed with 250-Hz vibration, suggesting this high-frequency cutaneous input is filtered out by motoneurons innervating tibialis anterior. Our findings have important implications for assessing the risk of balance impairment in older adults.

Force Maintenance Accuracy Using a Tool: Effects of Magnitude and Feedback

The ability to precisely produce a force via a hand-held tool is crucial in fine manipulations. In this paper, we study the error in maintaining a target force ranging from 0.5 to 5 N under two concurrent feedback conditions: pure haptic feedback (H), and visual plus haptic feedback (V + H). The results show that absolute error (AE) increases along with the increasing force magnitudes under both feedback conditions. For target forces ranging from 1.5 to 5 N, the relative error (RE) is approximately constant under both feedback conditions, while the RE significantly increases for the small target forces of 0.5 and 1 N. The effect of force magnitude on the coefficient of variation (CoV) is not significant for target forces ranging from 1.5 to 5 N. For both the RE and the CoV, the values under the H condition are significantly larger than those under the V + H condition. The effect of manipulation mode (i.e., a hand-held tool or a fingertip) on force maintenance accuracy is complex, i.e., its effect on RE is not significant while its effect on CoV is significant. Only for the magnitude of 0.5 N, the RE of using the tool was significantly greater than that of using the fingertip under both feedback conditions. For both the RE and the CoV, no interaction effect exists between manipulation mode, force magnitude and feedback condition.

Neurorehabilitation Strategies Focusing on Ankle Control Improve Mobility and Posture in Persons With Multiple Sclerosis

BACKGROUND AND PURPOSE

The neuromuscular impairments seen in the ankle plantarflexors have been identified as a primary factor that limits the mobility and standing postural balance of individuals with multiple sclerosis (MS). However, few efforts have been made to find effective treatment strategies that will improve the ankle plantarflexor control. Our objective was to determine whether an intensive 14-week neurorehabilitation protocol has the potential to improve the ankle plantarflexor control of individuals with MS. The secondary objectives were to determine whether the protocol would also improve postural control, plantarflexion strength, and mobility.

METHODS

Fifteen individuals with MS participated in a 14-week neurorehabilitation protocol, and 20 healthy adults served as a comparison group. The primary measure was the amount of variability in the submaximal steady-state isometric torque, which assessed plantarflexor control. Secondary measures were the Sensory Organization Test composite score, maximum plantarflexion torque, and the spatiotemporal gait kinematics.

RESULTS

There was less variability in the plantarflexion torques after the neurorehabilitation protocol (preintervention, 4.15% ± 0.5%; postintervention, 2.27% ± 0.3%). In addition, there were less postural sway (preintervention, 51.87 ± 0.2 points; postintervention, 67.8 ± 0.5 points), greater plantarflexion strength (preintervention, 0.46 ± 0.04 Nm/kg; postintervention, 0.57 ± 0.05 Nm/kg), and faster walking speeds (preferred preintervention, 0.71 ± 0.05 m/s; preferred postintervention, 0.81 ± 0.05 m/s; fast-as-possible preintervention, 0.95 ± 0.06 m/s; postintervention, 1.11 ± 0.07 m/s). All of the outcome variables matched or trended toward those seen in the controls.

DISCUSSION AND CONCLUSIONS

The outcomes of this exploratory study suggest that the neurorehabilitation protocol employed in this investigation has the potential to promote clinically relevant improvements in the ankle plantarflexor control, standing postural balance, ankle plantarflexion strength, and the mobility of individuals with MS. Video abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A110).

Motor control differs for increasing and releasing force

Control of the motor output depends on our ability to precisely increase and release force. However, the influence of aging on force increase and release remains unknown. The purpose of this study, therefore, was to determine whether force control differs while increasing and releasing force in young and older adults. Sixteen young adults (22.5 ± 4 yr, 8 females) and 16 older adults (75.7 ± 6.4 yr, 8 females) increased and released force at a constant rate (10% maximum voluntary contraction force/s) during an ankle dorsiflexion isometric task. We recorded the force output and multiple motor unit activity from the tibialis anterior (TA) muscle and quantified the following outcomes: 1) variability of force using the SD of force; 2) mean discharge rate and variability of discharge rate of multiple motor units; and 3) power spectrum of the multiple motor units from 0-4, 4-10, 10-35, and 35-60 Hz. Participants exhibited greater force variability while releasing force, independent of age (P < 0.001). Increased force variability during force release was associated with decreased modulation of multiple motor units from 35 to 60 Hz (R(2) = 0.38). Modulation of multiple motor units from 35 to 60 Hz was further correlated to the change in mean discharge rate of multiple motor units (r = 0.66) and modulation from 0 to 4 Hz (r = -0.64). In conclusion, these findings suggest that force control is altered while releasing due to an altered modulation of the motor units.

Multiple sclerosis influences the precision of the ankle plantarflexon muscular force production

OBJECTIVE

To quantify the precision of the steady-state isometric control of the ankle plantarflexors musculature of individuals with multiple sclerosis (MS), and to evaluate if the precision is related to the mobility impairments.

METHODS

Individuals with MS and healthy adults performed a submaximal steady-state isometric contraction with the ankle plantarflexors. The coefficient of variation was used to assess the amount of variability or error in the precision of the torques generated by the ankle plantarflexor musculature. The participants also walked across a digital mat at their preferred and fast-as-possible walking speeds, which recorded their spatiotemporal gait kinematics.

RESULTS

The individuals with MS: (1) had reduced maximal voluntary torques at the ankle, (2) a greater amount of variability in the precision of the isometric ankle torques, (3) altered and more variable spatiotemporal gait kinematics, and (4) a greater amount of variability in the isometric ankle torques were related to a slower walking speed and cadence, shorter step length and a greater amount of gait variability.

CONCLUSIONS

These results further fuels the impression that a reduction in control of the ankle joint musculature may be a key factor in the mobility and balance impairments seen in individuals with MS.

Force fluctuations while pressing and moving against high- and low-friction touch screen surfaces

The purpose of this study was to identify the influence of a high- and low-friction surface on the ability to maintain a steady downward force during an index finger pressing and moving task. Fifteen right-handed subjects (24-48 years) performed a static force pressing task and a hybrid pressing and moving task on the surface of an iPad mini while holding a steady 2-N force on high- and low-friction surfaces. Variability of force was quantified as the standard deviation (SD) of normal force (F z) and shear force (F xy) across friction conditions and tasks. The SD of F z was 227 % greater during the hybrid task as compared to the static task (p < .001) and was 19 % greater for the high- versus low-friction condition (p = .033). There were positive correlations between SD of F z and F xy during the hybrid force/motion tasks on the high- and low-friction conditions (r (2) = 0.5 and 0.86, respectively), suggesting significant associations between normal and shear forces for this hybrid task. The correlation between the SD of F z for static and hybrid tasks was r (2) = 0.44, indicating that the common practice of examining the control of static tasks may not sufficiently explain performance during hybrid tasks, at least for the young subjects tested in the current study. As activities of daily living frequently require hybrid force/motion tasks (e.g., writing, doing the dishes, and cleaning counters), the results of this study emphasize the need to study motor performance during hybrid tasks in addition to static force tasks.

Balance Exercises Circuit improves muscle strength, balance, and functional performance in older women

This study introduces the Balance Exercises Circuit (BEC) and examines its effects on muscle strength and power, balance, and functional performance in older women. Thirty-five women aged 60+ (mean age = 69.31, SD = 7.35) were assigned to either a balance exercises group (BG, n = 14) that underwent 50-min sessions twice weekly, of a 12-week BEC program, or a wait-list control group (CG, n = 21). Outcome measures were knee extensor peak torque (PT), rate of force development (RFD), balance, Timed Up & Go (TUG), 30-s chair stand, and 6-min walk tests, assessed at baseline and 12 weeks. Twenty-three participants completed follow-up assessments. Mixed analysis of variance models examined differences in outcomes. The BG displayed improvements in all measures at follow-up and significantly improved compared with CG on, isokinetic PT60, PT180 (p = 0.02), RFD (p < 0.05), balance with eyes closed (p values range .02 to <.01) and TUG (p = 0.03), all with medium effect sizes. No changes in outcome measures were observed in the CG. BEC improved strength, power, balance, and functionality in older women. The BEC warrants further investigation as a fall prevention intervention.

Postural Steadiness and Ankle Force Variability in Peripheral Neuropathy

INTRODUCTION

The purpose was to determine the effect of peripheral neuropathy (PN) on motor output variability for ankle muscles of older adults, and the relation between ankle motor variability and postural stability in PN patients.

METHODS

Older adults with (O-PN) and without PN (O), and young adults (Y) underwent assessment of standing postural stability and ankle muscle force steadiness.

RESULTS

O-PN displayed impaired ankle muscle force control and postural stability compared with O and Y groups. For O-PN, the amplitude of plantarflexor force fluctuations was moderately correlated with postural stability under no-vision conditions (r = .54, p = .01).

DISCUSSION

The correlation of variations in ankle force with postural stability in PN suggests a contribution of ankle muscle dyscontrol to the postural instability that impacts physical function for older adults with PN.

Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases

Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients' brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.

Functional implications of impaired control of submaximal hip flexion following stroke

INTRODUCTION

We quantified submaximal torque regulation during low to moderate intensity isometric hip flexion contractions in individuals with stroke and the associations with leg function.

METHODS

Ten participants with chronic stroke and 10 controls performed isometric hip flexion contractions at 5%, 10%, 15%, 20%, and 40% of maximal voluntary contraction (MVC) in paretic, nonparetic, and control legs.

RESULTS

Participants with stroke had larger torque fluctuations (coefficient of variation, CV), for both the paretic and nonparetic legs, than controls (P < 0.05) with the largest CV at 5% MVC in the paretic leg (P < 0.05). The paretic CV correlated with walking speed (r2 = 0.54) and Berg Balance Score (r2 = 0.40). At 5% MVC, there were larger torque fluctuations in the contralateral leg during paretic contractions compared with the control leg.

CONCLUSIONS

Impaired low-force regulation of paretic leg hip flexion can be functionally relevant and related to control versus strength deficits poststroke.

Fatigability of the dorsiflexors and associations among multiple domains of motor function in young and old adults

Declines in neuromuscular function, including measures of mobility, muscle strength, steadiness, and patterns of muscle activation, accompany advancing age and are often associated with reduced quality of life and mortality. Paradoxically, older adults are less fatigable than young adults in some tasks. The purpose of this study was to determine the influence of age on fatigability of the dorsiflexors and to evaluate the ecological validity of this test by comparing it to motor function subdomains known to decline with advancing age. The community-dwelling older adults (n=52, 75.2±6.0years) were more fatigable than young adults (n=26, 22.2±3.7years), as assessed by endurance time for supporting a submaximal load (20% of one-repetition maximum; 1-RM) with an isometric contraction of the dorsiflexor muscles (8.9±0.6min and 15.5±0.9min, p<0.001), including participants matched for 1-RM load and sex (Y: 13.3±4.0min, O: 8.5±6.1min, n=11 pairs, 6 women, p<0.05). When the older adults were separated into two groups (65-75 and 76-90years), however, only endurance time for the oldest group was less than that for the other two groups (p<0.01). All measures of motor function were significantly correlated (all p<0.05) with dorsiflexor endurance time for the older adults, and multiple regression analysis revealed that the variance in endurance time was most closely associated with age, steadiness, and knee flexor strength (R(2)=0.50, p<0.001). These findings indicate that dorsiflexor fatigability provides a valid biomarker of motor function in older adults.

Oscillations in motor unit discharge are reflected in the low-frequency component of rectified surface EMG and the rate of change in force

Common drive to a motor unit (MU) pool manifests as low-frequency oscillations in MU discharge rate, producing fluctuations in muscle force. The aim of the study was to examine the temporal correlation between instantaneous MU discharge rate and rectified EMG in low frequencies. Additionally, we attempted to examine whether there is a temporal correlation between the low-frequency oscillations in MU discharge rate and the first derivative of force (dF/dt). Healthy young subjects produced steady submaximal force with their right finger as a single task or while maintaining a pinch-grip force with the left hand as a dual task. Surface EMG and fine-wire MU potentials were recorded from the first dorsal interosseous muscle in the right hand. Surface EMG was band-pass filtered (5-1,000 Hz) and full-wave rectified. Rectified surface EMG and the instantaneous discharge rate of MUs were smoothed by a Hann-window of 400 ms duration (equivalent to 2 Hz low-pass filtering). In each of the identified MUs, the smoothed MU discharge rate was positively correlated with the rectified-and-smoothed EMG as confirmed by the distinct peak in cross-correlation function with greater values in the dual task compared with the single task. Additionally, the smoothed MU discharge rate was temporally correlated with dF/dt more than with force and with rectified-and-smoothed EMG. The results indicated that the low-frequency component of rectified surface EMG and the first derivative of force provide temporal information on the low-frequency oscillations in the MU discharge rate.

Motor control of the lower extremity musculature in children with cerebral palsy

The aim of this investigation was to quantify the differences in torque steadiness and variability of the muscular control in children with cerebral palsy (CP) and typically developing (TD) children. Fifteen children with CP (age=14.2±0.7 years) that had a Gross Motor Function Classification System (GMFCS) score of I-III and 15 age and gender matched TD children (age=14.1±0.7 years) participated in this investigation. The participants performed submaximal steady-state isometric contractions with the ankle, knee, and hip while surface electromyography (sEMG) was recorded. An isokinetic dynamometer was used to measure the steady-state isometric torques while the participants matched a target torque of 20% of the subject's maximum voluntary torque value. The coefficient of variation was used to assess the amount of variability in the steady-state torque, while approximate entropy was used to assess the regularity of the steady-state torque over time. Lastly, the distribution of the power spectrum of the respective sEMG was evaluated. The results of this investigation were: 1) children with CP had a greater amount of variability in their torque steadiness at the ankle than TD children, 2) children with CP had a greater amount of variability at the ankle joint than at the knee and hip joint, 3) the children with CP had a more regular steady-state torque pattern than TD children for all the joints, 4) the ankle sEMG of children with CP was composed of higher harmonics than that of the TD children.

Modulation of force below 1 Hz: age-associated differences and the effect of magnified visual feedback

Oscillations in force output change in specific frequency bins and have important implications for understanding aging and pathological motor control. Although previous studies have demonstrated that oscillations from 0–1 Hz can be influenced by aging and visuomotor processing, these studies have averaged power within this bandwidth and not examined power in specific frequencies below 1 Hz. The purpose was to determine whether a differential modulation of force below 1 Hz contributes to changes in force control related to manipulation of visual feedback and aging. Ten young adults (25±4 yrs, 5 men) and ten older adults (71±5 yrs, 4 men) were instructed to accurately match a target force at 2% of their maximal isometric force for 35 s with abduction of the index finger. Visual feedback was manipulated by changing the visual angle (0.05°, 0.5°, 1.5°) or removing it after 15 s. Modulation of force below 1 Hz was quantified by examining the absolute and normalized power in seven frequency bins. Removal of visual feedback increased normalized power from 0–0.33 Hz and decreased normalized power from 0.66–1.0 Hz. In contrast, magnification of visual feedback (visual angles of 0.5° and 1.5°) decreased normalized power from 0–0.16 Hz and increased normalized power from 0.66–1.0 Hz. Older adults demonstrated a greater increase in the variability of force with magnification of visual feedback compared with young adults (P = 0.05). Furthermore, older adults exhibited differential force modulation of frequencies below 1 Hz compared with young adults (P<0.05). Specifically, older adults exhibited greater normalized power from 0–0.16 Hz and lesser normalized power from 0.66–0.83 Hz. The changes in force modulation predicted the changes in the variability of force with magnification of visual feedback (R² = 0.80). Our findings indicate that force oscillations below 1 Hz are associated with force control and are modified by aging and visual feedback.

Synergistic co-activation in multi-directional postural control in humans

To examine the muscle synergies of multi-directional postural control, we calculated the target-directed variance fraction (η) and net action direction of each muscle using the electromyogram-weighted averaging (EWA) method. Subjects stood barefoot on a force platform and maintained their posture by producing a center of pressure (COP) in twelve target directions. Surface electromyograms were recorded from 6 right-sided muscles: tibialis anterior (TA), soleus (SOL), lateral gastrocnemius (LG), medial gastrocnemius (MG), fibularis longus (FL), and gluteus medius (GM). η was calculated from COP with duration of 20-s, during which the COP was relatively constant. The EWA method was applied to the EMG and the two COP components to estimate the net action direction of each muscle. The results showed that η values in all directions did not cross the 0.8 threshold. This suggests that human postural control is achieved by synergistic co-activation. The EWA revealed that the net action directions of TA, SOL, LG, MG, and GM were 277.6°, 71.1°, 87.7°, 94.0°, and 2.2°, respectively. This suggests that postural maintenance by muscle synergy can be attributed to the relevant muscles having various action directions. These results demonstrate that muscle synergies can be investigated using COP fluctuations.

Extreme levels of noise constitute a key neuromuscular deficit in the elderly

Fluctuations during isometric force production tasks occur due to the inability of musculature to generate purely constant submaximal forces and are considered to be an estimation of neuromuscular noise. The human sensori-motor system regulates complex interactions between multiple afferent and efferent systems, which results in variability during functional task performance. Since muscles are the only active component of the motor system, it therefore seems reasonable that neuromuscular noise plays a key role in governing variability during both standing and walking. Seventy elderly women (including 34 fallers) performed multiple repetitions of isometric force production, quiet standing and walking tasks. No relationship between neuromuscular noise and functional task performance was observed in either the faller or the non-faller cohorts. When classified into groups with either nominal (group NOM, 25^th –75^th percentile) or extreme (either too high or too low, group EXT) levels of neuromuscular noise, group NOM demonstrated a clear association (r²>0.23, p<0.05) between neuromuscular noise and variability during task performance. On the other hand, group EXT demonstrated no such relationship, but also tended to walk slower, and had lower stride lengths, as well as lower isometric strength. These results suggest that neuromuscular noise is related to the quality of both static and dynamic functional task performance, but also that extreme levels of neuromuscular noise constitute a key neuromuscular deficit in the elderly.

Ankle variability is amplified in older adults due to lower EMG power from 30-60 Hz

The purpose of this study was to determine the neuromuscular mechanisms of the involved muscles that contribute to the greater positional variability at the ankle joint in older adults compared with young adults. Eleven young adults (25.6±4.9 years) and nine older adults (76.9±5.9 years) were asked to accurately match and maintain a horizontal target line with 5° dorsiflexion of their ankle for 20 s. The loads were 5 and 15% of the one repetition maximum load (1 RM). The visual gain was kept constant at 1° for all trials. Positional variability was quantified as the standard deviation (SD) of the detrended position signal. The neural activation of the tibialis anterior and soleus muscles was quantified as the normalized EMG amplitude, power spectrum density (PSD; EMG oscillations) and coactivation of the two muscles. As expected, positional variability was greater in older adults (older: 0.11±0.06° vs. young: 0.04±0.02°; p=.003). The only significant neural difference occurred for the PSD of the tibialis anterior muscle, where young adults exhibited significantly greater power than older adults from 30-60 Hz. The amplified positional variability of ankle joint in older adults was associated with lower power from 30-60 Hz oscillations in the tibialis anterior muscle (r(2)=.3, p=.01). These results provide novel evidence that older adults exhibit greater positional variability with the ankle joint relative to young adults likely due to their inability to activate the tibialis anterior muscle from 30-60 Hz.

Association of Force Steadiness of Plantar Flexor Muscles and Postural Sway during Quiet Standing by Young Adults

This study was conducted to assess the relations of force fluctuations during isometric plantar-flexion and postural sway during quiet standing. Twelve healthy men ( M age = 21 yr., SD = 1) performed unilateral plantar flexion measured by a strain gauge force transducer. Participants performed force-matching tasks; sustained plantar flexion for 20 sec. at levels corresponding to 10% and 20% of maximum voluntary contraction with the visual feedback. Also, participants were asked to stand quietly with their eyes open, and then the center of mass displacement and velocity in the anteroposterior were measured. In analysis, postural sway was associated with force fluctuation at only 10% of maximum voluntary contraction. The statistically significant correlation between variables was found only at corresponding contraction intensities for plantar-flexor muscles. From this one may infer neural strategies in plantar-flexor muscles during quiet standing may be characteristics similar to those controlling the plantar-flexion force in young adults.

Index finger position fluctuations reflect multi-muscle coordination

We hypothesized that movement fluctuations in the index finger reflect the integrated result of the coordination of multiple muscles because index finger movements are determined by the cooperation of multiple muscles spanning the metacarpophalangeal (MCP) joint. To evaluate this hypothesis, the aim of the present study was to examine the fluctuations of the index finger in abduction-adduction and extension-flexion directions during a position-holding task using two laser displacement sensors. Eleven healthy men maintained their index finger position while supporting a load at 5% of the maximal voluntary contraction force. To maintain the position of the index finger, displacement of the index finger in the abduction-adduction and extension-flexion directions was measured from a distance with two laser displacement sensors that were positioned to the lateral side of and above the index finger. The index finger movements fluctuated around the target position in not only the abduction-adduction direction but also the extension-flexion direction. The path length of finger displacement and the standard deviation of finger acceleration were significantly greater in the extension-flexion direction than in the abduction-adduction direction. These results suggest that the index finger movements quantified by two laser displacement sensors reflect the coordination of multiple muscles spanning the MCP joint.

Postural sway during quiet standing is related to physiological tremor and muscle volume in young and elderly adults

To examine the age-related deterioration in postural control, we investigated the association between postural sway during quiet standing and either amplitude of physiological tremor or muscle volume of the plantar flexors in 20 young and 20 elderly adults. They maintained a quiet standing position on a force platform for 60s with their eyes open or closed. During quiet standing, physiological tremors detected using a piezoresistive accelerometer were recorded from the soleus muscle, and the center of pressure (COP) displacement and body acceleration in the antero-posterior direction were calculated using the ground reaction forces as an assessment of postural sway. Muscle volume was predicted from muscle thickness by an ultrasonographic image. The physiological tremor of the soleus muscle during quiet standing was significantly greater in elderly than in young adults, and a positive association between physiological tremor and the amplitude of postural sway was found for young and elderly adults combined. Furthermore, physiological tremor was positively correlated with the high-frequency component of COP sway during quiet standing. A significantly negative relation between the muscle volume of the plantar flexors and postural sway was found in both age groups. These results suggest that physiological tremor reflects high-frequency fluctuations in postural sway during quiet standing in young and elderly adults, and age-related increases in the postural sway amplitude in the antero-posterior direction may be related to a decrease in muscle volume of the plantar flexors for maintaining an upright posture.

Age-related changes in the behavior of the muscle-tendon unit of the gastrocnemius medialis during upright stance

Mechanical properties of the muscle-tendon unit change with aging, but it is not known how these modifications influence the control of lower leg muscles during upright stance. In this study, young and elderly adults stood upright on a force platform with and without vision while muscle architecture and myotendinous junction movements (expressed relative to the change in the moment on the x-axis of the force platform) were recorded by ultrasonography and muscle activity by electromyography. The results show that the maximal amplitude of the sway in the antero-posterior direction was greater in elderly adults (age effect, P < 0.05) and was accompanied by an increase in lower leg muscle activity compared with young adults. Moreover, the data highlight that fascicles shorten during forward sway and lengthen during backward sways but more so for young (−4 ± 3 and −4 ± 3 mm/Nm, respectively) than elderly adults (−0.7 ± 3 and 0.8 ± 3 mm/Nm, respectively; age × sway, P < 0.001). Concurrently, the pennation angle increased and decreased during forward and backward sways, respectively, with greater changes in young than elderly adults (age × sway, P < 0.001). In contrast, no significant differences were observed between age groups for tendon lengthening and shortening during sways. The results indicate that, compared with young, elderly adults increase the stiffness of the muscular portion of the muscle-tendon unit during upright stance that may compensate for the age-related decrease in tendon stiffness. These observations suggest a shift in the control strategy used to maintain balance.

Asymmetry of force fluctuation during low and moderate intensity isometric knee extensions

The purpose of this study was to investigate the asymmetry of force fluctuation during isometric knee extension at low and moderate intensities. 11 healthy men (M age = 21 yr., SD = 1) performed unilateral force matching tasks; sustained isometric knee extension at 20% and 30% maximal voluntary contraction (MVC). During the tasks, a mechanomyogram was measured by an accelerometer arrangement placed on the vastus lateralis. Although force fluctuation was not significantly different between the two legs at 20% MVC, it was higher in the left (weaker) leg than in the right (stronger) leg at 30% MVC. A significant difference in mean power frequency of the mechanomyographic signal between the two legs was also observed only at 30% MVC. These results suggest that the asymmetry of force fluctuation during isometric knee extension was not statistically significant at low intensity; however, it was significant at moderate intensity. These differences in force fluctuation between intensities might be influenced by different motor-unit firing rates in active muscle.

Cortical and segmental excitability during fatiguing contractions of the soleus muscle in humans

OBJECTIVE

The aim of this study was to examine the cortical and segmental excitability changes during fatigue of the soleus muscle.

METHODS

Ten healthy young subjects performed 45 plantar flexion maximal voluntary contractions (MVCs) (7-s on/3-s off) in 9 epochs of five contractions. Motor evoked potentials (MEPs) using transcranial magnetic stimulation and H-reflexes were assessed during the task.

RESULTS

The torque and the soleus EMG activity both showed the greatest decline during the 1st epoch, followed by a gradual, but significant decrease by the end of the task (∼70% pre-fatigue). The H-reflex sampled at rest after each epoch decreased to 66.6±18.3% pre-fatigue after the first epoch, and then showed no further change. The MEP on 10% pre-fatigue MVC after each epoch increased progressively (252.9±124.2% pre-fatigue). There was no change in the MEPs on the 3rd MVC in each epoch. The silent period on the MVC increased (109.0±9.2% pre-fatigue) early with no further changes during the task.

CONCLUSIONS

These findings support that the motor cortex increases excitability during fatigue, but with a concomitant inhibition.

SIGNIFICANCE

These findings are in contrast to upper extremity muscles and may reflect a distinct response specific to postural, fatigue-resistant muscle.

Aging and variability of voluntary contractions

Older adults exhibit greater motor variability, which impairs their accuracy and function, compared with young adults. Low-intensity training that emphasizes muscle coordination reduces variability in older adults. Furthermore, a low amount of visual feedback minimizes age-associated differences in variability. We hypothesize that an intervention that combines muscle coordination and reduced visual feedback would be advantageous to improve motor control in older adults.