Tuning of Muscle Synergies During Walking Along Rectilinear and Curvilinear Trajectories in Humans

Influence of Backpack Carriage and Walking Speed on Muscle Synergies in Healthy Children

Four to five muscle synergies account for children's locomotion and appear to be consistent across alterations in speed and slopes. Backpack carriage induces alterations in gait kinematics in healthy children, raising questions regarding the clinical consequences related to orthopedic and neurological diseases and ergonomics. However, to support clinical decisions and characterize backpack carriage, muscle synergies can help with understanding the alterations induced in this condition at the motor control level. In this study, we investigated how children adjust the recruitment of motor patterns during locomotion, when greater muscular demands are required (backpack carriage). Twenty healthy male children underwent an instrumental gait analysis and muscle synergies extraction during three walking conditions: self-selected, fast and load conditions. In the fast condition, a reduction in the number of synergies (three to four) was needed for reconstructing the EMG signal with the same accuracy as in the other conditions (three to five). Synergies were grouped in only four clusters in the fast condition, while five clusters were needed for the self-selected condition. The right number of clusters was not clearly identified in the load condition. Speed and backpack carriage altered nearly every spatial-temporal parameter of gait, whereas kinematic alterations reflected mainly hip and pelvis adaptations. Although the synergistic patterns were consistent across conditions, indicating a similar motor pattern in different conditions, the fast condition required fewer synergies for reconstructing the EMG signal with the same level of accuracy.

Characteristics of muscle synergy extracted using an autoencoder in patients with stroke during the curved walking in comparison with healthy controls

BACKGROUND AND OBJECTIVE

This study investigated the spatial and temporal features of muscle synergy during two types of curved walking (CW), according to whether the analyzed legs were located on the outside (OCW) or inside (ICW) on the basis of the curve direction during CW, in patients with stroke.

METHODS

Thirteen patients with stroke and seven age-matched healthy controls participated in this study. Using the autoencoder technique, four muscle synergies were extracted from eight muscles of the paretic legs in patients with stroke and the dominant legs in healthy controls. Walking speed, variance accounted for (VAF) of the four synergies, and each synergy with the same number were compared. Pearson's correlation and activation peak timing calculation were used to identify spatial and temporal features, respectively.

RESULTS

Regarding walking speed in patients with stroke, ICW was significantly faster than OCW (P = 0.027). Regarding spatial features, muscle weighting values of patients with stroke in synergy 3 that were mainly involved in the early swing phase had the lowest similarity [r = 0.30] during OCW, and synergy 4 that was mainly involved in the late swing phase had the lowest similarity [r = 0.39] during ICW compared to the healthy group. Meanwhile, in terms of temporal features, activation peak timings of patients with stroke in synergy 1, which was mainly involved in the early stance phase, and synergy 2, which was mainly involved in the mid-late stance phase, were significantly delayed during OCW (P < .001, P = 0.003), while peak timings of synergy 1 and synergy 3 were delayed during ICW (P = .004, P = .002).

SIGNIFICANCE

Based on distinctive features of spatial synergy during the swing phase of CW and temporal synergy during the swing-stance transition phase of CW in patients with stroke in gait rehabilitation, specific approaches need to be considered depending on the curve direction and each gait phase.

Consistent control information driven musculoskeletal model for multiday myoelectric control

Objective.Musculoskeletal model (MM)-based myoelectric interface has aroused great interest in human-machine interaction. However, the performance of electromyography (EMG)-driven MM in long-term use would be degraded owing to the inherent non-stationary characteristics of EMG signals. Here, to improve the estimation performance without retraining, we proposed a consistent muscle excitation extraction approach based on an improved non-negative matrix factorization (NMF) algorithm for MM when applied to simultaneous hand and wrist movement prediction.Approach.We added constraints andL2-norm regularization terms to the objective function of classic NMF regarding muscle weighting matrix and time-varying profiles, through which stable muscle synergies across days were identified. The resultant profiles of these synergies were then used to drive the MM. Both offline and online experiments were conducted to evaluate the performance of the proposed method in inter-day scenarios.Main results.The results demonstrated significantly better and more robust performance over several competitive methods in inter-day experiments, including machine learning methods, EMG envelope-driven MM, and classic NMF-based MM. Furthermore, the analysis of control information on different days revealed the effectiveness of the proposed method in obtaining consistent muscle excitations.Significance.The outcomes potentially provide a novel and promising pathway for the robust and zero-retraining control of myoelectric interfaces.

The Effect of Walking in High Heels on the Activation and Deactivation of Upper Trunk Muscles

The aim of the study was to investigate how high-heeled walking affects the coordination changes of timing of upper trunk muscle activation, and the possible occurrence of health problems in this part of the body of young women. We used surface electromyography (EMG) for data collection. The research group consisted of 30 women. Statistical significance of the changes in muscle coordination was confirmed when evaluating two of the four upper trunk muscles studied. M. trapezius and m. pectoralis major are not subject to changes in gait in high heels (HH) from the point of view of timing on a statistical level, but HH increase the intensity of muscle contraction of all monitored muscles, and therefore we recommend limiting the wearing of HH in case of health problems related to these muscles.

Inter-muscular coordination during running on grass, concrete and treadmill

Running is an exercise that can be performed in different environments that imposes distinct foot-floor interactions. For instance, running on grass may help reducing instantaneous vertical impact loading, while compromising natural speed. Inter-muscular coordination during running is an important factor to understand motor performance, but little is known regarding the impact of running surface hardness on inter-muscular coordination. Therefore, we investigated whether inter-muscular coordination during running is influenced by running surface. Surface electromyography (EMG) from 12 lower limb muscles were recorded from young male individuals (n = 9) while running on grass, concrete, and on a treadmill. Motor modules consisting of weighting coefficients and activation signals were extracted from the multi-muscle EMG datasets representing 50 consecutive running cycles using non-negative matrix factorization. We found that four motor modules were sufficient to represent the EMG from all running surfaces. The inter-subject similarity across muscle weightings was the lowest for running on grass (r = 0.76 ± 0.11) compared to concrete (r = 0.81 ± 0.07) and treadmill (r = 0.78 ± 0.05), but no differences in weighting coefficients were found when analyzing the number of significantly active muscles and residual muscle weightings (p > 0.05). Statistical parametric mapping showed no temporal differences between activation signals across running surfaces (p > 0.05). However, the activation duration (% time above 15% peak activation) was significantly shorter for treadmill running compared to grass and concrete (p < 0.05). These results suggest predominantly similar neuromuscular strategies to control multiple muscles across different running surfaces. However, individual adjustments in inter-muscular coordination are required when coping with softer surfaces or the treadmill's moving belt.

The Number and Structure of Muscle Synergies Depend on the Number of Recorded Muscles: A Pilot Simulation Study with OpenSim

The muscle synergy approach is used to evaluate motor control and to quantitatively determine the number and structure of the modules underlying movement. In experimental studies regarding the upper limb, typically 8 to 16 EMG probes are used depending on the application, although the number of muscles involved in motor generation is higher. Therefore, the number of motor modules may be underestimated and the structure altered with the standard spatial synergy model based on the non-negative matrix factorization (NMF). In this study, we compared the number and structure of muscle synergies when considering 12 muscles (an "average" condition that represents previous studies) and 32 muscles of the upper limb, also including multiple muscle heads and deep muscles. First, we estimated the muscle activations with an upper-limb model in OpenSim using data from multi-directional reaching movements acquired in experimental sessions; then, spatial synergies were extracted from EMG activations from 12 muscles and from 32 muscles and their structures were compared. Finally, we compared muscle synergies obtained from OpenSim and from real experimental EMG signals to assess the reliability of the results. Interestingly, we found that on average, an additional synergy is needed to reconstruct the same R² level with 32 muscles with respect to 12 muscles; synergies have a very similar structure, although muscles with comparable physiological functions were added to the synergies extracted with 12 muscles. The additional synergies, instead, captured patterns that could not be identified with only 12 muscles. We concluded that current studies may slightly underestimate the number of controlled synergies, even though the main structure of synergies is not modified when adding more muscles. We also show that EMG activations estimated with OpenSim are in partial (but not complete) agreement with experimental recordings. These findings may have significative implications for motor control and clinical studies.

A machine learning approach for the identification of kinematic biomarkers of chronic neck pain during single- and dual-task gait

BACKGROUND

Changes in gait characteristics have been reported in people with chronic neck pain (CNP).

RESEARCH QUESTION

Can we classify people with and without CNP by training machine learning models with Inertial Measurement Units (IMU)-based gait kinematic data?

METHODS

Eighteen asymptomatic individuals and 21 participants with CNP were recruited for the study and performed two gait trajectories, (1) linear walking with their head straight (single-task) and (2) linear walking with continuous head-rotation (dual-task). Kinematic data were recorded from three IMU sensors attached to the forehead, upper thoracic spine (T1), and lower thoracic spine (T12). Temporal and spectral features were extracted to generate the dataset for both single- and dual-task gait. To evaluate the most significant features and simultaneously reduce the dataset size, the Neighbourhood Component Analysis (NCA) method was utilized. Three supervised models were applied, including K-Nearest Neighbour, Support Vector Machine, and Linear Discriminant Analysis to test the performance of the most important temporal and spectral features.

RESULTS

The performance of all classifiers increased after the implementation of NCA. The best performance was achieved by NCA-Support Vector Machine with an accuracy of 86.85%, specificity of 83.30%, and sensitivity of 92.85% during the dual-task gait using only nine features.

SIGNIFICANCE

The results present a data-driven approach and machine learning-based methods to identify test conditions and features from high-dimensional data obtained during gait for the classification of people with and without CNP.

Assessing Neurokinematic and Neuromuscular Connectivity During Walking Using Mobile Brain-Body Imaging

Gait is a common but rather complex activity that supports mobility in daily life. It requires indeed sophisticated coordination of lower and upper limbs, controlled by the nervous system. The relationship between limb kinematics and muscular activity with neural activity, referred to as neurokinematic and neuromuscular connectivity (NKC/NMC) respectively, still needs to be elucidated. Recently developed analysis techniques for mobile high-density electroencephalography (hdEEG) recordings have enabled investigations of gait-related neural modulations at the brain level. To shed light on gait-related neurokinematic and neuromuscular connectivity patterns in the brain, we performed a mobile brain/body imaging (MoBI) study in young healthy participants. In each participant, we collected hdEEG signals and limb velocity/electromyography signals during treadmill walking. We reconstructed neural signals in the alpha (8–13 Hz), beta (13–30 Hz), and gamma (30–50 Hz) frequency bands, and assessed the co-modulations of their power envelopes with myogenic/velocity envelopes. Our results showed that the myogenic signals have larger discriminative power in evaluating gait-related brain-body connectivity with respect to kinematic signals. A detailed analysis of neuromuscular connectivity patterns in the brain revealed robust responses in the alpha and beta bands over the lower limb representation in the primary sensorimotor cortex. There responses were largely contralateral with respect to the body sensor used for the analysis. By using a voxel-wise analysis of variance on the NMC images, we revealed clear modulations across body sensors; the variability across frequency bands was relatively lower, and below significance. Overall, our study demonstrates that a MoBI platform based on hdEEG can be used for the investigation of gait-related brain-body connectivity. Future studies might involve more complex walking conditions to gain a better understanding of fundamental neural processes associated with gait control, or might be conducted in individuals with neuromotor disorders to identify neural markers of abnormal gait.

Modular control of muscle coordination patterns during various stride time and stride length combinations

BACKGROUND

Modular organization in muscular control is generally specified as synergistic muscle groups that are hierarchically organized. There are conflicting perspectives regarding modular organization for regulation of walking speeds, with regard to whether modular organization is relatively consistent across walking speeds. This conflict might arise from different stride time (time for one stride) and stride length combinations for achieving the same walking speed.

RESEARCH QUESTION

Does the regulation of the modular organization depend on stride time and stride length (stride time-length) combinations?

METHODS

Ten healthy men walked at a moderate speed (nondimensional speed = 0.4) on a treadmill at five different stride time-length combinations (very short, short, preferred, long, and very long). Surface electromyograms from 16 muscles in the trunk and lower limb were recorded. The modular organization was modeled as muscle synergies, which represent groups of synchronously activated muscles. Muscle synergies were extracted using a decomposition technique. The number of synergies and their activation durations were analyzed.

RESULTS

The number of synergies was consistent in the preferred and quasi-preferred condition (median: 4.5 [short], 4.5 [preferred], 5 [long]), while it varied in the extreme condition (median: 4 [very short] and 6 [very long]; 0.02 ≤  p ≤ 0.09). Gait parameters (stride time, stride length, stance time, swing time, and double stance time) were significantly different for preferred and quasi-preferred conditions (p <  0.03).

SIGNIFICANCE

Our results provide additional insights on the flexibility of modular control during walking, namely that the number of synergies or activations are fine-tuned even within one walking speed. Our finding implies that a variety of walking patterns can be achieved by consistent synergies except for extreme walking patterns.

Primitive muscle synergies reflect different modes of coordination in upper limb motions

The motor system relies on the recruitment of motor modules to perform various movements. Muscle synergies are the modules used by the central nervous system to simplify the control of complex motor tasks. In this paper, we aim to explore the primitive synergies to reflect different modes of coordination in upper limb motions. Muscle synergies and corresponding activation coefficients were extracted via non-negative matrix factorization from the electromyography signals of three basic and four complex upper limb motions in sagittal plane and coronal plane. Similarities of muscle synergies and activation coefficients between different tasks and different subjects were compared. Moreover, we used network theory to assess the coordination between multiple muscles and to elucidate the neural implementation of muscle synergies. The results showed that the combination of different sets of primitive muscle synergies can achieve complex motions in different planes. The muscle synergy network topology differed significantly between different tasks. We also demonstrated the potential of this study for the understanding of human motor control mechanism and implications for neurorehabilitation.

Young adults recruit similar motor modules across walking, turning, and chair transfers

Moving about in the world during daily life requires executing and successfully shifting between a variety of functional tasks, such as rising from a chair or bed, walking, turning, and navigating stairs. Moreover, moving about during daily life requires not only navigating between different functional tasks, but also performing these tasks in the presence of mental distractions. However, little is known about underlying neuromuscular control for executing and shifting between these different tasks. In this study, we investigated muscle coordination across walking, turning, and chair transfers by applying motor module (a.k.a. muscle synergy) analysis to the Timed-Up-and-Go (TUG) test with and without a secondary cognitive dual task. We found that healthy young adults recruit a small set of common motor modules across the subtasks of the TUG test and that their composition is robust to cognitive distraction. Instead, cognitive distraction impacted motor module activation timings such that they became more consistent. This work is the first to demonstrate motor module generalization across multiple tasks that are both functionally different and crucial for healthy mobility. Overall, our results suggest that the central nervous system may draw from a "library" of modular control strategies to navigate the variety of movements and cognitive demands required of daily life.

Correlation between cardiopulmonary metabolic energy cost and lower-limb muscle activity during inclined treadmill gait in older adults

BACKGROUND

Inclined walking requires more cardiopulmonary metabolic energy and muscle strength than flat-level walking. This study sought to investigate changes in lower-limb muscle activity and cardiopulmonary metabolic energy cost during treadmill walking with different inclination grades and to discern any correlation between these two measures in older adults.

METHODS

Twenty-four healthy older adults (n = 11 males; mean age: 75.3 ± 4.0 years) participated. All participants walked on a treadmill that was randomly inclined at 0% (condition 1), 10% (condition 2), and 16% (condition 3) for five minutes each. Simultaneous measurements of lower-limb muscle activity and cardiopulmonary metabolic energy cost during inclined treadmill walking were collected. Measured muscles included the rectus abdominis (RA), erector spinae (ES), rectus femoris (RF), biceps femoris (BF), vastus medialis (VM), tibialis anterior (TA), medial head of the gastrocnemius (GCM), and soleus (SOL) muscles on the right side.

RESULTS

As compared with 0% inclined treadmill gait, the 10% inclined treadmill gait increased the net cardiopulmonary metabolic energy cost by 22.9%, while the 16% inclined treadmill gait increased the net cardiopulmonary metabolic energy cost by 44.2%. In the stance phase, as the slope increased, activity was significantly increased in the RA, RF, VM, BF, GCM, and SOL muscles. In the swing phase, As the slope increased activity was significantly increased in the RA, RF, VM, BF, and TA muscles. SOL muscle activity was most relevant to the change in cardiopulmonary metabolic energy cost in the stance phase of inclined treadmill walking. The relationship between the increase in cardiopulmonary metabolic energy cost and changes in muscle activity was also significant in the VM, GCM, and RF.

CONCLUSION

This study demonstrated that changes in SOL, VM, GCM, and RA muscle activity had a significant relationship with cardiopulmonary metabolic energy cost increment during inclined treadmill walking. These results can be used as basic data for various gait-training programs and as an indicator in the development of assistive algorithms of wearable walking robots for older adults.

TRIAL REGISTRATION

Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04614857 (05/11/2020).

Effects of body weight support and guidance force settings on muscle synergy during Lokomat walking

BACKGROUND

The Lokomat is a robotic device that has been suggested to make gait therapy easier, more comfortable, and more efficient. In this study, we asked whether the Lokomat promotes physiological muscle activation patterns, a fundamental question when considering motor learning and adaptation.

METHODS

We investigated lower limb muscles coordination in terms of muscle activity level, muscle activity pattern similarity, and muscle synergy in 15 healthy participants walking at 3 km/h on either a treadmill or in a Lokomat at various guidance forces (GF: 30, 50 or 70%) and body weight supports (BWS: 30, 50 or 70% of participant's body weight).

RESULTS

Walking in the Lokomat was associated with a greater activation level of the rectus femoris and vastus medialis (×2-3) compared to treadmill walking. The level of activity tended to be diminished in gastrocnemius and semi-tendinosus, which particularly affected the similarity with treadmill walking (normalized scalar product NSP = 0.7-0.8). GF and BWS independently altered the muscle activation pattern in terms of amplitude and shape. Increasing BWS decreased the level of activity in all but one muscle (the soleus). Increasing GF slightly improved the similarity with treadmill walking for the tibialis anterior and vastus medialis muscles. The muscle synergies (N = 4) were similar (NSP = 0.93-0.97), but a cross-validation procedure revealed an alteration by the Lokomat. The activation of these synergies differed (NSP = 0.74-0.82).

CONCLUSION

The effects of GF and BWS are modest compared to the effect of the Lokomat itself, suggesting that Lokomat design should be improved to promote more typical muscle activity patterns.

Basic Spatiotemporal Gait Variables of Young and Older Healthy Volunteers Walking Along a Novel Figure-of-8 Path

Background: Locomotion along curved trajectories requires fine coordination among body segments. Elderly people may adopt a cautious attitude when steering. A simple, expeditious, patient-friendly walking protocol can be a tool to help clinicians. We evaluated the feasibility of a procedure based upon a newly designed Figure-of-eight (nFo8) path and an easy measurement operation. Methods: Sixty healthy volunteers, aged from 20 to 86 years, walked three times at self-selected speed along a 20 m linear (LIN) and the 20 m nFo8 path. Number of steps, mean speed and walk ratio (step length/cadence) were collected. Data were analysed for the entire cohort and for the groups aged 20-45, 46-65, and >65 years. Results: There was no difference in mean LIN walking speed between the two younger groups but the oldest was slower. During nFo8, all groups were slower (about 16%) than during LIN. Cadence was not different across groups but lower during nFo8 in each group. Step length was about 8% shorter in the two younger groups and 14% shorter in the oldest during nFo8 compared to LIN. Walk ratio was the smallest in the oldest group for both LIN and nFo8. Conclusions: A complex nFo8 walking path, with fast and easy measurement of a simple set of variables, detects significant differences with moderate and large effects in gait variables in people >65 years. This challenging trajectory is more revealing than LIN. Further studies are needed to develop a quick clinical tool for assessment of gait conditions or outcome of rehabilitative treatments.

Patient-specific functional electrical stimulation strategy based on muscle synergy and walking posture analysis for gait rehabilitation of stroke patients

OBJECTIVE

To evaluate a novel multi-channel functional electrical stimulation (FES) rehabilitation method based on the evaluation of patient-specific walking dysfunction.

METHODS

This study investigated a novel multi-channel FES-based rehabilitation method that analysed the patient's muscle synergy and walking posture. A patient-specific FES profile was produced in the pre-evaluation stage by comparing the muscle synergy and walking posture of the patient with those of healthy control subjects. During the rehabilitation phase, this profile was used to determine an appropriate FES pulse width and amplitude for stimulating the patient's muscles as they walked across a flat surface.

RESULTS

Two stroke patients with hemiplegic symptoms participated in a clinical evaluation of the proposed method involving a 4-week course of rehabilitation. An evaluation of the rehabilitation results based on a comparison of the pre- and post-rehabilitation muscle synergy and walking posture revealed that the rehabilitation enhanced the muscle synergy similarity between the patients and healthy control subjects and their quantitative walking performance, as measured by a 10-m walk test and walking speed, by up to 23.38% and 30.00%, respectively.

CONCLUSION

These results indicated that the proposed rehabilitation method improved walking ability by improving muscle coordination and adequately supporting weakened muscles in stroke patients.

How to improve the muscle synergy analysis methodology?

Muscle synergy analysis is increasingly used in domains such as neurosciences, robotics, rehabilitation or sport sciences to analyze and better understand motor coordination. The analysis uses dimensionality reduction techniques to identify regularities in spatial, temporal or spatio-temporal patterns of multiple muscle activation. Recent studies have pointed out variability in outcomes associated with the different methodological options available and there was a need to clarify several aspects of the analysis methodology. While synergy analysis appears to be a robust technique, it remain a statistical tool and is, therefore, sensitive to the amount and quality of input data (EMGs). In particular, attention should be paid to EMG amplitude normalization, baseline noise removal or EMG filtering which may diminish or increase the signal-to-noise ratio of the EMG signal and could have major effects on synergy estimates. In order to robustly identify synergies, experiments should be performed so that the groups of muscles that would potentially form a synergy are activated with a sufficient level of activity, ensuring that the synergy subspace is fully explored. The concurrent use of various synergy formulations-spatial, temporal and spatio-temporal synergies- should be encouraged. The number of synergies represents either the dimension of the spatial structure or the number of independent temporal patterns, and we observed that these two aspects are often mixed in the analysis. To select a number, criteria based on noise estimates, reliability of analysis results, or functional outcomes of the synergies provide interesting substitutes to criteria solely based on variance thresholds.

Modularity in Motor Control: Similarities in Kinematic Synergies Across Varying Locomotion Tasks

Kinematic synergies (kSYN) provide an approach to quantify the covariation of joint motions and to explain the mechanisms underlying human motor behavior. A low-dimensional control strategy by means of the activation of a moderate number of kSYN would simplify the performance of complex motor tasks. The purpose of this study was to examine similarities between the kSYN of varying locomotion tasks: straight-line walking, walking a 90° spin turn and walking upstairs. Task-specific kSYN were extracted from full body kinematic recordings of 13 participants by principal component analysis. The first five kSYN accounting for most of the variance within each task were selected for further analysis following previous studies. The similarities between the kSYN of the three different locomotion tasks were quantified by calculating cosine similarities (SIM), as a vector-based similarity measure ranging from 0 (no similarity) to 1 (high similarity), between absolute principal component loading vectors. A SIM between two kSYN > 0.8 was interpreted as highly similar. Two to three highly similar kSYN were identified when comparing two individual tasks with each other. One kSYN, primarily characterized by anteversion and retroversion of the arms and legs, were found to be similar in all three tasks. Additional kSYN that occurred between individual tasks reflected mainly an upwards/downwards movement of the body or a countercyclical knee flexion/extension. The results demonstrate that the three investigated locomotion tasks are characterized by kSYN and that certain kSYN repeatedly occur across the three locomotion tasks. PCA yields kSYN which are in descent order according to their amount of total variance accounted for. Referring to the placing of a kSYN within the order as priorization, we found a change in priorization of repeatedly occurring kSYN across the individual tasks. The findings support the idea that movements can be efficiently performed through a flexible combination of a lower number of control-relevant variables.

Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study

BACKGROUND

Muscle synergies analysis can provide a deep understanding of motor impairment after stroke and of changes after rehabilitation. In this study, the neuro-mechanical analysis of leg cycling was used to longitudinally investigate the motor recovery process coupled with cycling training augmented by Functional Electrical Stimulation (FES) in subacute stroke survivors.

METHODS

Subjects with ischemic subacute stroke participated in a 3-week training of FES-cycling with visual biofeedback plus usual care. Participants were evaluated before and after the intervention through clinical scales, gait spatio-temporal parameters derived from an instrumented mat, and a voluntary pedaling test. Biomechanical metrics (work produced by the two legs, mechanical effectiveness and symmetry indexes) and bilateral electromyography from 9 leg muscles were acquired during the voluntary pedaling test. To extract muscles synergies, the Weighted Nonnegative Matrix Factorization algorithm was applied to the normalized EMG envelopes. Synergy complexity was measured by the number of synergies required to explain more than 90% of the total variance of the normalized EMG envelopes and variance accounted for by one synergy. Regardless the inter-subject differences in the number of extracted synergies, 4 synergies were extracted from each patient and the cosine-similarity between patients and healthy weight vectors was computed.

RESULTS

Nine patients (median age of 75 years and median time post-stroke of 2 weeks) were recruited. Significant improvements in terms of clinical scales, gait parameters and work produced by the affected leg were obtained after training. Synergy complexity well correlated to the level of motor impairment at baseline, but it did not change after training. We found a significant improvement in the similarity of the synergy responsible of the knee flexion during the pulling phase of the pedaling cycle, which was the mostly compromised at baseline. This improvement may indicate the re-learning of a more physiological motor strategy.

CONCLUSIONS

Our findings support the use of the neuro-mechanical analysis of cycling as a method to assess motor recovery after stroke, mainly in an early phase, when gait evaluation is not yet possible. The improvement in the modular coordination of pedaling correlated with the improvement in motor functions and walking ability achieved at the end of the intervention support the role of FES-cycling in enhancing motor re-learning after stroke but need to be confirmed in a controlled study with a larger sample size.

TRIAL REGISTRATION

ClinicalTrial.gov, NCT02439515. Registered on May 8, 2015, .

Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy

Hemophilic arthropathy is the result of repetitive intra-articular bleeding and synovial inflammation. In people with hemophilic arthropathy (PWHA), very little is known about the neural control of individual muscles during movement. The aim of the present study was to assess if the neural control of individual muscles and coordination between antagonistic muscle pairs and joint kinematics during gait are affected in PWHA. Thirteen control subjects (CG) walked overground at their preferred and slow velocity (1 m/s), and 14 PWHA walked overground at the preferred velocity (1 m/s). Joint kinematics and temporal gait parameters were assessed using four inertial sensors. Surface electromyography (EMG) was collected from gluteus maximus (GMAX), gluteus medius (GMED), vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), medial gastrocnemius (MG), lateral gastrocnemius (LG), soleus (SOL), tibialis anterior (TA), semitendinosus (ST), and biceps femoris (BF). Waveforms were compared using the time-series analysis through statistical parametric mapping. In PWHA compared to CG, EMG amplitude during the stance phase was higher for LG (for both velocities of the CG), BF (slow velocity only), and ST (preferred velocity only) (p < 0.05). Co-contraction during the stance phase was higher for MG-TA, LG-TA, VL-BF, VM-ST, LG-VL, and MG-VM (both velocities) (p < 0.05). MG and LG were excited earlier (preferred velocity only) (p < 0.05). A later offset during the stance phase was found for VL, BF, and ST (both velocities), and BF and GMAX (preferred velocity only) (p < 0.05). In addition, the range of motion in knee and ankle joints was lower in PWHA (both velocities) and hip joint (preferred velocity only) (p < 0.05). In conclusion, the neural control of individual muscles and coordination between antagonistic muscles during gait in PWHA differs substantially from control subjects.

Modular Organization of Muscle Synergies to Achieve Movement Behaviors

Muscle synergy has been applied to comprehend how the central nervous system (CNS) controls movements for decades. However, it is not clear about the motion control mechanism and the relationship between motions and muscle synergies. In this paper, we designed two experiments to corroborate the hypothesis: (1) motions can be decomposed to motion primitives, which are driven by muscle synergy primitives and (2) variations of motion primitives in direction and scale are modulated by activation coefficients rather than muscle synergy primitives. Surface electromyographic (EMG) signals were recorded from nine muscles of the upper limb. Nonnegative matrix factorization (NMF) was applied to extract muscle synergy vectors and corresponding activation coefficients. We found that synergy structures of different movement patterns were similar (α=0.05). The motion modulation indexes (MMI) among movement patterns in reaching movements showed apparent differences. Merging coefficients and reconstructed similarity of synergies between simple motions and complex motions were significant. This study revealed the motion control mechanism of the CNS and provided a rehabilitation and evaluation method for patients with motor dysfunction in exercise and neuroscience.

Walking Along Curved Trajectories. Changes With Age and Parkinson's Disease. Hints to Rehabilitation

In this review, we briefly recall the fundamental processes allowing us to change locomotion trajectory and keep walking along a curved path and provide a review of contemporary literature on turning in older adults and people with Parkinson's Disease (PD). The first part briefly summarizes the way the body exploits the physical laws to produce a curved walking trajectory. Then, the changes in muscle and brain activation underpinning this task, and the promoting role of proprioception, are briefly considered. Another section is devoted to the gait changes occurring in curved walking and steering with aging. Further, freezing during turning and rehabilitation of curved walking in patients with PD is mentioned in the last part. Obviously, as the research on body steering while walking or turning has boomed in the last 10 years, the relevant critical issues have been tackled and ways to improve this locomotor task proposed. Rationale and evidences for successful training procedures are available, to potentially reduce the risk of falling in both older adults and patients with PD. A better understanding of the pathophysiology of steering, of the subtle but vital interaction between posture, balance, and progression along non-linear trajectories, and of the residual motor learning capacities in these cohorts may provide solid bases for new rehabilitative approaches.

Podokinetic After-Rotation Is Transiently Enhanced or Reversed by Unilateral Axial Muscle Proprioceptive Stimulation

Unilateral axial muscle vibration, eliciting a proprioceptive volley, is known to incite steering behavior. Whole-body rotation while stepping in place also occurs as an after-effect of stepping on a circular treadmill (podokinetic after-rotation, PKAR). Here, we tested the hypothesis that PKAR is modulated by axial muscle vibration. If both phenomena operate through a common pathway, enhancement or cancellation of body rotation would occur depending on the stimulated side when vibration is administered concurrently with PKAR. Seventeen subjects participated in the study. In one session, subjects stepped in place eyes open on the center of a platform that rotated counterclockwise 60°/s for 10 min. When the platform stopped, subjects continued stepping in place blindfolded. In other session, a vibratory stimulus (100 Hz, 2 min) was administered to right or left paravertebral muscles at lumbar level at two intervals during the PKAR. We computed angular body velocity and foot step angles from markers fixed to shoulders and feet. During PKAR, all subjects rotated clockwise. Decreased angular velocity was induced by right vibration. Conversely, when vibration was administered to the left, clockwise rotation velocity increased. The combined effect on body rotation depended on the time at which vibration was administered during PKAR. Under all conditions, foot step angle was coherent with shoulder angular velocity. PKAR results from continuous asymmetric input from the muscles producing leg rotation, while axial muscle vibration elicits a proprioceptive asymmetric input. Both conditioning procedures appear to produce their effects through a common mechanism. We suggest that both stimulations would affect our straight ahead by combining their effects in an algebraic mode.

Neuromuscular control during gait in people with haemophilic arthropathy

INTRODUCTION

Effects of haemophilic arthropathy on neuromuscular control during gait are currently unknown.

AIMS

(a) To assess how haemophilic arthropathy affects the complexity of neuromuscular control during gait; (b) To investigate the relationship between complexity of neuromuscular control and joint impairment.

METHODS

Thirteen control subjects (CG) walked overground at their preferred and a slow velocity and thirteen people with haemophilic arthropathy (PWHA) walking at their preferred velocity. Surface electromyography (EMG) was collected from eleven leg muscles. Electromyography variance explained by muscle synergies (sets of co-activated muscles that can be recruited by a single signal) was calculated by the total variance accounted (tVAF). Three measures were used to evaluate complexity of neuromuscular control: (a) the number of synergies required for tVAF > 90%, (b) tVAF as a function of the number of muscle synergies, and (c) the dynamic motor control index (Walk-DMC). Impairment of ankle and knee joints was determined by the Haemophilia Joint Health Score (HJHS).

RESULTS

The same number of the muscle synergies was found for each group (P > 0.05). For both walking velocities tested, tVAF1 was higher in PHWA (P < 0.05). The Walk-DMC of PWHA was lower than that of the CG for both walking velocities (P < 0.05). For PWHA, no significant correlation was found between HJHS (sum knee and ankle) and Walk-DMC index (r = -0.32, P = 0.28).

CONCLUSIONS

These results indicate differences between PWHA and CG in the neuromuscular control of gait. The Walk-DMC and tVAF1 may be useful measures to assess changes in neuromuscular control in response to treatment.

Temporal and spatial asymmetries during stationary cycling cause different feedforward and feedback modifications in the muscular control of the lower limbs

Motor adaptations are useful for studying the way in which the lower limbs are controlled by the brain. However, motor adaptation paradigms for the lower limbs are typically based on locomotion tasks, where the necessity of maintaining postural stability is the main driver of adaptation and could possibly mask other underlying processes. In this study we investigated whether small temporal or spatial asymmetries can trigger motor adaptations during stationary cycling, where stability is not directly compromised. Fourteen healthy individuals participated in two experiments: in one of the experiments, the angle between the crank arms of the pedals was altered by 10° to induce a temporal asymmetry; in the other experiment, the length of the right pedal was shortened by 2.4 cm to induce a spatial asymmetry. We recorded the acceleration of the crank arms and the electromographic signals of 16 muscles (8 per leg). The analysis of the accelerometer data was used to investigate the presence of motor adaptations. Muscle synergy analysis was performed on each side to quantify changes in neuromuscular control. We found that motor adaptations are present in response to temporal asymmetries and are obtained by progressively shifting the activation patterns of two synergies on the right leg. Spatial asymmetries, on the other hand, appear to trigger a feedback-driven response that does not present an aftereffect. This response is characterized by a steplike decrease in activity in the right gastrocnemius when the asymmetry is present and likely reflects the altered task demands.

NEW & NOTEWORTHY The processes driving lower limb motor adaptations are not fully clear, and previous research appears to indicate that adaptations are mainly driven by stability. We show that lower limb adaptations can be obtained also in the absence of an explicit balance threat. We also show that adaptations are present when kinematic error cannot be compensated for, suggesting the presence of intrinsic error measures regulating the timing of activation of the two legs.

You are better off running than walking revisited: Does an acute vestibular imbalance affect muscle synergies?

It has been suggested that vestibular cues are inhibited for the benefit of spinal locomotor centres in parallel with the increase in locomotion speed. This study aimed at quantifying the influence of a transient vestibular tone imbalance (TVTI) on gait kinematics, muscle activity and muscle synergies during walking and running. Twelve participants walk or run at a self-selected speed with or without TVTI, which was generated by 10 body rotations just prior the locomotion task. Three-dimensional lower-limb kinematic was recorded simultaneously with the surface electromyographic (EMG) activity of 8 muscles to extract muscle synergies via non-negative matrix factorization. Under TVTI, there was an increased gait deviation in walking compared to running (22.8 ± 8.4° and 8.5 ± 3.6°, respectively; p < 0.01), while the number (n = 4) and the composition of the muscle synergies did not differ across conditions (p = 0.78). A higher increase (p < 0.05) in EMG activity due to TVTI was found during walking compared to running, especially during stance. These findings confirmed that the central nervous system inhibited misleading vestibular signals according to the increase in locomotion speed for the benefit of spinal mechanisms, expressed by the muscle synergies.

Alterations of Muscle Synergies During Voluntary Arm Reaching Movement in Subacute Stroke Survivors at Different Levels of Impairment

Motor system uses muscle synergies as a modular organization to simplify the control of movements. Motor cortical impairments, such as stroke and spinal cord injuries, disrupt the orchestration of the muscle synergies and result in abnormal movements. In this paper, the alterations of muscle synergies in subacute stroke survivors were examined during the voluntary reaching movement. We collected electromyographic (EMG) data from 35 stroke survivors, ranging from Brunnstrom Stage III to VI, and 25 age-matched control subjects. Muscle synergies were extracted from the activity of 7 upper-limb muscles via nonnegative matrix factorization under the criterion of 95% variance accounted for. By comparing the structure of muscle synergies and the similarity of activation coefficients across groups, we can validate the increasing activation of pectoralis major muscle and the decreasing activation of elbow extensor of triceps in stroke groups. Furthermore, the similarity of muscle synergies was significantly correlated with the Brunnstrom Stage (R = 0.52, p < 0.01). The synergies of stroke survivors at Brunnstrom Stage IV–III gradually diverged from those of control group, but the activation coefficients remained the same after stroke, irrespective of the recovery level.

Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed

Background

Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases?

Methods

We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated.

Results

Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase.

Conclusion

The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson's Disease

We hypothesised that rehabilitation specifically addressing balance in Parkinson's disease patients might improve not only balance but locomotion as well. Two balance-training protocols (standing on a moving platform and traditional balance exercises) were assessed by assigning patients to two groups (Platform, n = 15, and Exercises, n = 17). The platform moved periodically in the anteroposterior, laterolateral, and oblique direction, with and without vision in different trials. Balance exercises were based on the Otago Exercise Program. Both platform and exercise sessions were administered from easy to difficult. Outcome measures were (a) balancing behaviour, assessed by both Index of Stability (IS) on platform and Mini-BESTest, and (b) gait, assessed by both baropodometry and Timed Up and Go (TUG) test. Falls Efficacy Scale-International (FES-I) and Parkinson's Disease Questionnaire (PDQ-8) were administered. Both groups exhibited better balance control, as assessed both by IS and by Mini-BESTest. Gait speed at baropodometry also improved in both groups, while TUG was less sensitive to improvement. Scores of FES-I and PDQ-8 showed a marginal improvement. A four-week treatment featuring no gait training but focused on challenging balance tasks produces considerable gait enhancement in mildly to moderately affected patients. Walking problems in PD depend on postural instability and are successfully relieved by appropriate balance rehabilitation. This trial is registered with ClinicalTrials.gov NCT03314597.

Speed-Dependent Modulation of Muscle Activity Based on Muscle Synergies during Treadmill Walking

The regulation of walking speed is easily achieved. However, the central nervous system (CNS) must coordinate numerous muscles in order to achieve a smooth and continuous control of walking speed. To control walking speed appropriately, the CNS may need to utilize a simplified system for the control of numerous muscles. Previous studies have revealed that the CNS may control walking via muscle synergies that simplify the control of muscles by modularly organizing several muscles. We hypothesized that the CNS controls the walking speed by flexibly modulating activation of muscle synergies within one gait cycle. Then, we investigated how the activation of muscle synergies depend on walking speeds using the center of activity (CoA) that indicates the center of the distribution of activation timing within one gait cycle. Ten healthy men walked on a treadmill at 14 different walking speeds. We measured the surface electromyograms (EMGs) and kinematic data. Muscle synergies were extracted using non-negative matrix factorization. Then, we calculated the CoA of each muscle synergy. We observed that the CoA of each specific synergy would shift as the walking speed changed. The CoA that was mainly activated during the heel contact phase (C₁) and the activation that contributed to the double support phase (C₃) shifted to the earlier phase as the walking speed increased, whereas the CoA that produced swing initiation motion (C₄) and the activation that related to the late-swing phase (C₅) shifted to the later phase. This shifting of the CoA indicates that the CNS controls intensive activation of muscle synergies during the regulation of walking speed. In addition, shifting the CoA might be associated with changes in kinematics or kinetics depending on the walking speed. We concluded that the CNS flexibly controls the activation of muscle synergies in regulation of walking speed.

Muscle Synergies for Turning During Human Walking

Muscle synergy describes reduced set of functional muscle co-activation patterns. We aimed to identify muscle synergies of turning compared with straight walking. Twelve healthy adults (men: 7, women: 5) performed straight walking (SW), left turning (LT), and right turning (RT) at self-selected speeds. By using non-negative matrix factorization (NMF), we extracted muscle synergies from sixteen electromyography (EMG) signals on the right side and assigned similar muscle synergies among SW, LT, and RT into the same cluster by combining k-means clustering and intraclass correlation coefficient (ICC) analysis. We obtained task-specific clusters of muscle synergies extracted from SW, LT, or RT condition and identified the clusters that share synergies among the conditions. The central nervous system produces specific synergies involving turning behaviors and fundamental synergies for walking.

Curved Walking Rehabilitation with a Rotating Treadmill in Patients with Parkinson's Disease: A Proof of Concept

Training subjects to step-in-place eyes open on a rotating platform while maintaining a fixed body orientation in space [podokinetic stimulation (PKS)] produces a posteffect consisting in inadvertent turning around while stepping-in-place eyes closed [podokinetic after-rotation (PKAR)]. Since the rationale for rehabilitation of curved walking in Parkinson's disease is not fully known, we tested the hypothesis that repeated PKS favors the production of curved walking in these patients, who are uneasy with turning, even when straight walking is little affected. Fifteen patients participated in 10 training sessions distributed in 3 weeks. Both counterclockwise and clockwise PKS were randomly administered in each session. PKS velocity and duration were gradually increased over sessions. The velocity and duration of the following PKAR were assessed. All patients showed PKAR, which increased progressively in peak velocity and duration. In addition, before and at the end of the treatment, all patients walked overground along linear and circular trajectories. Post-training, the velocity of walking bouts increased, more so for the circular than the linear trajectory. Cadence was not affected. This study has shown that parkinsonian patients learn to produce turning while stepping when faced with appropriate training and that this capacity translates into improved overground curved walking.