The flexion synergy, mother of all synergies and father of new models of gait

Comparison of operant escape and reflex tests of nociceptive sensitivity

Testing of reflexes such as flexion/withdrawal or licking/guarding is well established as the standard for evaluating nociceptive sensitivity and its modulation in preclinical investigations of laboratory animals. Concerns about this approach have been dismissed for practical reasons - reflex testing requires no training of the animals; it is simple to instrument; and responses are characterized by observers as latencies or thresholds for evocation. In order to evaluate this method, the present review summarizes a series of experiments in which reflex and operant escape responding are compared in normal animals and following surgical models of neuropathic pain or pharmacological intervention for pain. Particular attention is paid to relationships between reflex and escape responding and information on the pain sensitivity of normal human subjects or patients with pain. Numerous disparities between results for reflex and operant escape measures are described, but the results of operant testing are consistent with evidence from humans. Objective reasons are given for experimenters to choose between these and other methods of evaluating the nociceptive sensitivity of laboratory animals.

Task constraints and minimization of muscle effort result in a small number of muscle synergies during gait

Finding muscle activity generating a given motion is a redundant problem, since there are many more muscles than degrees of freedom. The control strategies determining muscle recruitment from a redundant set are still poorly understood. One theory of motor control suggests that motion is produced through activating a small number of muscle synergies, i.e., muscle groups that are activated in a fixed ratio by a single input signal. Because of the reduced number of input signals, synergy-based control is low dimensional. But a major criticism on the theory of synergy-based control of muscles is that muscle synergies might reflect task constraints rather than a neural control strategy. Another theory of motor control suggests that muscles are recruited by optimizing performance. Optimization of performance has been widely used to calculate muscle recruitment underlying a given motion while assuming independent recruitment of muscles. If synergies indeed determine muscle recruitment underlying a given motion, optimization approaches that do not model synergy-based control could result in muscle activations that do not show the synergistic muscle action observed through electromyography (EMG). If, however, synergistic muscle action results from performance optimization and task constraints (joint kinematics and external forces), such optimization approaches are expected to result in low-dimensional synergistic muscle activations that are similar to EMG-based synergies. We calculated muscle recruitment underlying experimentally measured gait patterns by optimizing performance assuming independent recruitment of muscles. We found that the muscle activations calculated without any reference to synergies can be accurately explained by on average four synergies. These synergies are similar to EMG-based synergies. We therefore conclude that task constraints and performance optimization explain synergistic muscle recruitment from a redundant set of muscles.

Locomotor patterns in cerebellar ataxia

Several studies have demonstrated how cerebellar ataxia (CA) affects gait, resulting in deficits in multijoint coordination and stability. Nevertheless, how lesions of cerebellum influence the locomotor muscle pattern generation is still unclear. To better understand the effects of CA on locomotor output, here we investigated the idiosyncratic features of the spatiotemporal structure of leg muscle activity and impairments in the biomechanics of CA gait. To this end, we recorded the electromyographic (EMG) activity of 12 unilateral lower limb muscles and analyzed kinematic and kinetic parameters of 19 ataxic patients and 20 age-matched healthy subjects during overground walking. Neuromuscular control of gait in CA was characterized by a considerable widening of EMG bursts and significant temporal shifts in the center of activity due to overall enhanced muscle activation between late swing and mid-stance. Patients also demonstrated significant changes in the intersegmental coordination, an abnormal transient in the vertical ground reaction force and instability of limb loading at heel strike. The observed abnormalities in EMG patterns and foot loading correlated with the severity of pathology [International Cooperative Ataxia Rating Scale (ICARS), a clinical ataxia scale] and the changes in the biomechanical output. The findings provide new insights into the physiological role of cerebellum in optimizing the duration of muscle activity bursts and the control of appropriate foot loading during locomotion.

The effect of muscle weakness on the capability gap during gross motor function: a simulation study supporting design criteria for exoskeletons of the lower limb

Background

Enabling persons with functional weaknesses to perform activities of daily living (ADL) is one of the main challenges for the aging society. Powered orthoses, or exoskeletons, have the potential to support ADL while promoting active participation of the user. For this purpose, assistive devices should be designed and controlled to deliver assistance as needed (AAN). This means that the level of assistance should bridge the capability gap, i.e. the gap between the capabilities of the subjects and the task requirements. However, currently the actuators of exoskeletons are mainly designed using inverse dynamics (ID) based calculations of joint moments. The goal of the present study is to calculate the capability gap for the lower limb during ADL when muscle weakness is present, which is needed for appropriate selection of actuators to be integrated in exoskeletons.

Methods

A musculoskeletal model (MM) is used to calculate the joint kinematics, joint kinetics and muscle forces of eight healthy subjects during ADL (gait, sit-to-stand, stand-to-sit, stair ascent, stair descent). Muscle weakness was imposed to the MM by a stepwise decrease in maximal isometric force imposed to all muscles. Muscle forces were calculated using static optimization. In order to compensate for muscle weakness, ideal moment actuators that represent the motors of an exoskeleton in the simulation were added to deliver AAN required to perform the task.

Results

The ID approach overestimates the required assistance since it relies solely on the demands of the task, whereas the AAN approach incorporates the capabilities of the subject. Furthermore, the ID approach delivers continuous support whereas the AAN approach targets the period where a capability gap occurs. The level of muscle weakness for which the external demands imposed by ADL can no longer be met by active muscle force production, is respectively 40%, 70%, 80% and 30%.

Conclusions

The present workflow allows estimating the AAN during ADL for different levels of muscle weakness, which can be used in the mechatronic design and control of powered exoskeletons. The AAN approach is a more physiological approach than the ID approach, since the MM accounts for the subject-specific capabilities of the user.

EMG patterns during assisted walking in the exoskeleton

Neuroprosthetic technology and robotic exoskeletons are being developed to facilitate stepping, reduce muscle efforts, and promote motor recovery. Nevertheless, the guidance forces of an exoskeleton may influence the sensory inputs, sensorimotor interactions and resulting muscle activity patterns during stepping. The aim of this study was to report the muscle activation patterns in a sample of intact and injured subjects while walking with a robotic exoskeleton and, in particular, to quantify the level of muscle activity during assisted gait. We recorded electromyographic (EMG) activity of different leg and arm muscles during overground walking in an exoskeleton in six healthy individuals and four spinal cord injury (SCI) participants. In SCI patients, EMG activity of the upper limb muscles was augmented while activation of leg muscles was typically small. Contrary to our expectations, however, in neurologically intact subjects, EMG activity of leg muscles was similar or even larger during exoskeleton-assisted walking compared to normal overground walking. In addition, significant variations in the EMG waveforms were found across different walking conditions. The most variable pattern was observed in the hamstring muscles. Overall, the results are consistent with a non-linear reorganization of the locomotor output when using the robotic stepping devices. The findings may contribute to our understanding of human-machine interactions and adaptation of locomotor activity patterns.

Preclinical evidence supporting the clinical development of central pattern generator-modulating therapies for chronic spinal cord-injured patients

Ambulation or walking is one of the main gaits of locomotion. In terrestrial animals, it may be defined as a series of rhythmic and bilaterally coordinated movement of the limbs which creates a forward movement of the body. This applies regardless of the number of limbs-from arthropods with six or more limbs to bipedal primates. These fundamental similarities among species may explain why comparable neural systems and cellular properties have been found, thus far, to control in similar ways locomotor rhythm generation in most animal models. The aim of this article is to provide a comprehensive review of the known structural and functional features associated with central nervous system (CNS) networks that are involved in the control of ambulation and other stereotyped motor patterns-specifically Central Pattern Generators (CPGs) that produce basic rhythmic patterned outputs for locomotion, micturition, ejaculation, and defecation. Although there is compelling evidence of their existence in humans, CPGs have been most studied in reduced models including in vitro isolated preparations, genetically-engineered mice and spinal cord-transected animals. Compared with other structures of the CNS, the spinal cord is generally considered as being well-preserved phylogenetically. As such, most animal models of spinal cord-injured (SCI) should be considered as valuable tools for the development of novel pharmacological strategies aimed at modulating spinal activity and restoring corresponding functions in chronic SCI patients.

Identification of a cellular node for motor control pathways

The rich behavioral repertoire of animals is encoded in the CNS as a set of motorneuron activation patterns, also called 'motor synergies'. However, the neurons that orchestrate these motor programs as well as their cellular properties and connectivity are poorly understood. Here we identify a population of molecularly defined motor synergy encoder (MSE) neurons in the mouse spinal cord that may represent a central node in neural pathways for voluntary and reflexive movement. This population receives direct inputs from the motor cortex and sensory pathways and, in turn, has monosynaptic outputs to spinal motorneurons. Optical stimulation of MSE neurons drove reliable patterns of activity in multiple motor groups, and we found that the evoked motor patterns varied on the basis of the rostrocaudal location of the stimulated MSE. We speculate that these neurons comprise a cellular network for encoding coordinated motor output programs.

Can modular strategies simplify neural control of multidirectional human locomotion?

Each human lower limb contains over 50 muscles that are coordinated during locomotion. It has been hypothesized that the nervous system simplifies muscle control through modularity, using neural patterns to activate muscles in groups called synergies. Here we investigate how simple modular controllers based on invariant neural primitives (synergies or patterns) might generate muscle activity observed during multidirectional locomotion. We extracted neural primitives from unilateral electromyographic recordings of 25 lower limb muscles during five locomotor tasks: walking forward, backward, leftward and rightward, and stepping in place. A subset of subjects also performed five variations of forward (unidirectional) walking: self-selected cadence, fast cadence, slow cadence, tiptoe, and uphill (20% incline). We assessed the results in the context of dimensionality reduction, defined here as the number of neural signals needing to be controlled. For an individual task, we found that modular architectures could theoretically reduce dimensionality compared with independent muscle control, but we also found that modular strategies relying on neural primitives shared across different tasks were limited in their ability to account for muscle activations during multi- and unidirectional locomotion. The utility of shared primitives may thus depend on whether they can be adapted for specific task demands, for instance, by means of sensory feedback or by being embedded within a more complex sensorimotor controller. Our findings indicate the need for more sophisticated formulations of modular control or alternative motor control hypotheses in order to understand muscle coordination during locomotion.

Plasticity and modular control of locomotor patterns in neurological disorders with motor deficits

Human locomotor movements exhibit considerable variability and are highly complex in terms of both neural activation and biomechanical output. The building blocks with which the central nervous system constructs these motor patterns can be preserved in patients with various sensory-motor disorders. In particular, several studies highlighted a modular burst-like organization of the muscle activity. Here we review and discuss this issue with a particular emphasis on the various examples of adaptation of locomotor patterns in patients (with large fiber neuropathy, amputees, stroke and spinal cord injury). The results highlight plasticity and different solutions to reorganize muscle patterns in both peripheral and central nervous system lesions. The findings are discussed in a general context of compensatory gait mechanisms, spatiotemporal architecture and modularity of the locomotor program.

Common muscle synergies for balance and walking

Little is known about the integration of neural mechanisms for balance and locomotion. Muscle synergies have been studied independently in standing balance and walking, but not compared. Here, we hypothesized that reactive balance and walking are mediated by a common set of lower-limb muscle synergies. In humans, we examined muscle activity during multidirectional support-surface perturbations during standing and walking, as well as unperturbed walking at two speeds. We show that most muscle synergies used in perturbations responses during standing were also used in perturbation responses during walking, suggesting common neural mechanisms for reactive balance across different contexts. We also show that most muscle synergies using in reactive balance were also used during unperturbed walking, suggesting that neural circuits mediating locomotion and reactive balance recruit a common set of muscle synergies to achieve task-level goals. Differences in muscle synergies across conditions reflected differences in the biomechanical demands of the tasks. For example, muscle synergies specific to walking perturbations may reflect biomechanical challenges associated with single limb stance, and muscle synergies used during sagittal balance recovery in standing but not walking were consistent with maintaining the different desired center of mass motions in standing vs. walking. Thus, muscle synergies specifying spatial organization of muscle activation patterns may define a repertoire of biomechanical subtasks available to different neural circuits governing walking and reactive balance and may be recruited based on task-level goals. Muscle synergy analysis may aid in dissociating deficits in spatial vs. temporal organization of muscle activity in motor deficits. Muscle synergy analysis may also provide a more generalizable assessment of motor function by identifying whether common modular mechanisms are impaired across the performance of multiple motor tasks.