Neuromechanical interactions between the limbs during human locomotion: an evolutionary perspective with translation to rehabilitation

Differences in brain activation and connectivity during unaffected hand exercise in subacute and convalescent stroke patients

Patients experiencing severe hemiplegia following a stroke struggle to rehabilitate their affected limbs. Cross-education (CE) training emerges as a promising rehabilitation method due to its safety, simplicity, low risk, and ability to effectively improve muscle strength in the affected limb. However, controversy surrounds the neural mechanisms and clinical applications of CE. To address this, we employed functional near-infrared spectroscopy to monitor the response of regions of interest (ROI) and functional connectivity in patients with stroke experiencing severe hemiplegia during one session of 50% maximal voluntary contraction (MVC) strength training with less-affected hand in both subacute and convalescent phases. Our objective was to compare the two stroke groups to gain insight into the potential utility for unilateral training of the less-affected limb as an effective rehabilitation approach during different phases post of stroke. The findings revealed varying degrees of activation in the ROIs within the affected hemisphere across both groups during the task. Additionally, we found that the subacute stroke patients with severe hemiplegia (SPS) had higher blood oxygen levels in the ipsilesional primary motor (iM1), ipsilesional pre-motor and supplementary motor area (iP-SMA) and contralesional P-SMA (cP-SMA). Functional connectivity strength between the iM1 and contralesional brain regions, as well as between the iP-SMA and ipsilesional ROIs, showed statistically significant differences in SPS compared to convalescent stroke patients with severe hemiplegia (CPS) during a 50% MVC strength training session using the less-affected hand. SIGNIFICANCE STATEMENT: Exploring the neural mechanisms underlying one session of 50% MVC strength training with less-affected hand sheds light on a safe therapy. The study enhances our understanding of less-affected hand training and investigates the feasibility as a future rehabilitation approach. Analyzing how one session of 50% MVC strength training with less-affected hand affects brain activation and connectivity could lead to more tailored and effective rehabilitation strategies.

Intra- and interlimb effects of gait retraining in individuals with knee hyperextension

BACKGROUND

Gait retraining, which typically focuses on the most severely affected limb or joint, has shown promising results in treating faulty running and walking patterns. The closed-chain nature of gait during the stance phase may influence kinematic changes in the adjacent joints of the trained leg. In addition, the coupled nature of the lower extremity motion of gait suggests that changes in one leg may transfer to the other. This study aimed to assess the intra- and inter-limb transfer of kinematic changes following gait retraining to reduce knee extension in individuals with hyperextension walking patterns.

METHODS

Seventeen women with knee hyperextension gait patterns participated in six treadmill retraining sessions. All participants received verbal and real-time visual kinematic feedback in the form of knowledge of results. This intervention study took place at the Gait Analysis Laboratory at the University of Iowa. Mean peak sagittal-plane lower extremity joint kinematics during overground walking at pretraining, post-training, and 1- and 8-month follow-ups were calculated for analysis and comparisons.

FINDINGS

The post-training changes in ankle range of motion returned to baseline values by the 8-month follow-up. There was a significant transfer effect of kinematic changes to the untrained knee following gait retraining.

INTERPRETATION

Training one knee did not result in long-term compensatory kinematic changes in the other joints. In addition, the improvements in knee extension range of motion were transferred to the untrained knee and retained at the 8-month follow-up. This study supports the use of gait retraining as an effective clinical intervention.

A New Measure for Quantifying Four-Limb Coordination of Human Gait Based on Mobility Sensors

Coordinated movement of four limbs is a hallmark of healthy locomotion. No measures exist to quantify four-limb coordination. This study aimed to investigate temporal four-limb coordination and proposed a new metric for quantifying the inter-limb phase of rhythmic locomotion-related movements. Kinetic data of arm and leg movements generated during walking (self-selected speed) from healthy adults were used to extract the phases (φ) between all possible limb pairings. The φ series were used to calculate each pair's Phase Coordination Index (PCI). The PCI quantifies the accuracy and consistency of generating anti-phased rhythmic movements (lower PCI values mean better coordination). We also calculated the Quadruple-PCI (Q-PCI) by combining all φ values of all limb pairs. We found a significant correlation between the PCI values of all limb pairings and the Q-PCI (pairs involving arms: Pearson's R > 0.79, p < 0.001; leg-leg: Pearson's R = 0.3, p < 0.01). The PCI values that involve arms (median values between 6.5% and 8.3%) were significantly higher than the leg-leg PCI (median values between 3.8% and 4.1%), and the Q-PCI (median values between 8.3% and 9.7%) was significantly higher than all other PCI values. We also found a negative correlation between the arm swing amplitude and the PCI values (Spearman's Rho of different limb pairings ranging from -0.25 to -0.5, p < 0.05), suggesting that higher arm swing amplitude leads to better coordination. Four-limb coordination analysis is a novel method for comprehensive assessment of gait coordination, which is often compromised among persons with disabilities.

Lateralized modulation of cortical beta power during human gait is related to arm swing

Human gait is a complex behavior requiring dynamic control of upper and lower extremities that is accompanied by cortical activity in multiple brain areas. We investigated the contribution of beta (15-30 Hz) and gamma (30-50 Hz) band electroencephalography (EEG) activity during specific phases of the gait cycle, comparing treadmill walking with and without arm swing. Modulations of spectral power in the beta band during early double support and swing phases source-localized to the sensorimotor cortex ipsilateral, but not contralateral, to the leading leg. The lateralization disappeared in the condition with constrained arms, together with an increase of activity in bilateral supplementary motor areas. By contrast, gamma band modulations that localized to the presumed leg area of sensorimotor cortex around the heel-strike events were unaffected by arm movement. Our findings demonstrate that arm swing is accompanied by considerable cortical activation that should not be neglected in gait-related neuroimaging studies.

Exploring How the Arms Can Help the Legs in Facilitating Gait Rehabilitation

Inspired by the ideas from the fields of gait rehabilitation, neuroscience, and locomotion biomechanics and energetics, a body of work is reviewed that has led to propose a conceptual framework for novel "self-assistive" walking devices that could further promote walking recovery from incomplete spinal cord injuries. The underlying rationale is based on a neural coupling mechanism that governs the coordinated movements of the arms and legs during walking, and that the excitability of these neural pathways can be exploited by actively engaging the arms during locomotor training. Self-assistive treadmill walking rehabilitation devices are envisioned as an approach that would allow an individual to actively use their arms to help the legs during walking. It is hoped that the conceptual framework inspires the design and use of self-assistive walking devices that are tailored to assist individuals with an incomplete spinal cord injury to regain their functional walking ability.

Dynamic networks of cortico-muscular interactions in sleep and neurodegenerative disorders

The brain plays central role in regulating physiological systems, including the skeleto-muscular and locomotor system. Studies of cortico-muscular coordination have primarily focused on associations between movement tasks and dynamics of specific brain waves. However, the brain-muscle functional networks of synchronous coordination among brain waves and muscle activity rhythms that underlie locomotor control remain unknown. Here we address the following fundamental questions: what are the structure and dynamics of cortico-muscular networks; whether specific brain waves are main network mediators in locomotor control; how the hierarchical network organization relates to distinct physiological states under autonomic regulation such as wake, sleep, sleep stages; and how network dynamics are altered with neurodegenerative disorders. We study the interactions between all physiologically relevant brain waves across cortical locations with distinct rhythms in leg and chin muscle activity in healthy and Parkinson's disease (PD) subjects. Utilizing Network Physiology framework and time delay stability approach, we find that 1) each physiological state is characterized by a unique network of cortico-muscular interactions with specific hierarchical organization and profile of links strength; 2) particular brain waves play role as main mediators in cortico-muscular interactions during each state; 3) PD leads to muscle-specific breakdown of cortico-muscular networks, altering the sleep-stage stratification pattern in network connectivity and links strength. In healthy subjects cortico-muscular networks exhibit a pronounced stratification with stronger links during wake and light sleep, and weaker links during REM and deep sleep. In contrast, network interactions reorganize in PD with decline in connectivity and links strength during wake and non-REM sleep, and increase during REM, leading to markedly different stratification with gradual decline in network links strength from wake to REM, light and deep sleep. Further, we find that wake and sleep stages are characterized by specific links strength profiles, which are altered with PD, indicating disruption in the synchronous activity and network communication among brain waves and muscle rhythms. Our findings demonstrate the presence of previously unrecognized functional networks and basic principles of brain control of locomotion, with potential clinical implications for novel network-based biomarkers for early detection of Parkinson's and neurodegenerative disorders, movement, and sleep disorders.

A sensory signal related to left-right symmetry modulates intra- and interlimb cutaneous reflexes during locomotion in intact cats

Introduction

During locomotion, cutaneous reflexes play an essential role in rapidly responding to an external perturbation, for example, to prevent a fall when the foot contacts an obstacle. In cats and humans, cutaneous reflexes involve all four limbs and are task- and phase modulated to generate functionally appropriate whole-body responses.

Methods

To assess task-dependent modulation of cutaneous interlimb reflexes, we electrically stimulated the superficial radial or superficial peroneal nerves in adult cats and recorded muscle activity in the four limbs during tied-belt (equal left-right speeds) and split-belt (different left-right speeds) locomotion.

Results

We show that the pattern of intra- and interlimb cutaneous reflexes in fore- and hindlimbs muscles and their phase-dependent modulation were conserved during tied-belt and split-belt locomotion. Short-latency cutaneous reflex responses to muscles of the stimulated limb were more likely to be evoked and phase-modulated when compared to muscles in the other limbs. In some muscles, the degree of reflex modulation was significantly reduced during split-belt locomotion compared to tied-belt conditions. Split-belt locomotion increased the step-by-step variability of left-right symmetry, particularly spatially.

Discussion

These results suggest that sensory signals related to left-right symmetry reduce cutaneous reflex modulation, potentially to avoid destabilizing an unstable pattern.

Chronic motor performance following different traumatic brain injury severity-A systematic review

Introduction

Traumatic brain injury (TBI) is now known to be a chronic disease, causing ongoing neurodegeneration and linked to increased risk of neurodegenerative motor diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. While the presentation of motor deficits acutely following traumatic brain injury is well-documented, however, less is known about how these evolve in the long-term post-injury, or how the initial severity of injury affects these outcomes. The purpose of this review, therefore, was to examine objective assessment of chronic motor impairment across the spectrum of TBI in both preclinical and clinical models.

Methods

PubMed, Embase, Scopus, and PsycINFO databases were searched with a search strategy containing key search terms for TBI and motor function. Original research articles reporting chronic motor outcomes with a clearly defined TBI severity (mild, repeated mild, moderate, moderate-severe, and severe) in an adult population were included.

Results

A total of 97 studies met the inclusion criteria, incorporating 62 preclinical and 35 clinical studies. Motor domains examined included neuroscore, gait, fine-motor, balance, and locomotion for preclinical studies and neuroscore, fine-motor, posture, and gait for clinical studies. There was little consensus among the articles presented, with extensive differences both in assessment methodology of the tests and parameters reported. In general, an effect of severity was seen, with more severe injury leading to persistent motor deficits, although subtle fine motor deficits were also seen clinically following repeated injury. Only six clinical studies investigated motor outcomes beyond 10 years post-injury and two preclinical studies to 18-24 months post-injury, and, as such, the interaction between a previous TBI and aging on motor performance is yet to be comprehensively examined.

Conclusion

Further research is required to establish standardized motor assessment procedures to fully characterize chronic motor impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols. Longitudinal studies investigating the same cohort over time are also a key for understanding the interaction between TBI and aging. This is particularly critical, given the risk of neurodegenerative motor disease development following TBI.

Epidural stimulation restores muscle synergies by modulating neural drives in participants with sensorimotor complete spinal cord injuries

Multiple studies have corroborated the restoration of volitional motor control after motor-complete spinal cord injury (SCI) through the use of epidural spinal cord stimulation (eSCS), but rigorous quantitative descriptions of muscle coordination have been lacking. Six participants with chronic, motor and sensory complete SCI underwent a brain motor control assessment (BMCA) consisting of a set of structured motor tasks with and without eSCS. We investigated how muscle activity complexity and muscle synergies changed with and without stimulation. We performed this analysis to better characterize the impact of stimulation on neuromuscular control. We also recorded data from nine healthy participants as controls. Competition exists between the task origin and neural origin hypotheses underlying muscle synergies. The ability to restore motor control with eSCS in participants with motor and sensory complete SCI allows us to test whether changes in muscle synergies reflect a neural basis in the same task. Muscle activity complexity was computed with Higuchi Fractal Dimensional (HFD) analysis, and muscle synergies were estimated using non-negative matrix factorization (NNMF) in six participants with American Spinal Injury Association (ASIA) Impairment Score (AIS) A. We found that the complexity of muscle activity was immediately reduced by eSCS in the SCI participants. We also found that over the follow-up sessions, the muscle synergy structure of the SCI participants became more defined, and the number of synergies decreased over time, indicating improved coordination between muscle groups. Lastly, we found that the muscle synergies were restored with eSCS, supporting the neural hypothesis of muscle synergies. We conclude that eSCS restores muscle movements and muscle synergies that are distinct from those of healthy, able-bodied controls.

Disinhibition of short-latency but not long-latency afferent inhibition of the lower limb during upper-limb muscle contraction

Research has demonstrated that motor and sensory functions of the lower limbs can be modulated by upper-limb muscle contractions. However, whether sensorimotor integration of the lower limb can be modulated by upper-limb muscle contractions is still unknown. [AQ: NR Original articles do not require structured abstracts. Hence, abstract subsections have been deleted. Please check.]Human sensorimotor integration has been studied using short- or long-latency afferent inhibition (SAI or LAI, respectively), which refers to inhibition of motor-evoked potentials (MEPs) elicited via transcranial magnetic stimulation by preceding peripheral sensory stimulation. In the present study, we aimed to investigate whether upper-limb muscle contractions could modulate the sensorimotor integration of the lower limbs by examining SAI and LAI. Soleus muscle MEPs following electrical tibial nerve stimulation (TSTN) during rest or voluntary wrist flexion were recorded at inter-stimulus intervals (ISIs) of 30 (i.e. SAI), 100, and 200 ms (i.e. LAI). The soleus Hoffman reflex following TSTN was also measured to identify whether MEP modulation occurred at the cortical or the spinal level. Results showed that lower-limb SAI, but not LAI, was disinhibited during voluntary wrist flexion. Furthermore, the soleus Hoffman reflex following TSTN during voluntary wrist flexion was unchanged when compared with that during the resting state at any ISI. Our findings suggest that upper-limb muscle contractions modulate sensorimotor integration of the lower limbs and that disinhibition of lower-limb SAI during upper-limb muscle contractions is cortically based.

Sensory Perturbations from Hindlimb Cutaneous Afferents Generate Coordinated Functional Responses in All Four Limbs during Locomotion in Intact Cats

Coordinating the four limbs is an important feature of terrestrial mammalian locomotion. When the foot dorsum contacts an obstacle, cutaneous mechanoreceptors send afferent signals to the spinal cord to elicit coordinated reflex responses in the four limbs to ensure dynamic balance and forward progression. To determine how the locomotor pattern of all four limbs changes in response to a sensory perturbation evoked by activating cutaneous afferents from one hindlimb, we electrically stimulated the superficial peroneal (SP) nerve with a relatively long train at four different phases (mid-stance, stance-to-swing transition, mid-swing, and swing-to-stance transition) of the hindlimb cycle in seven adult cats. The largest functional effects of the stimulation were found at mid-swing and at the stance-to-swing transition with several changes in the ipsilateral hindlimb, such as increased activity in muscles that flex the knee and hip joints, increased joint flexion and toe height, increased stride/step lengths and increased swing duration. We also observed several changes in support periods to shift support from the stimulated hindlimb to the other three limbs. The same stimulation applied at mid-stance and the swing-to-stance transition produced more subtle changes in the pattern. We observed no changes in stride and step lengths in the ipsilateral hindlimb with stimulation in these phases. We did observe some slightly greater flexions at the knee and ankle joints with stimulation at mid-stance and a reduction in double support periods and increase in triple support. Our results show that correcting or preventing stumbling involves functional contributions from all four limbs.

A comparison of the energy demands of quadrupedal movement training to walking

Background

Quadrupedal movement training (QMT) is a novel alternative form of exercise recently shown to improve several fitness characteristics including flexibility, movement quality, and dynamic balance. However, the specific energy demands of this style of training remain unknown. Therefore, the purpose of this study was to compare the energy expenditure (EE) of a beginner-level quadrupedal movement training (QMT) class using Animal Flow (AF) to walking, and to compare EE between segments of the AF class and gender.

Methods

Participants (15 male, 15 female) completed 60-min sessions of AF, treadmill walking at a self-selected intensity (SSIT) and treadmill walking at an intensity that matched the heart rate of the AF session (HRTM). Indirect calorimetry was used to estimate energy expenditure.

Results

AF resulted in an EE of 6.7 ± 1.8 kcal/min, 5.4 ± 1.0 METs, and HR of 127.1 ± 16.1 bpm (63.4 ± 8.1% of the subjects' age-predicted maximum HR), while SSIT resulted in an EE of 5.1 ± 1.0 kcal/min, 4.3 ± 0.7 METs, HR of 99.8 ± 13.5 bpm (49.8 ± 6.7% age-predicted maximum HR), and HRTM resulted in and EE of 7.6 ± 2.2 kcal/min, 6.1 ± 1.0 METs, and HR of 124.9 ± 16.3 bpm (62.3 ± 8.2% age-predicted maximum HR). Overall, EE, METs, HR and respiratory data for AF was greater than SSIT (p's < 0.001) and either comparable or slightly less than HRTM. The Flow segment showed the highest EE (8.7 ± 2.7 kcal/min), METs (7.0 ± 1.7) and HR (153.2 ± 15.7 bpm). Aside from HR, males demonstrated greater EE, METs, and respiratory values across all sessions and segments of AF than females.

Conclusions

QMT using AF meets the ACSM's criteria for moderate-intensity physical activity and should be considered a viable alternative to help meet physical activity guidelines.

Control of Forelimb and Hindlimb Movements and Their Coordination during Quadrupedal Locomotion across Speeds in Adult Spinal Cats

Coordinating the four limbs is critical for terrestrial mammalian locomotion. Thoracic spinal transection abolishes neural communication between the brain and spinal networks controlling hindlimb/leg movements. Several studies have shown that animal models of spinal transection (spinalization), such as mice, rats, cats, and dogs recover hindlimb locomotion with the forelimbs stationary or suspended. We know less on the ability to generate quadrupedal locomotion after spinal transection, however. We collected kinematic and electromyography data in four adult cats during quadrupedal locomotion at five treadmill speeds before (intact cats) and after low-thoracic spinal transection (spinal cats). We show that adult spinal cats performed quadrupedal treadmill locomotion and modulated their speed from 0.4 m/sec to 0.8 m/sec but required perineal stimulation. During quadrupedal locomotion, several compensatory strategies occurred, such as postural adjustments of the head and neck and the appearance of new coordination patterns between the forelimbs and hindlimbs, where the hindlimbs took more steps than the forelimbs. We also observed temporal changes, such as shorter forelimb cycle/swing durations and shorter hindlimb cycle/stance durations in the spinal state. Forelimb double support periods occupied a greater proportion of the cycle in the spinal state, and hindlimb stride length was shorter. Coordination between the forelimbs and hindlimbs was weakened and more variable in the spinal state. Changes in muscle activity reflected spatiotemporal changes in the locomotor pattern. Despite important changes in the pattern, our results indicate that biomechanical properties of the musculoskeletal system play an important role in quadrupedal locomotion and offset some of the loss in neural communication between networks controlling the forelimbs and hindlimbs after spinal transection.

Whole Body Coordination for Self-Assistance in Locomotion

The dynamics of the human body can be described by the accelerations and masses of the different body parts (e.g., legs, arm, trunk). These body parts can exhibit specific coordination patterns with each other. In human walking, we found that the swing leg cooperates with the upper body and the stance leg in different ways (e.g., in-phase and out-of-phase in vertical and horizontal directions, respectively). Such patterns of self-assistance found in human locomotion could be of advantage in robotics design, in the design of any assistive device for patients with movement impairments. It can also shed light on several unexplained infrastructural features of the CNS motor control. Self-assistance means that distributed parts of the body contribute to an overlay of functions that are required to solve the underlying motor task. To draw advantage of self-assisting effects, precise and balanced spatiotemporal patterns of muscle activation are necessary. We show that the necessary neural connectivity infrastructure to achieve such muscle control exists in abundance in the spinocerebellar circuitry. We discuss how these connectivity patterns of the spinal interneurons appear to be present already perinatally but also likely are learned. We also discuss the importance of these insights into whole body locomotion for the successful design of future assistive devices and the sense of control that they could ideally confer to the user.

Higher Responsiveness of Pattern Generation Circuitry to Sensory Stimulation in Healthy Humans Is Associated with a Larger Hoffmann Reflex

Simple Summary

Individual differences in the sensorimotor circuitry play an important role for understanding the nature of behavioral variability and developing personalized therapies. While the spinal network likely requires relatively rigid organization, it becomes increasingly evident that adaptability and inter-individual variability in the functioning of the neuronal circuitry is present not only in the brain but also in the spinal cord. In this study we investigated the relationship between the excitability of pattern generation circuitry and segmental reflexes in healthy humans. We found that the high individual responsiveness of pattern generation circuitries to tonic sensory input in both the upper and lower limbs was related to larger H-reflexes. The results provide further evidence for the importance of physiologically relevant assessments of spinal cord neuromodulation and the individual physiological state of reflex pathways.

Abstract

The state and excitability of pattern generators are attracting the increasing interest of neurophysiologists and clinicians for understanding the mechanisms of the rhythmogenesis and neuromodulation of the human spinal cord. It has been previously shown that tonic sensory stimulation can elicit non-voluntary stepping-like movements in non-injured subjects when their limbs were placed in a gravity-neutral unloading apparatus. However, large individual differences in responsiveness to such stimuli were observed, so that the effects of sensory neuromodulation manifest only in some of the subjects. Given that spinal reflexes are an integral part of the neuronal circuitry, here we investigated the extent to which spinal pattern generation excitability in response to the vibrostimulation of muscle proprioceptors can be related to the H-reflex magnitude, in both the lower and upper limbs. For the H-reflex measurements, three conditions were used: stationary limbs, voluntary limb movement and passive limb movement. The results showed that the H-reflex was considerably higher in the group of participants who demonstrated non-voluntary rhythmic responses than it was in the participants who did not demonstrate them. Our findings are consistent with the idea that spinal reflex measurements play important roles in assessing the rhythmogenesis of the spinal cord.

Sensory enhancement of warm-up amplifies subsequent grip strength and cycling performance

PURPOSE

In sport and exercise, warm-ups induce various physiological changes that facilitate subsequent performance. We have shown that delivering patterned stimulation to cutaneous afferents during sprint cycling mitigates fatigue-related decrements in performance, and that repeated sensory stimulation amplifies spinal reflex excitability. Therefore, the purpose of this study was to assess whether sensory enhancement of warm-up would affect subsequent high-intensity arm cycling performance.

METHODS

Participants completed three experimental sessions, in which they randomly performed either a control, stim, or sleeve warm-up condition prior to maximal duration arm cycling. During the control condition, warmup consisted of low-intensity arm cycling for 15 min. The stim condition was the same, except they received alternating pulses (400 ms, 50 Hz) of stimulation just above their perceptual threshold to the wrists during warm-up. The third condition required participants to wear custom fabricated compression sleeves around the elbow during warm-up. Grip strength and spinal reflex excitability were measured before and after each warm-up and fatigue protocol, which required participants to arm cycle at 85% of peak power output until they reached volitional fatigue. Peak power output was determined during an incremental test at minimum 72 h prior to the first session.

RESULTS

Both sensory enhanced warm-up conditions amplified subsequent high-intensity arm cycling performance by ~ 30%. Additionally, the stim and sleeve warm-up conditions yielded improvements in grip strength (increased by ~ 5%) immediately after the sensory enhanced warm-ups. Ergogenic benefits from the sensory enhanced warm-up conditions did not differ between one another.

CONCLUSION

These findings demonstrate that enhanced sensory input during warm-up can elicit improvements in both maximal and submaximal performance measures.

Five weeks of Yuishinkai karate training improves balance and neuromuscular function in older adults: a preliminary study

Background

Martial arts training has shown positive impacts on balance and physiological measurements. Further investigation of the contents and feasibility of an effective therapeutic assessment of martial arts is needed in older adults, mainly for future applications and real-world implementation.

Methods

Sixteen older adults (8 male, 8 female, age 59–90 years), with or without chronic conditions, participated in a preliminary study using 5-weeks of karate training and a triple baseline control procedure. Group and single subject data analyses were conducted for dynamic balance, Timed Up and Go (TUG), hand grip, ankle plantarflexion force, and spinal cord excitability (via the soleus H-reflex) pre- and post-training.

Results

On average, participants completed a total of 2437 steps, 1762 turns, 3585 stance changes, 2047 punches, 2757 blocks, and 1253 strikes. Karate training improved dynamic balance performance such that the group average time was reduced (time to target (−13.6%, p = 0.020) and time to center (−8.3%, p = 0.010)). TUG was unchanged when considering the entire group (p = 0.779), but six participants displayed significant changes. Left handgrip (7.9%, p = 0.037), and plantarflexion force in the right (28.8%, p = 0.045) and left leg (13.3%, p = 0.024) increased for the group. Spinal cord excitability remained unchanged in group data analysis but 5 individuals had modulated H_max/M_max ratios.

Conclusion

5-weeks of karate training delivered in a fashion to mimic generally accessible community-level programs improved balance and strength in older adults. Whole-body movement embodied in karate training enhanced neuromuscular function and postural control. We met the overriding goal of this preliminary study to emphasize and assess feasibility and safety for the generalizability of martial arts interventions to real-world communities to impact health outcomes. Further quantitative work should explore threshold dose and development of martial arts training interventions as potential “exercise is medicine” functional fitness for older adults.

Characterization of interlimb interaction via transcutaneous spinal stimulation of cervical and lumbar spinal enlargements

The use of transcutaneous electrical spinal stimulation (TSS) to modulate sensorimotor networks after neurological insult has garnered much attention from both researchers and clinicians in recent years. Although many different stimulation paradigms have been reported, the interlimb effects of these neuromodulation techniques have been little studied. The effects of multisite TSS on interlimb sensorimotor function are of particular interest in the context of neurorehabilitation, as these networks have been shown to be important for functional recovery after neurological insult. The present study utilized a condition-test paradigm to investigate the effects of interenlargement TSS on spinal motor excitability in both cervical and lumbosacral motor pools. Additionally, comparison was made between the conditioning effects of lumbosacral and cervical TSS and peripheral stimulation of the fibular nerve and ulnar nerve, respectively. In 16/16 supine, relaxed participants, facilitation of spinally evoked motor responses (sEMRs) in arm muscles was seen in response to lumbosacral TSS or fibular nerve stimulation, whereas facilitation of sEMRs in leg muscles was seen in response to cervical TSS or ulnar nerve stimulation. The decreased latency between TSS- and peripheral nerve-evoked conditioning implicates interlimb networks in the observed facilitation of motor output. The results demonstrate the ability of multisite TSS to engage interlimb networks, resulting in the bidirectional influence of cervical and lumbosacral motor output. The engagement of interlimb networks via TSS of the cervical and lumbosacral enlargements represents a feasible method for engaging spinal sensorimotor networks in clinical populations with compromised motor function.NEW & NOTEWORTHY Bidirectional interlimb modulation of spinal motor excitability can be evoked by transcutaneous spinal stimulation over the cervical and lumbosacral enlargements. Multisite transcutaneous spinal stimulation engages spinal sensorimotor networks thought to be important in the recovery of function after spinal cord injury.

Neural Substrates of Transcutaneous Spinal Cord Stimulation: Neuromodulation across Multiple Segments of the Spinal Cord

Transcutaneous spinal cord stimulation (tSCS) has the potential to promote improved sensorimotor rehabilitation by modulating the circuitry of the spinal cord non-invasively. Little is currently known about how cervical or lumbar tSCS influences the excitability of spinal and corticospinal networks, or whether the synergistic effects of multi-segmental tSCS occur between remote segments of the spinal cord. The aim of this review is to describe the emergence and development of tSCS as a novel method to modulate the spinal cord, while highlighting the effectiveness of tSCS in improving sensorimotor recovery after spinal cord injury. This review underscores the ability of single-site tSCS to alter excitability across multiple segments of the spinal cord, while multiple sites of tSCS converge to facilitate spinal reflex and corticospinal networks. Finally, the potential and current limitations for engaging cervical and lumbar spinal cord networks through tSCS to enhance the effectiveness of rehabilitation interventions are discussed. Further mechanistic work is needed in order to optimize targeted rehabilitation strategies and improve clinical outcomes.

Control of Mammalian Locomotion by Somatosensory Feedback

When animals walk overground, mechanical stimuli activate various receptors located in muscles, joints, and skin. Afferents from these mechanoreceptors project to neuronal networks controlling locomotion in the spinal cord and brain. The dynamic interactions between the control systems at different levels of the neuraxis ensure that locomotion adjusts to its environment and meets task demands. In this article, we describe and discuss the essential contribution of somatosensory feedback to locomotion. We start with a discussion of how biomechanical properties of the body affect somatosensory feedback. We follow with the different types of mechanoreceptors and somatosensory afferents and their activity during locomotion. We then describe central projections to locomotor networks and the modulation of somatosensory feedback during locomotion and its mechanisms. We then discuss experimental approaches and animal models used to investigate the control of locomotion by somatosensory feedback before providing an overview of the different functional roles of somatosensory feedback for locomotion. Lastly, we briefly describe the role of somatosensory feedback in the recovery of locomotion after neurological injury. We highlight the fact that somatosensory feedback is an essential component of a highly integrated system for locomotor control. © 2021 American Physiological Society. Compr Physiol 11:1-71, 2021.

Intra- and Intermuscular Coherence and Body Acceleration Control in Older Adults during Bipedal Stance

Our aim was to clarify the effect of aging on the coherence of electromyograms of plantar flexor pairs during bipedal stance and to clarify the relationship between coherence and center-of-mass acceleration (COMacc). The subjects were 16 adults and 18 older adults. Intra- and intermuscular coherence and phase analyses were used to analyze the muscle pairs of bilateral and unilateral plantar flexor muscle groups. The relationship between coherence value and anterior-posterior COMacc of the plantar flexor muscle pairs was also examined to determine whether the connectivity of the lower limb muscle pairs is functionally important. The older adults showed higher coherence in the frequency range of 0-4 Hz for muscle pairs than the younger adults. In phase analysis, the older adults showed a phase difference between bilateral heteronymous muscle pairs in the frequency range of 0-6 Hz, which was one of the characteristics not seen in the younger adults. Correlation analysis showed that all the muscle pairs were moderately correlated with COMacc in the older adults. Not only does aging affects the organization of the bilateral and unilateral postural muscle activity of the plantar flexors during bipedal stance, but such organization may also be related to the increased COMacc characteristics of older adults.

Association of bilateral lower limb coordination while standing with body sway control and aging

PURPOSE

Coordinated movements of both lower limbs may be a clinically important indicator of motor control during quiet standing. From a neurological point of view, it is known that extensive coupling of muscles must be coordinated an upright posture. However, movement coordination between the lower limbs is the final motor output, is unknown. In this study, we focussed on the ground reaction force (GRF) vector and clarified the time and frequency characteristics of the force vectors of both lower limbs.

MATERIALS AND METHODS

A total of 16 healthy young adults and 18 healthy older adults participated and placed each bare foot on one of two force plates to measure the GRF vectors (i.e., anteroposterior, mediolateral, and vertical) of each lower limb and determine the centre of mass (COM) acceleration in the anteroposterior direction (COMacc). Characteristics of the coordination of both lower limbs during movements were analysed using coherence analysis and cross-correlation function analysis (CCF).

RESULTS

The coherence levels of the force vectors of both lower limbs were higher in all three directions and significantly increased in the older adults. CCF analysis showed that the force vectors of both lower limbs were negatively correlated at the zero-time lag. Moreover, a weak correlation was observed between COMacc and coherence values.

CONCLUSIONS

The assessment of bilateral lower limb connectivity using force vectors can be used as an evaluation method to reflect changes in the ability to control bipedal standing during ageing.

Synergistic interaction between sensory inputs and propriospinal signalling underlying quadrupedal locomotion

KEY POINTS

Stimulation of hindlimb afferent fibres can both stabilize and increase the activity of fore- and hindlimb motoneurons during fictive locomotion. The increase in motoneuron activity is at least partially due to the production of doublets of action potentials in a subpopulation of motoneurons. These results were obtained using an in vitro brainstem/spinal cord preparation of neonatal rat.

ABSTRACT

Quadrupedal locomotion relies on a dynamic coordination between central pattern generators (CPGs) located in the cervical and lumbar spinal cord, and controlling the fore- and hindlimbs, respectively. It is assumed that this CPG interaction is achieved through separate closed-loop processes involving propriospinal and sensory pathways. However, the functional consequences of a concomitant involvement of these different influences on the degree of coordination between the fore- and hindlimb CPGs is still largely unknown. Using an in vitro brainstem/spinal cord preparation of neonatal rat, we found that rhythmic, bilaterally alternating stimulation of hindlimb sensory input pathways elicited coordinated hindlimb and forelimb CPG activity. During pharmacologically induced fictive locomotion, lumbar dorsal root (DR) stimulation entrained and stabilized an ongoing cervico-lumbar locomotor-like rhythm and increased the amplitude of both lumbar and cervical ventral root bursting. The increase in cervical burst amplitudes was correlated with the occurrence of doublet action potential firing in a subpopulation of motoneurons, enabling the latter to transition between low and high frequency discharge according to the intensity of DR stimulation. Moreover, our data revealed that propriospinal and sensory pathways act synergistically to strengthen cervico-lumbar interactions. Indeed, split-bath experiments showed that fully coordinated cervico-lumbar fictive locomotion was induced by combining pharmacological stimulation of either the lumbar or cervical CPGs with lumbar DR stimulation. This study thus highlights the powerful interactions between sensory and propriospinal pathways which serve to ensure the coupling of the fore- and hindlimb CPGs for effective quadrupedal locomotion.

Evaluation of safety and performance of the self balancing walking system Atalante in patients with complete motor spinal cord injury

STUDY DESIGN

Prospective, open label, observational.

OBJECTIVES

To present results of the first clinical study on a newly developed robotic exoskeleton (Atalante®, Wandercraft, Paris, France) that enables individuals with spinal cord injury (SCI) to perform ambulatory functions without technical aids.

SETTING

Two sites specialized in SCI rehabilitation, France.

METHODS

Inclusion criteria were presence of chronic complete SCI (AIS A) ranging from T5 to T12. The study protocol included 12 one-hour training sessions during 3 weeks. Patients walked on floor with robotic assistance and wore a harness connected to a mobile suspension system (without weight-bearing) to prevent from falling. Main outcome was the ability to walk 10 meters unassisted, secondary outcomes were assessment of other ambulatory functions, bladder and bowel functions, pain and spasticity.

RESULTS

Twelve patients were enrolled, and 11 completed the protocol, mean age 33,9 years. Six patients had T6 levels of lesion or above. Seven patients passed the 10mWT at the 12th session unassisted (mean walking speed 0.13 m/s) while four required some human help. All patients succeeded at the other ambulatory tests (stand-up, sit-down, balance, turn). There were no significant change for bladder (Qualiveen) or bowel (NBD) functions, neuropathic pain (NPSI, NPRS), yet five patients reported a subjective improvement of their bowel function. Impact on spasticity was variable depending on the muscle examined (Ashworth). Ischial skin erosion was seen in one patient that needed local dressing.

CONCLUSION

The Atalante system is safe and enables to perform ambulatory functions in patients with complete SCI.

Disturbance of neural coupling between upper and lower limbs during gait transition

Humans spontaneously alternate between walking and running with a change in locomotion speed, which is termed gait transition. It has been suggested that sensory information in the muscle is a factor that triggers the gait transition; however, direct evidence for this has not been presented. In addition, it has been suggested that upper limb movement during human gait facilitates leg muscle activity due to the neural coupling between the upper and lower limbs. We hypothesized that a disturbance of afferent inputs in the neural coupling between the upper and lower limbs suppressively act on the gait transition. Here, we aimed to deepen the understanding of contribution of the afferent inputs in neural coupling between the upper and lower limbs to the gait transition. Eight participants performed spontaneous walk-to-run and run-to-walk transitions under two different conditions: Normal (arms swinging normally); and TIS (partial blocking of afferent inputs from the arms by inducing tourniquet ischemia). We compared the preferred gait transition speeds (PTS), joint angles, muscle activities, and muscle synergies between the two conditions. Control of coordinated muscle activities can be investigated by analyzing muscle synergies, which are groups of muscles that activate together. The PTS, joint angle profiles, muscle activity profiles, and muscle synergies were nearly identical between conditions (walk-to-run PTS at Normal and TIS: 6.9 ± 0.4 and 6.9 ± 0.4 km/h; run-to-walk PTS at Normal and TIS: 6.6 ± 0.4 and 6.5 ± 0.4 km/h; p = 0.869 and p = 0.402, respectively). Therefore, we conclude that the control of gait transition is little affected by disturbing the neural coupling between the upper and lower limbs by reducing afferent inputs from the forearms and distal upper arms. Our findings might reflect robustness of the neural coupling between the upper and lower limbs during locomotion against neural perturbations or disturbances.

Investigation of Power Specific Motor Primitives in an Upper Limb Rotational Motion

The purpose of this study was to investigate muscle synergies (MS) during upper limb cycling motion across power levels (20, 40, 60, 80, 100, and 120 watts). The MS hypothesis is important to the understanding of modular control for human movements. In this study, we explore its importance in execution of phasic movements at various power levels. Electromyographic (EMG) signals were recorded from 7 upper limb muscles during cycling for 30s on a hand-cycle ergometer. A Non-Negative Matrix factorization (NNMF) algorithm was used to extract MS. Cosine similarity was used to compare the MS and cross-correlation was used to compare activation coefficients. We found that the number and structure of synergies were consistent across power levels while admitting modulation in their activation coefficients. A total of three shared MS explaining ≥95% of the variance accounted for (VAF) represented push and pull mechanism during cyclic motion.

The Effect of Tai Chi Chuan Training on Stereotypic Behavior of Children with Autism Spectrum Disorder

This quasi-experimental study investigated effects of Tai Chi Chuan training on stereotypic behavior of children with autism spectrum disorder. Twenty-three participants (mean age = 9.60 ± 1.40 years) were assigned to experimental (N = 12) and control (N = 11) groups. The experimental group received 12 weeks of Tai Chi training and all participants had pre, post, and one-month follow-up assessments. Stereotypic behavior measured using Gilliam Autism Rating Scale 2 Scores, was significantly altered by ~ 25% in the Tai Chi Chuan group. Behavioral change was maintained at follow up since there was no significant difference between that and the posttest. In conclusion, Tai Chi Chuan training is a useful and appropriate intervention to modulate behavior in individuals with autism spectrum disorder.

Simultaneous Cervical and Lumbar Spinal Cord Stimulation Induces Facilitation of Both Spinal and Corticospinal Circuitry in Humans

Coupling between cervical and lumbar spinal networks (cervico-lumbar coupling) is vital during human locomotion. Impaired cervico-lumbar coupling after neural injuries or diseases can be reengaged via simultaneous arm and leg cycling training. Sensorimotor circuitry including cervico-lumbar coupling may further be enhanced by non-invasive modulation of spinal circuity using transcutaneous spinal cord stimulation (tSCS). This project aimed to determine the effect of cervical, lumbar, or combined tSCS on spinal reflex (Hoffmann [H-]) and corticospinal (motor evoked potential [MEP]) excitability during a static or cycling cervico-lumbar coupling task. Fourteen neurologically intact study participants were seated in a recumbent leg cycling system. H-reflex and MEP amplitudes were assessed in the left flexor carpi radialis (FCR) muscle during two tasks (Static and Cycling) and four conditions: (1) No tSCS, (2) tSCS applied to the cervical enlargement (Cervical); (3) tSCS applied to the lumbar enlargement (Lumbar); (4) simultaneous cervical and lumbar tSCS (Combined). While cervical tSCS did not alter FCR H-reflex amplitude relative to No tSCS, lumbar tSCS significantly facilitated H-reflex amplitude by 11.1%, and combined cervical and lumbar tSCS significantly enhanced the facilitation to 19.6%. Neither cervical nor lumbar tSCS altered MEP amplitude alone (+4.9 and 1.8% relative to legs static, No tSCS); however, combined tSCS significantly increased MEP amplitude by 19.7% compared to No tSCS. Leg cycling alone significantly suppressed the FCR H-reflex relative to static, No tSCS by 13.6%, while facilitating MEP amplitude by 18.6%. When combined with leg cycling, tSCS was unable to alter excitability for any condition. This indicates that in neurologically intact individuals where interlimb coordination and corticospinal tract are intact, the effect of leg cycling on cervico-lumbar coupling and corticospinal drive was not impacted significantly with the tSCS intensity used. This study demonstrates, for the first time, that tonic activation of spinal cord networks through multiple sites of tSCS provides a facilitation of both spinal reflex and corticospinal pathways. It remains vital to determine if combined tSCS can influence interlimb coupling after neural injury or disease when cervico-lumbar connectivity is impaired.

Ipsilateral motor pathways to the lower limb after stroke: Insights and opportunities

Stroke-related damage to the crossed lateral corticospinal tract causes motor deficits in the contralateral (paretic) limb. To restore functional movement in the paretic limb, the nervous system may increase its reliance on ipsilaterally descending motor pathways, including the uncrossed lateral corticospinal tract, the reticulospinal tract, the rubrospinal tract, and the vestibulospinal tract. Our knowledge about the role of these pathways for upper limb motor recovery is incomplete, and even less is known about the role of these pathways for lower limb motor recovery. Understanding the role of ipsilateral motor pathways to paretic lower limb movement and recovery after stroke may help improve our rehabilitative efforts and provide alternate solutions to address stroke-related impairments. These advances are important because walking and mobility impairments are major contributors to long-term disability after stroke, and improving walking is a high priority for individuals with stroke. This perspective highlights evidence regarding the contributions of ipsilateral motor pathways from the contralesional hemisphere and spinal interneuronal pathways for paretic lower limb movement and recovery. This perspective also identifies opportunities for future research to expand our knowledge about ipsilateral motor pathways and provides insights into how this information may be used to guide rehabilitation.

Interhemispheric inhibition to the biceps brachii during arm cycling

This is the first demonstration of interhemispheric inhibition (IHI) during a locomotor output, arm cycling. IHI was quantified by assessing the depth of the ipsilateral silent period (iSP) evoked via transcranial magnetic stimulation of the motor cortex. There was a significant reduction in electromyography (EMG) amplitude of the iSP during cycling compared with the control EMG (16.8% ± 17.1%; p < 0.001). Depth and area for measuring the iSP during arm cycling are discussed.

Novelty: This is the first study to demonstrate activation of the cortical circuit, interhemispheric inhibition, during a locomotor output.

Long-lasting changes in muscle activation and step cycle variables induced by repetitive sensory stimulation to discrete areas of the foot sole during walking

We examined whether repetitive electrical stimulation to discrete foot sole regions that are phase-locked to the step cycle modulates activity patterns of ankle muscles and induces neuronal adaptation during human walking. Nonnoxious repetitive foot sole stimulation (STIM; 67 pulses at 333 Hz) was given to the medial forefoot (f-M) or heel (HL) regions at 1) the stance-to-swing transition, 2) swing-to-stance transition, or 3) midstance, during every step cycle for 10 min. Stance, but not swing, durations were prolonged with f-M STIM delivered at stance-to-swing transition, and these changes remained for up to 20-30 min after the intervention. Electromyographic (EMG) burst durations and amplitudes in the ankle extensors were also prolonged and persisted for 20 min after the intervention. Interestingly, STIM to HL was ineffective at inducing modulation, suggesting stimulation location-specific adaptation. In contrast, STIM to HL (but not f-M), at the swing-to-stance phase transition, shortened the step cycle by premature termination of swing. Furthermore, the onset of EMG bursts in the ankle extensors appeared earlier than in the control condition. STIM delivered during the midstance phase was ineffective at modulating the step cycle, highlighting phase-dependent adaptation. These effects were absent when STIM was applied while mimicking static postures for each walking phase during standing. Our findings suggest that the combination of walking-related neuronal activity with repetitive sensory inputs from the foot can generate short-term adaptation that is phase-dependent and localized to the site of STIM.NEW & NOTEWORTHY Repetitive (∼10 min) long (200 ms) trains of sensory stimulation to discrete areas of the foot sole produce persistent changes in muscle activity and cycle timing during walking. Interactions between the delivery phase and stimulus location determine the expression of the adaptations. These observations bear striking similarities to those in decerebrate cat experiments and may be usefully translated to improving locomotor function after neurotrauma.

Network Physiology of Cortico-Muscular Interactions

Skeletal muscle activity is continuously modulated across physiologic states to provide coordination, flexibility and responsiveness to body tasks and external inputs. Despite the central role the muscular system plays in facilitating vital body functions, the network of brain-muscle interactions required to control hundreds of muscles and synchronize their activation in relation to distinct physiologic states has not been investigated. Recent approaches have focused on general associations between individual brain rhythms and muscle activation during movement tasks. However, the specific forms of coupling, the functional network of cortico-muscular coordination, and how network structure and dynamics are modulated by autonomic regulation across physiologic states remains unknown. To identify and quantify the cortico-muscular interaction network and uncover basic features of neuro-autonomic control of muscle function, we investigate the coupling between synchronous bursts in cortical rhythms and peripheral muscle activation during sleep and wake. Utilizing the concept of time delay stability and a novel network physiology approach, we find that the brain-muscle network exhibits complex dynamic patterns of communication involving multiple brain rhythms across cortical locations and different electromyographic frequency bands. Moreover, our results show that during each physiologic state the cortico-muscular network is characterized by a specific profile of network links strength, where particular brain rhythms play role of main mediators of interaction and control. Further, we discover a hierarchical reorganization in network structure across physiologic states, with high connectivity and network link strength during wake, intermediate during REM and light sleep, and low during deep sleep, a sleep-stage stratification that demonstrates a unique association between physiologic states and cortico-muscular network structure. The reported empirical observations are consistent across individual subjects, indicating universal behavior in network structure and dynamics, and high sensitivity of cortico-muscular control to changes in autonomic regulation, even at low levels of physical activity and muscle tone during sleep. Our findings demonstrate previously unrecognized basic principles of brain-muscle network communication and control, and provide new perspectives on the regulatory mechanisms of brain dynamics and locomotor activation, with potential clinical implications for neurodegenerative, movement and sleep disorders, and for developing efficient treatment strategies.

Arm cycling increases the short-latency reflex from ankle dorsiflexor afferents to knee extensor muscles

Low-intensity electrical stimulation of the common peroneal nerve (CPN) evokes a short latency reflex in the heteronymous knee extensor muscles (referred to as the CPN reflex). The CPN reflex is facilitated at a heel strike during walking, contributing to body weight support. However, the origin of the CPN reflex increase during walking remains unclear. We speculate that this increase originates from multiple sources due to a body of evidence suggesting the presence of neural coupling between the arms and legs. Therefore, we investigated the extent to which the CPN reflex is modulated during rhythmic arm cycling. Twenty-eight subjects sat in an armchair and were asked to perform arm cycling at a moderate cadence using a stationary ergometer while performing isometric contraction of the knee extensors, such that the CPN reflex was evoked. The CPN reflex was evoked by stimulating the CPN [0.9-2.0× the motor threshold (MT) in the tibialis anterior muscle] at the level of the neck of the fibula. The CPN-reflex amplitude was measured from the vastus lateralis (VL). The biphasic reflex response in the VL was evoked within 27-45 ms following CPN stimulation. The amplitude of the CPN reflex increased during arm cycling compared with that before cycling. The modulation of the CPN reflex during arm cycling was detected only for CPN stimulation intensity around 1.2× MT. Furthermore, CPN-reflex modulation was not observed during the isometric contraction of the arm or passive arm cycling. Our results suggest the presence of neural coupling between the CPN-reflex pathways and neural systems generating locomotive arm movement.NEW & NOTEWORTHY Whether locomotive arm movements contribute to the control of the reflex pathway from ankle dorsiflexor afferents to knee extensor muscles [common peroneal nerve (CPN)-reflex] is an unresolved issue. The CPN reflex in the stationary leg was facilitated only by arm cycling, and not by passive or isometric motor tasks. Our results suggest that the arm locomotor system modulates the reflex pathway from ankle dorsiflexor afferents to the knee extensor muscles.

The Effects of a Novel Quadrupedal Movement Training Program on Functional Movement, Range of Motion, Muscular Strength, and Endurance

Buxton, JD, Prins, PJ, Miller, MG, Moreno, A, Welton, GL, Atwell, AD, Talampas, TR, and Elsey, GE. The effects of a novel quadrupedal movement training program on functional movement, range of motion, muscular strength, and endurance. J Strength Cond Res XX(X): 000-000, 2020-Quadrupedal movement training (QMT) is a form of bodyweight training incorporating animal poses, transitions, and crawling patterns to reportedly improve fitness. This type of training may improve multiple facets of fitness, unfortunately, little evidence exists to support commercial claims and guide practitioners in the best use of QMT. Therefore, the purpose of this study was to assess the impact of a commercially available QMT program on functional movement, dynamic balance, range of motion, and upper body strength and endurance. Forty-two active college-age (19.76 ± 2.10 years) subjects (males = 19, females = 23) were randomly assigned to a QMT (n = 21) or control (CON) (n = 21) group for 8 weeks. Quadrupedal movement training consisted of 60-minute classes performed 2×·wk in addition to regular physical activity. Active range of motion, Functional Movement Screen (FMS), Y-Balance Test (YBT), handgrip strength, and push-up endurance were assessed before and after the intervention. The QMT group showed significantly greater improvements than the CON group in FMS composite score (1.62 ± 1.53 vs. 0.33 ± 1.15, p = 0.004) and FMS advanced movements (0.81 ± 0.87 vs. 0.01 ± 0.71, p = 0.002) and fundamental stability (0.57 ± 0.75 vs. 0.05 ± 0.50, p = 0.011), along with hip flexion, hip lateral rotation, and shoulder extension (p < 0.05). No significant differences between groups were observed for dynamic balance or upper body strength and endurance. Our results indicate that QMT can improve FMS scores and various active joint ranges of motion. Quadrupedal movement training is a viable alternative form of training to improve whole-body stabilization and flexibility.

Inclination angles of the ankle and head relative to the centre of mass identify gait deviations post-stroke

BACKGROUND

Whole-body movement adjustments during gait are common post-stroke, but comprehensive ways of quantifying and evaluating gait from a whole-body perspective are lacking.

RESEARCH QUESTION

Can novel kinematic variables related to Center of Mass (CoM) position discriminate side asymmetries as well as coordination between the upper and lower body during gait within persons post-stroke and compared to non-disabled controls?

METHODS

Thirty-one persons post-stroke and 41 age-matched non-disabled controls walking at their self-selected speed were recorded by 3D motion capture. The Ankle-CoM Inclination Angle (A-CoMIA) and the Head-CoM Inclination Angle (H-CoMIA) defined the angle between the CoM and the ankle and the head, respectively, in the frontal plane. These angles and their angular velocities were compared between groups, and with regard to motor impairment severity during all phases of the gait cycle (GC) using a functional interval-wise testing analysis suitable for curve data. Upper and lower body coordination was assessed using cross- correlation.

RESULTS

The A-CoMIA was symmetrical between body sides in persons post-stroke but larger compared to controls. The angular velocity of A-CoMIA also differed when compared to controls. The H-CoMIA was consistently asymmetrical in persons post-stroke and larger than in controls throughout the stance phase. There were only minor group differences in the angular velocity of H-CoMIA, with some side asymmetry in persons post-stroke. The A-CoMIA of the non-affected side, and the H- CoMIA, discriminated between persons with more severe impairments compared to those with milder impairments post-stroke. The variables showed strong cross- correlations in both groups.

SIGNIFICANCE

The A-CoMIA and Head-CoMIA discriminated post-stroke gait from non-disabled, as well as motor impairment severity. These variables with the advantageous curve analysis during the entire GC add valuable whole-body information to existing parameters of post-stroke gait analysis through assessment of symmetry and upper and lower body coordination.

Maturation of the Locomotor Circuitry in Children With Cerebral Palsy

The first years of life represent an important phase of maturation of the central nervous system, processing of sensory information, posture control and acquisition of the locomotor function. Cerebral palsy (CP) is the most common group of motor disorders in childhood attributed to disturbances in the fetal or infant brain, frequently resulting in impaired gait. Here we will consider various findings about functional maturation of the locomotor output in early infancy, and how much the dysfunction of gait in children with CP can be related to spinal neuronal networks vs. supraspinal dysfunction. A better knowledge about pattern generation circuitries in infancy may improve our understanding of developmental motor disorders, highlighting the necessity for regulating the functional properties of abnormally developed neuronal locomotor networks as a target for early sensorimotor rehabilitation. Various clinical approaches and advances in biotechnology are also considered that might promote acquisition of the locomotor function in infants at risk for locomotor delays.

Preliminary development and technical evaluation of a belt-actuated robotic rehabilitation platform

BACKGROUND:

To provide effective rehabilitation in the early post-injury stage, a novel robotic rehabilitation platform is proposed, which provides full-body arm-leg rehabilitation via belt actuation to severely disabled patients who are restricted to bed rest.

OBJECTIVE:

To design and technically evaluate the preliminary development of the rehabilitation platform, with focus on the generation of various leg movements.

METHODS:

Two computer models were developed by importing the components from SolidWorks into Simscape Multibody in MATLAB. This allowed simulation of various stepping movements in supine-lying and side-lying positions. Two belt-actuated test rigs were manufactured and automatic control programs were developed in TIA Portal. Finally, the functionality of the test rigs was technically evaluated.

RESULTS:

Computer simulation yielded target positions for the generation of various stepping movements in the experimental platforms. The control system enabled the two-drive test rig to provide three modes of stepping in a supine position. In addition, the four-drive test rig produced walking-like stepping in a side-lying position.

CONCLUSIONS:

This work confirmed the feasibility of the mechanical development and control system of the test rigs, which are deemed applicable for further development of the overall novel robotic rehabilitation platform.

Muscle Synergies and Coherence Networks Reflect Different Modes of Coordination During Walking

When walking speed is increased, the frequency ratio between the arm and leg swing switches spontaneously from 2:1 to 1:1. We examined whether these switches are accompanied by changes in functional connectivity between multiple muscles. Subjects walked on a treadmill with their arms swinging along their body while kinematics and surface electromyography (EMG) of 26 bilateral muscles across the body were recorded. Walking speed was varied from very slow to normal. We decomposed EMG envelopes and intermuscular coherence spectra using non-negative matrix factorization (NMF), and the resulting modes were combined into multiplex networks and analyzed for their community structure. We found five relevant muscle synergies that significantly differed in activation patterns between 1:1 and 2:1 arm-leg coordination and the transition period between them. The corresponding multiplex network contained a single module indicating pronounced muscle co-activation patterns across the whole body during a gait cycle. NMF of the coherence spectra distinguished three EMG frequency bands: 4-8, 8-22, and 22-60 Hz. The community structure of the multiplex network revealed four modules, which clustered functional and anatomical linked muscles across modes of coordination. Intermuscular coherence at 4-22 Hz between upper and lower body and within the legs was particularly pronounced for 1:1 arm-leg coordination and was diminished when switching between modes of coordination. These findings suggest that the stability of arm-leg coordination is associated with modulations in long-distant neuromuscular connectivity.

Changing coupling between the arms and legs with slow walking speeds alters regulation of somatosensory feedback

Arm swing movement is coordinated with movement of the legs during walking, where the frequency of coordination depends on walking speed. At typical speeds, arm and leg movements, respectively, are frequency locked in a 1:1 ratio but at slow speeds this changes to a 2:1 ratio. It is unknown if the changes in interlimb ratio that accompany slow walking speeds alters regulation of somatosensory feedback. To probe the neural interactions between the arms and legs, somatosensory linkages in the form of interlimb cutaneous reflexes were examined. It was hypothesized that different interlimb frequencies and walking speeds would result in changes in the modulation of cutaneous reflexes between the arms and legs. To test this hypothesis, participants walked in four combinations of walking speed (typical, slow) and interlimb coordination (1:1, and 2:1), while cutaneous reflexes and background muscle activity were evaluated with stimulation applied to the superficial peroneal nerve at the ankle and superficial radial nerve at the wrist. Results show main effects of interlimb coordination and walking speed on cutaneous reflex modulation, effects are largest in the swing phase, and a directional coupling was observed, where changes in the frequency of arm movements had a greater effect on muscle activity in the legs compared to the reverse. Task-dependent modulation was also revealed from stimulation at local and remote sources. Understanding the underlying neural mechanisms for the organization of rhythmic arm movement, and its coordination with the legs in healthy participants, can give insight into pathological walking, and will facilitate the development of effective strategies for the rehabilitation of walking.

Spinal Circuits Mediate a Stretch Reflex Between the Upper Limbs in Humans

Inter-limb reflexes play an important role in coordinating behaviors involving different limbs. Previous studies have demonstrated that human elbow muscles express an inter-limb stretch reflex at long-latency (50-100 ms), a timing consistent with a trans-cortical linkage. Here we probe for inter-limb stretch reflexes in the shoulder muscles of human participants. Unexpected torque pulses displaced one or both shoulders while participants adopted a steady posture against background torques. The results demonstrated inter-limb stretch reflexes occurring at short-latency for both shoulder extensors and flexors; the rapid timing (36-50 ms) must involve a spinal linkage for the two arms. Inter-limb stretch reflexes were also observed at long-latency yet they were opposite to the preceding short-latency; when the short-latency stretch reflex was excitatory then the long-latency stretch reflex was inhibitory and vice versa. Comparing the responses to contralateral arm displacement to those during simultaneous displacement of both arms revealed that inhibitory inter-limb stretch reflexes are independent of within-limb stretch reflexes, but that excitatory inter-limb stretch reflexes are suppressed by within-limb stretch reflexes. Our results provide the first demonstration of short-latency inter-limb stretch reflexes in the upper limb of humans and reveal interacting spinal circuits for within-limb and inter-limb stretch reflexes.

Plantarflexion force is amplified with sensory stimulation during ramping submaximal isometric contractions

Stimulating cutaneous nerves, causing tactile sensations, reduces the perceived heaviness of an object, suggesting that either descending commands are facilitated or the perception of effort is reduced when tactile sensation is enhanced. Sensory stimulation can also mitigate decrements in motor output and spinal cord excitability that occur with fatigue. The effects of sensory stimulation applied with coincident timing of voluntary force output, however, are yet to be examined. Therefore, the purpose of this study was to examine effects of sensory enhancement to nerves innervating opposed skin areas of the foot (top or bottom) on force production during voluntary plantarflexion or dorsiflexion contractions. Stimulation trains were applied for 2 s at either a uniform 150 Hz or a modulated frequency that increased linearly from 50 to 150 Hz and were delivered at the initiation of the contraction. Participants were instructed to perform a ramp contraction [~10% maximal voluntary contraction (MVC)/s] to ~20% MVC and then to hold ~20% MVC for 2 s while receiving real-time visual feedback. Cutaneous reflexes were evoked 75 ms after initiating the hold (75 ms after sensory enhancement ended). Force output was greater for all sensory-enhanced conditions compared with control during plantarflexion; however, force output was not amplified during dorsiflexion. Cutaneous reflexes evoked after sensory enhancement were unaltered. These results indicate that sensory enhancement can amplify plantarflexion but not dorsiflexion, likely as a result of differences in neuroanatomical projections to the flexor and extensor motor pools. Further work is required to elucidate the mechanisms of enhanced force during cutaneous stimulation.NEW & NOTEWORTHY The efficacy of behaviorally timed sensory stimulation to enhance sensations and amplify force output has not been examined. Here we show cutaneous nerve sensory stimulation can amplify plantarflexion force output. This amplification in force occurs irrespective of whether the cutaneous field that is stimulated resides on the surface that is producing the force or the opposing surface. This information may provide insights for the development of technologies to improve performance and/or rehabilitation training.

We Are Upright-Walking Cats: Human Limbs as Sensory Antennae During Locomotion

Humans and cats share many characteristics pertaining to the neural control of locomotion, which has enabled the comprehensive study of cutaneous feedback during locomotion. Feedback from discrete skin regions on both surfaces of the human foot has revealed that neuromechanical responses are highly topographically organized and contribute to "sensory guidance" of our limbs during locomotion.

Therapeutic Elastic Tapes Applied in Different Directions Over the Triceps Surae Do Not Modulate Reflex Excitability of the Soleus Muscle

CONTEXT

Elastic taping has been widely used for either to facilitate or to inhibit muscle contraction. The efficacy of elastic taping is allegedly ascribed to physiological mechanisms related to subcutaneous tissue and muscle stimulation as a result of tape tension and direction. However, the underlying mechanisms that support the use of elastic taping are still unclear.

OBJECTIVE

To investigate changes in electrophysiological responses after 48 hours of tape application in different directions on the calf muscles of healthy individuals.

DESIGN

Within-subjects design.

SETTING

Research laboratory.

PARTICIPANTS

Twenty-seven physically active males (age 18.0 [4.2] y, height 1.65 [0.07] m, body mass 62.3 [10.3] kg) participated.

INTERVENTIONS

Soleus H-reflex responses were evoked through stimulation of the tibial posterior nerve with 2- to 4-second interval between stimuli (32 sweeps) for each condition (baseline: without tape; facilitation: tape applied from muscle origin to insertion; inhibition: tape applied from muscle insertion to origin).

MAIN OUTCOME MEASURES

The H-reflex amplitude values were normalized by the maximal direct response (Mmax). Parameters were estimated from a sigmoidal fit of the H-reflex recruitment curve (ascending limb).

RESULTS

No significant differences were found for the parameters derived from the recruitment curve of the H-reflex among the conditions (P > .05).

CONCLUSIONS

The authors' findings showed that, irrespective of the direction of tape application, the elastic tape applied over the triceps surae does not generate any significant alteration on the excitability of the reflex pathway for different subpopulations of motor units. The authors therefore suggest a re-examination of the current recommendations on taping direction in clinical and sports activities.

Corticospinal excitability to the biceps and triceps brachii during forward and backward arm cycling is direction- and phase-dependent

The purpose of this study was to evaluate corticospinal excitability to the biceps and triceps brachii during forward (FWD) and backward (BWD) arm cycling. Corticospinal and spinal excitability were assessed using transcranial magnetic stimulation and transmastoid electrical stimulation to elicit motor evoked potentials (MEPs) and cervicomedullary evoked potentials (CMEPs), respectively. MEPs and CMEPs were recorded from the biceps and triceps brachii during FWD and BWD arm cycling at 2 positions, 6 and 12 o’clock. The 6 o’clock position corresponded to mid-elbow flexion and extension during FWD and BWD cycling, respectively, while 12 o’clock corresponded to mid-elbow extension and flexion during FWD and BWD cycling, respectively. During the flexion phase, MEP and CMEP amplitudes of the biceps brachii were higher during FWD cycling. However, during the extension phase, MEP and CMEP amplitudes were higher during BWD cycling. For the triceps brachii, MEP amplitudes were higher during FWD cycling regardless of phase. However, CMEP amplitudes were phase-dependent. During the flexion phase, CMEPs of the triceps brachii were higher during FWD cycling compared with BWD, but during the extension phase CMEPs were higher during BWD cycling compared with FWD. The data suggest that corticospinal and spinal excitability to the biceps brachii is phase- and direction-dependent. In the triceps brachii, spinal, but not corticospinal, excitability is phase-dependent when comparing FWD and BWD cycling.

Novelty This is the first study to assess corticospinal excitability during FWD and BWD locomotor output. Corticospinal excitability during arm cycling depends on the direction, phase, and muscle being assessed.

Transcutaneous spinal cord stimulation of the cervical cord modulates lumbar networks

It has been established that coordinated arm and leg (A&L) cycling facilitates corticospinal drive and modulation of cervico-lumbar connectivity and ultimately improves overground walking in people with incomplete spinal cord injury or stroke. This study examined the effect of noninvasive transcutaneous spinal cord stimulation (tSCS) on the modulation of cervico-lumbar connectivity. Thirteen neurologically intact adults participated in the study. The excitability of the Hoffmann (H) reflex elicited in the soleus muscle was examined under multiple conditions involving either the arms held in a static position or rhythmic arm cycling while tSCS was applied to either the cervical or lumbar cord. As expected, soleus H-reflex amplitude was significantly suppressed by 19.2% during arm cycling (without tSCS) relative to arms static (without tSCS). Interestingly, tSCS of the cervical cord with arms static significantly suppressed the soleus H-reflex (−22.9%), whereas tSCS over the lumbar cord did not suppress the soleus H-reflex (−3.8%). The combination of arm cycling with cervical or lumbar tSCS did not yield additional suppression of the soleus H-reflex beyond that obtained with arm cycling alone or cervical tSCS alone. The results demonstrate that activation of the cervical spinal cord through both rhythmic arm cycling and tonic tSCS significantly modulates the activity of lumbar networks. This highlights the potential for engaging cervical spinal cord networks through tSCS during rehabilitation interventions to enhance cervico-lumbar connectivity. This connectivity is influential in facilitating improvements in walking function after neurological impairment.

NEW & NOTEWORTHY This is the first study to investigate the modulatory effects of transcutaneous spinal cord stimulation (tSCS) on cervico-lumbar connectivity. We report that both rhythmic activation of the cervical spinal cord through arm cycling and tonic activation of the cervical cord through tSCS significantly modulate the activity of lumbar networks. This suggests that engaging cervical spinal cord networks through tSCS during locomotor retraining interventions may not only enhance cervico-lumbar connectivity but also further improve walking capacity.

Propriospinal Neurons: Essential Elements of Locomotor Control in the Intact and Possibly the Injured Spinal Cord

Propriospinal interneurons (INs) communicate information over short and long distances within the spinal cord. They act to coordinate different parts of the body by linking motor circuits that control muscles across the forelimbs, trunk, and hindlimbs. Their role in coordinating locomotor circuits near and far may be invaluable to the recovery of locomotor function lost due to injury to the spinal cord where the flow of motor commands from the brain and brainstem to spinal motor circuits is disrupted. The formation and activation of circuits established by spared propriospinal INs may promote the re-emergence of locomotion. In light of progress made in animal models of spinal cord injury (SCI) and in human patients, we discuss the role of propriospinal INs in the intact spinal cord and describe recent studies investigating the assembly and/or activation of propriospinal circuits to promote recovery of locomotion following SCI.

Smoothness: an Unexplored Window into Coordinated Running Proficiency

Over the expanse of evolutionary history, humans, and predecessor Homo species, ran to survive. This legacy is reflected in many deeply and irrevocably embedded neurological and biological design features, features which shape how we run, yet were themselves shaped by running.

Smoothness is a widely recognised feature of healthy, proficient movement. Nevertheless, although the term ‘smoothness’ is commonly used to describe skilled athletic movement within practical sporting contexts, it is rarely specifically defined, is rarely quantified and remains barely explored experimentally. Elsewhere, however, within various health-related and neuro-physiological domains, many manifestations of movement smoothness have been extensively investigated. Within this literature, smoothness is considered a reflection of a healthy central nervous system (CNS) and is implicitly associated with practiced coordinated proficiency; ‘non-smooth’ movement, in contrast, is considered a consequence of pathological, un-practiced or otherwise inhibited motor control.

Despite the ubiquity of running across human cultures, however, and the apparent importance of smoothness as a fundamental feature of healthy movement control, to date, no theoretical framework linking the phenomenon of movement smoothness to running proficiency has been proposed. Such a framework could, however, provide a novel lens through which to contextualise the deep underlying nature of coordinated running control. Here, we consider the relevant evidence and suggest how running smoothness may integrate with other related concepts such as complexity, entropy and variability. Finally, we suggest that these insights may provide new means of coherently conceptualising running coordination, may guide future research directions, and may productively inform practical coaching philosophies.