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Hyngstrom AS, Nguyen JN, Murphy SA, Raab SC, Schmit BD, Gutterman DD, Durand MJ. Reduced oxygen desaturation in the vastus lateralis of chronic stroke survivors during graded muscle contractions. Top Stroke Rehabil 2024; 31:513-526. [PMID: 38095272 PMCID: PMC11129930 DOI: 10.1080/10749357.2023.2291902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/02/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Few studies have examined changes in skeletal muscle physiology post-stroke. This study examined changes in tissue oxygen saturation (StO2) of the vastus lateralis (VL) muscle of stroke survivors and age-matched control participants during maximal and submaximal isometric contractions of the knee extensor muscles. OBJECTIVES We hypothesized that tissue oxygen desaturation (ΔStO2) during knee extensor muscle contractions would be less in the VL in the paretic vs. the non-paretic and control legs. METHODS Ten chronic stroke survivors (>6 months post-stroke) with lower extremity muscle weakness and 10 age-matched controls completed this prospective cohort study. Maximum voluntary contractions (MVCs) of the knee extensor muscles were assessed with a Biodex dynamometer and StO2 of the VL was measured using near-infrared spectroscopy. RESULTS In the paretic leg of the stroke survivors little change in StO2 of the VL was observed during an MVC (ΔStO2 = -1.7 ± 1.8%) compared to the non-paretic (ΔStO2 = -5.1 ± 6.1%; p < 0.05) and control legs (ΔStO2 = -14.4 ± 8.8%; p < 0.05 vs. paretic and non-paretic leg). These differences remained when normalizing for strength differences between the legs. Compared to controls, both the paretic and non-paretic VL showed pronounced reductions in ΔStO2 during ramp and hold contractions equal to 20%, 40%, or 60% of the MVC (p < 0.05 vs. controls at all load levels). CONCLUSIONS These results indicate that oxygen desaturation in response to isometric muscle contractions is impaired in both the paretic and non-paretic leg muscle of stroke survivors compared to age-matched controls, and these differences are independent of differences in muscle strength.
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Affiliation(s)
| | - Jennifer N. Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
| | - Spencer A. Murphy
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA, 53233
| | - Stephanie C. Raab
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA, 53233
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA, 53226
| | - David D. Gutterman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
| | - Matthew J. Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
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Nieves-Rodriguez S, Barthélémy F, Woods JD, Douine ED, Wang RT, Scripture-Adams DD, Chesmore KN, Galasso F, Miceli MC, Nelson SF. Transcriptomic analysis of paired healthy human skeletal muscles to identify modulators of disease severity in DMD. Front Genet 2023; 14:1216066. [PMID: 37576554 PMCID: PMC10415210 DOI: 10.3389/fgene.2023.1216066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023] Open
Abstract
Muscle damage and fibro-fatty replacement of skeletal muscles is a main pathologic feature of Duchenne muscular dystrophy (DMD) with more proximal muscles affected earlier and more distal affected later in the disease course, suggesting that different skeletal muscle groups possess distinctive characteristics that influence their susceptibility to disease. To explore transcriptomic factors driving differential gene expression and modulating DMD skeletal muscle severity, we characterized the transcriptome of vastus lateralis (VL), a more proximal and susceptible muscle, relative to tibialis anterior (TA), a more distal and protected muscle, in 15 healthy individuals using bulk RNA sequencing to identify gene expression differences that may mediate their relative susceptibility to damage with loss of dystrophin. Matching single nuclei RNA sequencing data was generated for 3 of the healthy individuals, to infer cell composition in the bulk RNA sequencing dataset and to improve mapping of differentially expressed genes to their cell source of expression. A total of 3,410 differentially expressed genes were identified and mapped to cell type using single nuclei RNA sequencing of muscle, including long non-coding RNAs and protein coding genes. There was an enrichment of genes involved in calcium release from the sarcoplasmic reticulum, particularly in the myofibers and these myofiber genes were higher in the VL. There was an enrichment of genes in "Collagen-Containing Extracellular Matrix" expressed by fibroblasts, endothelial, smooth muscle and pericytes, with most genes higher in the TA, as well as genes in "Regulation Of Apoptotic Process" expressed across all cell types. Previously reported genetic modifiers were also enriched within the differentially expressed genes. We also identify 6 genes with differential isoform usage between the VL and TA. Lastly, we integrate our findings with DMD RNA sequencing data from the TA, and identify "Collagen-Containing Extracellular Matrix" and "Negative Regulation Of Apoptotic Process" as differentially expressed between DMD compared to healthy. Collectively, these findings propose novel candidate mechanisms that may mediate differential muscle susceptibility in muscular dystrophies and provide new insight into potential therapeutic targets.
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Affiliation(s)
- Shirley Nieves-Rodriguez
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
| | - Florian Barthélémy
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
- Department of Microbiology, David Geffen School of Medicine and College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jeremy D. Woods
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Emilie D. Douine
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Richard T. Wang
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
| | - Deirdre D. Scripture-Adams
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
- Department of Microbiology, David Geffen School of Medicine and College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kevin N. Chesmore
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
| | - Francesca Galasso
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - M. Carrie Miceli
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
- Department of Microbiology, David Geffen School of Medicine and College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Stanley F. Nelson
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Center for Duchenne Muscular Dystrophy at UCLA, Los Angeles, CA, United States
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Cleland BT, Sisel E, Madhavan S. Motor evoked potential latency and duration from tibialis anterior in individuals with chronic stroke. Exp Brain Res 2021; 239:2251-2260. [PMID: 34059935 DOI: 10.1007/s00221-021-06144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Ipsilateral motor pathways from the contralesional hemisphere to the paretic limbs may be upregulated to compensate for impaired function after stroke. Onset latency and duration of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) provide insight into compensatory pathways but have been understudied in the lower limb. This study assessed MEP onset latency and duration in the lower limb after stroke, and compared ipsilateral and contralateral MEPs in the paretic and non-paretic limb. We hypothesized that: (1) onset latency would be longer for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb, and (2) duration would be shorter for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb. Data were collected as a part of a pre-test of a randomized controlled trial. TMS was applied to the ipsilateral and contralateral hemisphere of the paretic and non-paretic limb. MEP onset latency and duration were calculated from the tibialis anterior. Thirty-five participants with chronic stroke were included in the final analysis. Onset latency was longer in the paretic than the non-paretic limb (~ 6.0 ms) and longer after ipsilateral than contralateral stimulation (~ 1.8 ms). Duration was longer in the paretic than the non-paretic limb (~ 9.2 ms) and longer after contralateral than ipsilateral stimulation (~ 5.2 ms). Ipsilateral MEPs may be elicited through ipsilateral pathways with fewer fibers with a higher activation threshold and/or greater spinal branching. MEPs from the paretic limb may reflect slower central motor conduction, peripheral changes, or changes in motor pathway.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA
| | - Emily Sisel
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
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Barry AJ, Kamper DG, Stoykov ME, Triandafilou K, Roth E. Characteristics of the severely impaired hand in survivors of stroke with chronic impairments. Top Stroke Rehabil 2021; 29:181-191. [PMID: 33657985 DOI: 10.1080/10749357.2021.1894660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Diminished sensorimotor control of the hand is one of the most common outcomes following stroke. This hand impairment substantially impacts overall function and quality of life; standard therapy often results in limited improvement. Mechanisms of dysfunction of the severely impaired post-stroke hand are still incompletely understood, thereby impeding the development of new targeted treatments.Objective: To identify and determine potential relationships among the mechanisms responsible for hand impairment following strokeMethods: This cohort study observed stroke survivors (n = 95) with severe, chronic hand impairment (Chedoke-McMaster Hand score = 2-3). Custom instrumentation created precise perturbations and measured kinematic responses. Muscle activation was recorded through electromyography. Strength, spasticity, muscle relaxation time, and muscle coactivation were quantified.Results: Maximum grip strength in the paretic hand was only 12% of that achieved by the nonparetic hand, and only 6 of 95 participants were able to produce any net extension force. Despite force deficits, spastic reflex response of the finger flexor evoked by imposed stretch averaged 90.1 ± 26.8% of maximum voluntary activation, relaxation time averaged 3.8 ± 0.8 seconds, and coactivation during voluntary extension exceeded 30% of maximum contraction, thereby resulting in substantial net flexion. Surprisingly, these hypertonicity measures were not significantly correlated with each other.Conclusions: Survivors of severe, chronic hemiparetic stroke experience profound weakness of both flexion and extension that arises from increased involuntary antagonist activation and decreased voluntary activation. The lack of correlation amongst hypertonicity measures suggests that these phenomena may arise from multiple, potentially independent mechanisms that could require different treatments.
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Affiliation(s)
| | - Derek G Kamper
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,UNC/NC State Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, USA.,Closed-Loop Engineering for Advanced Rehabilitation Research Core, North Carolina State University, Raleigh, North Carolina, USA
| | - Mary Ellen Stoykov
- Shirley Ryan AbilityLab, Arms + Hands Lab, Chicago, Illinios, USA.,Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Elliot Roth
- Shirley Ryan AbilityLab, Arms + Hands Lab, Chicago, Illinios, USA.,Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Abraha B, Chaves AR, Kelly LP, Wallack EM, Wadden KP, McCarthy J, Ploughman M. A Bout of High Intensity Interval Training Lengthened Nerve Conduction Latency to the Non-exercised Affected Limb in Chronic Stroke. Front Physiol 2018; 9:827. [PMID: 30013489 PMCID: PMC6036480 DOI: 10.3389/fphys.2018.00827] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
Objective: Evaluate intensity-dependent effects of a single bout of high intensity interval training (HIIT) compared to moderate intensity constant-load exercise (MICE) on corticospinal excitability (CSE) and effects on upper limb performance in chronic stroke. Design: Randomized cross-over trial. Setting: Research laboratory in a tertiary rehabilitation hospital. Participants: Convenience sample of 12 chronic stroke survivors. Outcome measures: Bilateral CSE measures of intracortical inhibition and facilitation, motor thresholds, and motor evoked potential (MEP) latency using transcranial magnetic stimulation. Upper limb functional measures of dexterity (Box and Blocks Test) and strength (pinch and grip strength). Results: Twelve (10 males; 62.50 ± 9.0 years old) chronic stroke (26.70 ± 23.0 months) survivors with moderate level of residual impairment participated. MEP latency from the ipsilesional hemisphere was lengthened after HIIT (pre: 24.27 ± 1.8 ms, and post: 25.04 ± 1.8 ms, p = 0.01) but not MICE (pre: 25.49 ± 1.10 ms, and post: 25.28 ± 1.0 ms, p = 0.44). There were no significant changes in motor thresholds, intracortical inhibition or facilitation. Pinch strength of the affected hand decreased after MICE (pre: 8.96 ± 1.9 kg vs. post: 8.40 ± 2.0 kg, p = 0.02) but not after HIIT (pre: 8.83 ± 2.0 kg vs. post: 8.65 ± 2.2 kg, p = 0.29). Regardless of type of aerobic exercise, higher total energy expenditure was associated with greater increases in pinch strength in the affected hand after exercise (R2 = 0.31, p = 0.04) and decreases in pinch strength of the less affected hand (R2 = 0.26 p = 0.02). Conclusion: A single bout of HIIT resulted in lengthened nerve conduction latency in the affected hand that was not engaged in the exercise. Longer latency could be related to the cross-over effects of fatiguing exercise or to reduced hand spasticity. Somewhat counterintuitively, pinch strength of the affected hand decreased after MICE but not HIIT. Regardless of the structure of exercise, higher energy expended was associated with pinch strength gains in the affected hand and strength losses in the less affected hand. Since aerobic exercise has acute effects on MEP latency and hand strength, it could be paired with upper limb training to potentiate beneficial effects.
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Affiliation(s)
- Beraki Abraha
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Arthur R Chaves
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Liam P Kelly
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Elizabeth M Wallack
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katie P Wadden
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jason McCarthy
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Desgeorges MM, Devillard X, Toutain J, Divoux D, Castells J, Bernaudin M, Touzani O, Freyssenet DG. Molecular Mechanisms of Skeletal Muscle Atrophy in a Mouse Model of Cerebral Ischemia. Stroke 2015; 46:1673-80. [DOI: 10.1161/strokeaha.114.008574] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/03/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Marine Maud Desgeorges
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
| | - Xavier Devillard
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
| | - Jérome Toutain
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
| | - Didier Divoux
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
| | - Josiane Castells
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
| | - Myriam Bernaudin
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
| | - Omar Touzani
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
| | - Damien Gilles Freyssenet
- From the Laboratoire de Physiologie de l’Exercice, Université de Lyon, Saint Etienne, France (M.M.D., X.D., J.C., D.G.F.); CNRS, UMR 6301 ISTCT, CERVOxy Group, GIP Cyceron, Caen, France (J.T., D.D., M.B., O.T.); CEA, DSV/I2BM, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.); and Université de Caen Basse Normandie, UMR 6301 ISTCT, Caen, France (J.T., D.D., M.B., O.T.)
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Santello M, Lang CE. Are movement disorders and sensorimotor injuries pathologic synergies? When normal multi-joint movement synergies become pathologic. Front Hum Neurosci 2015; 8:1050. [PMID: 25610391 PMCID: PMC4285090 DOI: 10.3389/fnhum.2014.01050] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022] Open
Abstract
The intact nervous system has an exquisite ability to modulate the activity of multiple muscles acting at one or more joints to produce an enormous range of actions. Seemingly simple tasks, such as reaching for an object or walking, in fact rely on very complex spatial and temporal patterns of muscle activations. Neurological disorders such as stroke and focal dystonia affect the ability to coordinate multi-joint movements. This article reviews the state of the art of research of muscle synergies in the intact and damaged nervous system, their implications for recovery and rehabilitation, and proposes avenues for research aimed at restoring the nervous system’s ability to control movement.
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Affiliation(s)
- Marco Santello
- Neural Control of Movement Laboratory, School of Biological and Health Systems Engineering, Arizona State University , Tempe, AZ , USA
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine in St. Louis , St. Louis, MO , USA
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Suresh NL, Concepcion NS, Madoff J, Rymer WZ. Anomalous EMG-force relations during low-force isometric tasks in hemiparetic stroke survivors. Exp Brain Res 2014; 233:15-25. [PMID: 25224701 DOI: 10.1007/s00221-014-4061-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
Hemispheric brain injury resulting from a stroke is often accompanied by muscle weakness in contralateral limbs. In neurologically intact subjects, appropriate motoneuronal recruitment and rate modulation are utilized to optimize muscle force production. In the present study, we sought to determine whether weakness in an affected hand muscle in stroke survivors is partially attributable to alterations in the control of muscle activation. Specifically, our goal was to characterize whether the surface EMG amplitude was systematically larger as a function of (low) force in paretic hand muscles as compared to contralateral muscles in the same subject. We tested a multifunctional muscle, the first dorsal interosseous (FDI), in multiple directions about the second metacarpophalangeal joint in ten hemiparetic and six neurologically intact subjects. In six of the ten stroke subjects, the EMG-force slope was significantly greater on the affected side as compared to the contralateral side, as well as compared to neurologically intact subjects. An unexpected set of results was a nonlinear relation between recorded EMG and generated force commonly observed in the paretic FDI, even at very low-force levels. We discuss possible experimental as well as physiological factors that may contribute to an increased EMG-force slope, concluding that changes in motor unit (MU) control are the most likely reasons for the observed changes.
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Affiliation(s)
- Nina L Suresh
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 E Superior Street, Room 1378, Chicago, IL, 60611, USA,
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9
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McNulty PA, Lin G, Doust CG. Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions. Front Hum Neurosci 2014; 8:518. [PMID: 25100969 PMCID: PMC4102083 DOI: 10.3389/fnhum.2014.00518] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/26/2014] [Indexed: 01/10/2023] Open
Abstract
Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface electromyography in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded in 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p < 0.001) with no differences between dominant and non-dominant sides for healthy subjects. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p < 0.001). Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p < 0.05). The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p < 0.05) but not ankle dorsiflexion. However the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects.
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Affiliation(s)
- Penelope A McNulty
- Neuroscience Research Australia Sydney, NSW, Australia ; School of Medical Sciences, UNSW Australia Sydney, NSW, Australia
| | - Gaven Lin
- Neuroscience Research Australia Sydney, NSW, Australia
| | - Catherine G Doust
- Neuroscience Research Australia Sydney, NSW, Australia ; School of Medical Sciences, UNSW Australia Sydney, NSW, Australia
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10
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Takahashi H, Himi N, Kuniyasu K, Koga T. Changes in the Lactate Threshold During Treadmill Exercise After Microsphere-Induced Infarction in Rats. J Stroke Cerebrovasc Dis 2012; 21:647-51. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/17/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022] Open
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von Walden F, Jakobsson F, Edström L, Nader GA. Altered autophagy gene expression and persistent atrophy suggest impaired remodeling in chronic hemiplegic human skeletal muscle. Muscle Nerve 2012; 46:785-92. [PMID: 22996233 DOI: 10.1002/mus.23387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2012] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Upper motor neuron lesions after stroke are a major cause of disability. We aimed to determine whether skeletal muscles from these patients display typical molecular signatures of inflammation, growth arrest, and atrophy. METHODS Muscle biopsies were analyzed for morphological, histochemical, ultrastructural, and molecular features indicative of changes in gene expression involved in muscle atrophy. RESULTS Chronic hemiplegia resulted in ~9.5% atrophy, fiber type shifts, and histochemical and ultrastructural signs of impaired remodeling. TNF and TWEAK expressions were unaltered, but MSTN mRNA was lower (-73%, P < 0.05) in paretic tibialis anterior vs. age-matched controls. The expression of autophagy-related genes (BCN-1, LC3, and GABARAPL1) was lower in paretic tibialis anterior (-81%, -48%, and -60%, respectively, P < 0.01) and soleus (-85%, -54%, and -60% respectively, P < 0.01) compared with old controls. CONCLUSIONS Persistent atrophy in chronic spastic hemiplegia may be associated with impaired remodeling partly due to altered autophagy gene expression.
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Affiliation(s)
- Ferdinand von Walden
- Department of Medicine, Center for Molecular Medicine L8:04, Karolinska Institute, 171 76 Stockholm, Sweden
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Knorr S, Rice CL, Garland SJ. Perspective on neuromuscular factors in poststroke fatigue. Disabil Rehabil 2012; 34:2291-9. [DOI: 10.3109/09638288.2012.683233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Smith LR, Lee KS, Ward SR, Chambers HG, Lieber RL. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. J Physiol 2011; 589:2625-39. [PMID: 21486759 DOI: 10.1113/jphysiol.2010.203364] [Citation(s) in RCA: 300] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cerebral palsy (CP) results from an upper motoneuron (UMN)lesion in the developing brain. Secondary to the UMNl esion,which causes spasticity, is a pathological response by muscle - namely, contracture. However, the elements within muscle that increase passive mechanical stiffness, and therefore result in contracture, are unknown. Using hamstring muscle biopsies from pediatric patients with CP (n =33) and control (n =19) patients we investigated passive mechanical properties at the protein, cellular, tissue and architectural levels to identify the elements responsible for contracture. Titin isoform, the major load-bearing protein within muscle cells, was unaltered in CP. Correspondingly, the passive mechanics of individual muscle fibres were not altered. However, CP muscle bundles, which include fibres in their constituent ECM, were stiffer than control bundles. This corresponded to an increase in collagen content of CP muscles measured by hydroxyproline assay and observed using immunohistochemistry. In vivo sarcomere length of CP muscle measured during surgery was significantly longer than that predicted for control muscle. The combination of increased tissue stiffness and increased sarcomere length interact to increase stiffness greatly of the contracture tissue in vivo. These findings provide evidence that contracture formation is not the result of stiffening at the cellular level, but stiffening of the ECM with increased collagen and an increase of in vivo sarcomere length leading to higher passive stresses.
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Affiliation(s)
- Lucas R Smith
- Departments of Bioengineering, University of California, San Diego, CA, USA
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Klein CS, Brooks D, Richardson D, McIlroy WE, Bayley MT. Voluntary activation failure contributes more to plantar flexor weakness than antagonist coactivation and muscle atrophy in chronic stroke survivors. J Appl Physiol (1985) 2010; 109:1337-46. [PMID: 20724561 DOI: 10.1152/japplphysiol.00804.2009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The contributions of nervous system muscle activation and muscle atrophy to poststroke weakness have not been evaluated together in the same subject. Maximal voluntary contraction (MVC) torque, voluntary activation (twitch interpolation), and electromyographic (EMG) amplitude were determined bilaterally in the plantar flexors of seven chronic stroke survivors (40-63 yr, 24-51 mo poststroke). Volumes of the plantar flexor muscles were determined bilaterally with magnetic resonance imaging (MRI). The mean (±SD) contralesional (paretic) MVC torque was less than one-half of the ipsilesional leg: 56.7 ± 57.4 vs. 147 ± 35.7 Nm (P = 0.006). Contralesional voluntary activation was only 48 ± 36.9%, but was near complete in the ipsilesional leg, 97 ± 1.9% (P = 0.01). The contralesional MVC EMG amplitude (normalized to the maximum M-wave peak-to-peak amplitude) of the gastrocnemii and soleus were 36.0 ± 28.5 and 36.0 ± 31.0% of the ipsilesional leg. Tibialis anterior (TA) EMG coactivation was not different between the contralesional (23.2 ± 24.0% of TA MVC EMG) and ipsilesional side (12.3 ± 5.7%) (P = 0.24). However, TA EMG coactivation was excessive (71%) in one subject and accounted for ~8% of her weakness based on the estimated antagonist torque. Relative (%ipsilesional leg) plantar flexor and gastrocnemii volumes were 88 ± 6% (P = 0.004) and 76 ± 15% (P = 0.01), respectively. Interlimb volume differences of the soleus, deep plantar flexors, and peronei were not significant. Preferred walking speed (0.83 ± 0.33 m/s) was related to the contralesional MVC torque (r(2) = 0.57, P = 0.05, N = 7), but the two subjects with the greatest weakness walked faster than three others. Our findings suggest that plantar flexor weakness in mobile chronic stroke survivors reflects mostly voluntary activation failure, with smaller contributions from antagonist activity and atrophy.
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Affiliation(s)
- Cliff S Klein
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
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Shao Q, Bassett DN, Manal K, Buchanan TS. An EMG-driven model to estimate muscle forces and joint moments in stroke patients. Comput Biol Med 2009; 39:1083-8. [PMID: 19818436 PMCID: PMC2784179 DOI: 10.1016/j.compbiomed.2009.09.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 08/29/2009] [Accepted: 09/10/2009] [Indexed: 11/18/2022]
Abstract
Individuals following stroke exhibit altered muscle activation and movement patterns. Improving the efficiency of gait can be facilitated by knowing which muscles are affected and how they contribute to the pathological pattern. In this paper we present an electromyographically (EMG) driven musculoskeletal model to estimate muscle forces and joint moments. Subject specific EMG for the primary ankle plantar and dorsiflexor muscles, and joint kinematics during walking for four subjects following stroke were used as inputs to the model to predict ankle joint moments during stance. The model's ability to predict the joint moment was evaluated by comparing the model output with the moment computed using inverse dynamics. The model did predict the ankle moment with acceptable accuracy, exhibiting an average R(2) value ranging between 0.87 and 0.92, with RMS errors between 9.7% and 14.7%. The values are in line with previous results for healthy subjects, suggesting that EMG-driven modeling in this population of patients is feasible. It is our hope that such models can provide clinical insight into developing more effective rehabilitation therapies and to assess the effects of an intervention.
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Affiliation(s)
- Qi Shao
- Center for Biomedical Engineering Research, Department of Mechanical Engineering, University of Delaware, Newark, 19716, USA
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Ivey FM, Hafer-Macko CE, Macko RF. Task-oriented treadmill exercise training in chronic hemiparetic stroke. ACTA ACUST UNITED AC 2009; 45:249-59. [PMID: 18566943 DOI: 10.1682/jrrd.2007.02.0035] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with stroke have elevated hemiparetic gait costs secondary to low activity levels and are often severely deconditioned. Decrements in peak aerobic capacity affect functional ability and cardiovascular-metabolic health and may be partially mediated by molecular changes in hemiparetic skeletal muscle. Conventional rehabilitation is time delimited in the subacute stroke phase and does not provide adequate aerobic intensity to reverse the profound detriments to fitness and function that result from stroke. Hence, we have studied progressive full body weight-support treadmill (TM) training as an adjunct therapy in the chronic stroke phase. Task-oriented TM training has produced measurable changes in fitness, function, and indices of cardiovascular-metabolic health after stroke, but the precise mechanisms for these changes remain under investigation. Further, the optimal dose of this therapy has yet to be identified for individuals with stroke and may vary as a function of deficit severity and outcome goals. This article summarizes the functional and metabolic decline caused by inactivity after stroke and provides current evidence that supports the use of TM training during the chronic stroke phase, with protocols and inclusion/exclusion criteria described. Our research findings are discussed in relation to associated research.
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Affiliation(s)
- Frederick M Ivey
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD 21201, USA
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Abstract
Patients with stroke are severely deconditioned, leading to metabolic abnormalities that significantly increase risk for myocardial infarction and recurrent stroke. This review characterizes the nature of the metabolic decline, the underlying causes, and the potential for progressive aerobic exercise to address metabolic impairment following disabling stroke. Although exercise training has previously been shown to improve peak aerobic capacity and sensorimotor function after stroke, establishing safe and effective exercise programs in this population presents unique challenges stemming from neurological deficit complexities and comorbid conditions. Thus, recommendations for application to practice are provided that include proper preexercise evaluation, guidelines for symptom-limited maximal effort exercise testing, as well as evidence-based suggestions for initiation and progression of an exercise program. Implementing regular, progressive exercise therapy is critical on the basis of the devastating impact of physical inactivity on overall metabolic heath. Prevalence of impaired or diabetic glucose metabolism may be as high as 80% in chronic stroke, predicting 2- and 3-fold increased risk for recurrent stroke, respectively. Tragically, nearly one third of patients with stroke experience recurrent stroke within 5 years, and comorbid cardiovascular conditions represent the leading cause of death in this population. Recent evidence showing the positive impact of exercise training on hyperinsulinemia and glucose tolerance in survivors of stroke is presented, given the central importance of these factors to overall cardiovascular risk. On the basis of these and other findings, structured exercise programs should be considered for all survivors of stroke.
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Higher amount of MyHC IIX in a wrist flexor in tetraplegic compared to hemiplegic cerebral palsy. J Neurol Sci 2008; 266:51-6. [DOI: 10.1016/j.jns.2007.08.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Revised: 08/27/2007] [Accepted: 08/30/2007] [Indexed: 11/20/2022]
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Hafer-Macko CE, Ryan AS, Ivey FM, Macko RF. Skeletal muscle changes after hemiparetic stroke and potential beneficial effects of exercise intervention strategies. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2008; 45:261-72. [PMID: 18566944 PMCID: PMC2978978 DOI: 10.1682/jrrd.2007.02.0040] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Stroke is the leading cause of disability in the United States. New evidence reveals significant structural and metabolic changes in skeletal muscle after stroke. Muscle alterations include gross atrophy and shift to fast myosin heavy chain in the hemiparetic (contralateral) leg muscle; both are related to gait deficit severity. The underlying molecular mechanisms of this atrophy and muscle phenotype shift are not known. Inflammatory markers are also present in contralateral leg muscle after stroke. Individuals with stroke have a high prevalence of insulin resistance and diabetes. Skeletal muscle is a major site for insulin-glucose metabolism. Increasing evidence suggests that inflammatory pathway activation and oxidative injury could lead to wasting, altered function, and impaired insulin action in skeletal muscle. The health benefits of exercise in disabled populations have now been recognized. Aerobic exercise improves fitness, strength, and ambulatory performance in subjects with chronic stroke. Therapeutic exercise may modify or reverse skeletal muscle abnormalities.
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Pontén EM, Stål PS. Decreased capillarization and a shift to fast myosin heavy chain IIx in the biceps brachii muscle from young adults with spastic paresis. J Neurol Sci 2006; 253:25-33. [PMID: 17196619 DOI: 10.1016/j.jns.2006.11.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 10/04/2006] [Accepted: 11/08/2006] [Indexed: 10/23/2022]
Abstract
Muscle spasticity and paresis are conditions that occur secondary to upper motor neuron lesions. The co-existence of decreased motor unit recruitment and intermittent over-activity generates confusion concerning the effect on muscle fiber characteristics. In order to increase the knowledge about the effect of upper motor lesion on capillarization and muscle fiber composition, the biceps brachii muscle from seven young adults with long duration of spastic paresis and seven age-matched controls were analyzed using morphological and enzyme- and immuno-histochemical techniques. The spastic muscles had a 38% lower capillary density (p=0.002), 30% fewer capillaries around each muscle fiber (p=0.02), and 16% fewer capillaries when related to the fiber size (p=0.04). The frequency of fibers expressing myosin heavy chain (MyHC) IIx increased (30% vs. 4%, p=0.006), while the percentage of fibers expressing MyHC I and MyHC IIa, respectively, decreased (22% vs. 46% and 7% vs. 29%, p<0.01). The high proportion of muscle fibers with low oxidative capacity and low capillary supply indicates that biceps brachii muscle from patients with upper motor lesions fatigue more easily than normal controls. We also observed a significantly higher variability in fiber size for fibers expressing MyHC I (p<0.04), and, in three of the subjects, a small amount of small fibers expressing developmental MyHCs was found. These results suggest that, although intermittent stretch reflex contractions might have an impact on the muscle characteristics in spastic paresis, the muscle phenotypic properties are more adapted to decreased voluntary motor unit recruitment.
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Affiliation(s)
- E M Pontén
- Department of Pediatric Orthopaedic Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
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21
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Abstract
Spastic paresis follows chronic disruption of the central execution of volitional command. Motor function in patients with spastic paresis is subjected over time to three fundamental insults, of which the last two are avoidable: (1) the neural insult itself, which causes paresis, i.e., reduced voluntary motor unit recruitment; (2) the relative immobilization of the paretic body part, commonly imposed by the current care environment, which causes adaptive shortening of the muscles left in a shortened position and joint contracture; and (3) the chronic disuse of the paretic body part, which is typically self-imposed in most patients. Chronic disuse causes plastic rearrangements in the higher centers that further reduce the ability to voluntarily recruit motor units, i.e., that aggravate baseline paresis. Part I of this review focuses on the pathophysiology of the first two factors causing motor impairment in spastic paresis: the vicious cycle of paresis-disuse-paresis and the contracture in soft tissues.
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Affiliation(s)
- Jean-Michel Gracies
- Department of Neurology, Mount Sinai Medical Center, One Gustave L Levy Place, Annenberg 2/Box 1052, New York, New York 10029-6574, USA.
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Abstract
OBJECTIVE To assess whether one-legged bicycling correlates with muscle strength and thereby could work as an outcome measure for persons with stroke. METHODS The study comprised 29 men (age 35-65) with a first occurrence of stroke 6-35 months earlier. Each leg was evaluated separately. A ramp protocol was used (10 W/min), with continuous recording of the ventilatory uptake (Vo(2)) and heart rate. An isokinetic dynamometer was used to assess strength and endurance. Enzyme assays were performed on muscle biopsy samples. RESULTS The peak isometric strength and isokinetic strength of the paretic leg correlated with the max. W on the bicycle. The oxidative enzyme citrate synthase correlated with the workload for both legs on the bicycle and lactate dehydrogenase correlated with peak isometric strength in both legs. CONCLUSIONS The one-legged bicycle exercise test can be used to assess endurance in persons with a previous stroke as it correlates with dynamometer testing and muscle biopsies.
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Affiliation(s)
- K S Sunnerhagen
- The Arvid Carlsson Institute, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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De Deyne PG, Hafer-Macko CE, Ivey FM, Ryan AS, Macko RF. Muscle molecular phenotype after stroke is associated with gait speed. Muscle Nerve 2004; 30:209-15. [PMID: 15266637 DOI: 10.1002/mus.20085] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The disability of patients after stroke is generally attributed to upper motor neuron defects, but secondary changes in paretic muscle may enhance the disability. We analyzed the molecular phenotype and metabolic profile of the paretic and nonparetic vastus lateralis (VL) and we measured the severity of gait deficit in 13 patients at least 6 months after ischemic stroke. The results showed a significant increase in the proportion of fast myosin heavy chain (MHC, 68 +/- 14%) in the paretic compared to the nonparetic VL (50 +/- 13%). The specific activity of citrate synthase and glyceraldehyde phosphodehydrogenase was not significantly different between the two sides. The proportion of fast MHC was inversely associated with severity of gait deficit indexed by self-selected walking speed in the paretic leg, but not the nonparetic leg. Our findings demonstrate significant and potentially modifiable secondary biologic changes in hemiparetic muscle phenotype that may contribute to the disability of stroke.
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Affiliation(s)
- Patrick G De Deyne
- Departments of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Ng AV, Miller RG, Gelinas D, Kent-Braun JA. Functional relationships of central and peripheral muscle alterations in multiple sclerosis. Muscle Nerve 2004; 29:843-52. [PMID: 15170617 DOI: 10.1002/mus.20038] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The functional implications of central motor impairment and peripheral muscle alterations in multiple sclerosis are unclear. Muscle strength, central and peripheral activation, and symptomatic fatigue were investigated in 16 patients with multiple sclerosis (MS) and 18 control subjects. Voluntary and electrically stimulated isometric contractions were obtained from the ankle dorsiflexor muscles. Maximal voluntary contraction (MVC) was 27% lower in MS patients than controls, although electrically stimulated force was similar. Muscle fat-free cross-sectional area (CSA) was similar in both groups. These data indicate central activation impairment in MS. Such impairment in MS was further demonstrated by decreased foot-tap speed, rate of voluntary force development, and central activation ratio. Peripheral activation changes in MS patients were modest. Although stimulated tetanic force was similar, force relaxation was slower in MS patients compared to controls, resulting in a left-shifted force-frequency relationship in MS. Motor function changes were not associated with fatigue but were associated with impaired ambulation. Thus, weakness and walking impairment, but not fatigue, were related to impaired central activation in MS. These findings may help optimize rehabilitation strategies designed to improve function in persons with MS.
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Affiliation(s)
- A V Ng
- Department of Radiology, University of California at San Francisco, San Francisco, California, USA.
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Katz-Leurer M, Shochina M, Carmeli E, Friedlander Y. The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1609-14. [PMID: 14639559 DOI: 10.1053/s0003-9993(03)00344-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effect of early aerobic training on the aerobic and functional abilities of patients in the subacute stage of cerebrovascular accident (CVA). DESIGN Randomized controlled trial. SETTING Rehabilitation unit in Israel. PARTICIPANTS Ninety-two patients who had a first CVA were randomly assigned to an exercise-training group or to a control group. INTERVENTION Aerobic training with a leg cycle ergometer for 8 weeks. MAIN OUTCOME MEASURES Workload, exercise time, resting and submaximal blood pressure and heart rate, and functional abilities. RESULTS A trend toward improvement was found in all aerobic parameters for the experimental group, but only heart rate at rest (P=.02), workload, and work time (P<.01) improved significantly. A trend for improvement was also found in all parameters of function for the experimental group, but only stair climbing was significantly better (P<.01). An interaction (95% confidence interval, 1.7-17.21) was found between age and aerobic training on walking distance. Although no significant effect was found in the group of younger patients (aged <65y), a significant difference in favor of training was noted in the group of older patients. CONCLUSIONS Patients with CVA in the subacute stage improved some of their aerobic and functional abilities after submaximal aerobic training.
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Affiliation(s)
- Michal Katz-Leurer
- Rehabilitation Department, Hadassah University Hospital, Jerusalem, Israel.
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Gracies JM. Pathophysiology of Impairment in Patients with Spasticity and Use of Stretch as a Treatment of Spastic Hypertonia. Phys Med Rehabil Clin N Am 2001. [DOI: 10.1016/s1047-9651(18)30031-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rouleaud S, Gaujard E, Petit H, Picard D, Dehail P, Joseph P, Mazaux J, Barat M. Isocinétisme et rééducation de la marche de l’hémiplégique. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s0168-6054(00)00047-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Halar EM. Management of Stroke Risk Factors During the Process of Rehabilitation: Secondary Stroke Prevention. Phys Med Rehabil Clin N Am 1999. [DOI: 10.1016/s1047-9651(18)30166-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith GV, Silver KH, Goldberg AP, Macko RF. "Task-oriented" exercise improves hamstring strength and spastic reflexes in chronic stroke patients. Stroke 1999; 30:2112-8. [PMID: 10512915 DOI: 10.1161/01.str.30.10.2112] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite the belief that after cerebral infarction only limited functional gains are possible beyond the subacute period, we tested the hypothesis that a 12-week program of "task-oriented" treadmill exercise would increase muscle strength and decrease spastic reflexes in chronic hemiparetic patients. METHODS Fourteen subjects, aged 66+/-3 (mean+/-SEM) years, with residual gait deviations due to remote stroke (>6 months), underwent repeated measures of reflexive and volitional (concentric and eccentric) torque with use of isokinetic dynamometry on the hamstring musculature bilaterally. Torque output was measured at 4 angular velocities (30(o), 60(o), 90(o), and 120(o)/s). RESULTS After 3 months of 3 times/wk low-intensity aerobic exercise, there were significant main effects (2 legs [P<0.01]x2 times [P<0. 01]x4 angular velocities [P<0.05]) for concentric torque production. Torque/time production in the concentric mode also improved significantly in the paretic (50%, P<0.01) and nonparetic hamstrings (31%, P<0.01). Eccentric torque/time production increased by 21% (P<0.01) and 22% (P<0.01) in the paretic and nonparetic hamstrings, respectively. Passive (reflexive) torque/time generation in the paretic hamstrings decreased by 11% (P<0.027). Reflexive torque/time was unchanged in the nonparetic hamstrings (P=0.45). CONCLUSIONS These findings provide evidence that progressive treadmill aerobic exercise training improves volitional torque and torque/time generation and reduces reflexive torque/time production in the hemiparetic limb. Strength changes associated with improved functional mobility in chronic hemiparetic stroke survivors after treadmill training will be reported in future articles.
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Affiliation(s)
- G V Smith
- Department of Physical Therapy, Division of Gerontology, University of Maryland-Baltimore School of Medicine, Baltimore, MD, USA.
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Sunnerhagen KS, Svantesson U, Lönn L, Krotkiewski M, Grimby G. Upper motor neuron lesions: their effect on muscle performance and appearance in stroke patients with minor motor impairment. Arch Phys Med Rehabil 1999; 80:155-61. [PMID: 10025489 DOI: 10.1016/s0003-9993(99)90113-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate muscular performance and appearance in patients with prior stroke who were ambulatory. DESIGN Nonrandomized study. SETTING University hospital laboratory. SUBJECTS Sixteen persons (11 men, 5 women) with minor motor impairments, 6 to 24 months after stroke, were included. As reference, data were used from a population-based sample of 144 men and women. MAIN OUTCOME MEASUREMENTS Muscle performance was evaluated using a Kin-Com dynamometer in both the affected and the nonaffected leg. Peak isometric strength was measured at a 60 degree angle in both extension and flexion. Maximal isokinetic strength was measured at 60 degrees/sec and at 180 degrees/sec. Endurance was evaluated during isometric and dynamic knee extensions. Muscle biopsies were taken on nine patients and muscle tissue areas were determined with computed tomography. RESULTS The affected leg was weaker but not different in relative endurance compared with the nonaffected side. The performance of the nonaffected side was somewhat lower than that of a matched reference population. No major difference in fiber composition between the affected and nonaffected legs was noted, except for a lower degree of capillarization in the affected leg. CONCLUSION In well-functioning stroke patients with good motor performance, further muscle training that includes resistance exercise might be indicated.
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Kent-Braun JA, Ng AV, Castro M, Weiner MW, Gelinas D, Dudley GA, Miller RG. Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J Appl Physiol (1985) 1997; 83:1998-2004. [PMID: 9390973 DOI: 10.1152/jappl.1997.83.6.1998] [Citation(s) in RCA: 163] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study examined functional, biochemical, and morphological characteristics of skeletal muscle in nine multiple sclerosis (MS) patients and eight healthy controls in an effort to ascertain whether intramuscular adaptations could account for excessive fatigue in this disease. Analyses of biopsies of the tibialis anterior muscle showed that there were fewer type I fibers (66 +/- 6 vs. 76 +/- 6%), and that fibers of all types were smaller (average downward arrow26%) and had lower succinic dehydrogenase (SDH; average downward arrow40%) and SDH/alpha-glycerol-phosphate dehydrogenase (GPDH) but not GPDH activities in MS vs. control subjects, suggesting that muscle in this disease is smaller and relies more on anaerobic than aerobic-oxidative energy supply than does muscle of healthy individuals. Maximal voluntary isometric force for dorsiflexion was associated with both average fiber cross-sectional area (r = 0.71, P = 0.005) and muscle fat-free cross-sectional area by magnetic resonance imaging (r = 0.80, P < 0. 001). Physical activity, assessed by accelerometer, was associated with average fiber SDH/GPDH (r = 0.78, P = 0.008). There was a tendency for symptomatic fatigue to be inversely associated with average fiber SDH activity (r = -0.57, P = 0.068). The results of this study suggest that the inherent characteristics of skeletal muscle fibers per se and of skeletal muscle as a whole are altered in the direction of disuse in MS. They also suggest that changes in skeletal muscle in MS may significantly affect function.
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Affiliation(s)
- J A Kent-Braun
- Department of Radiology, University of California, San Francisco 94121, California 94115, USA
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Frontera WR, Grimby L, Larsson L. Firing rate of the lower motoneuron and contractile properties of its muscle fibers after upper motoneuron lesion in man. Muscle Nerve 1997; 20:938-47. [PMID: 9236783 DOI: 10.1002/(sici)1097-4598(199708)20:8<938::aid-mus2>3.0.co;2-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We studied motor unit (MU) firing rate and contractile properties and myosin isoform composition of single muscle fibers after upper motoneuron lesion. Single-MUs and surface electromyogram (EMG) were recorded during voluntary contractions and locomotion in the paretic (P) and nonparetic (NP) tibialis anterior (TA) of 15 hemiparetics. P TA low-threshold MUs fired within the lower end of their normal range. High-threshold MUs fired below their normal range or were not recruited. Surface EMG was abnormally low and high in the P TA and NP TA, respectively. On muscle cross sections stained with histochemical methods, type I fibers represented 99.4%, 74.3% and 66.6% of NP, P, and control TA, respectively. P TA fibers expressing type I myosin heavy chain (MyHC) were smaller, weaker, and slower. In conclusion, low MU firing rate and activity in the P TA was associated with slower type I MyHC fibers, while increased activity in NP TA resulted in homogenous expression of type I MyHC.
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Affiliation(s)
- W R Frontera
- Department of Clinical Neurophysiology, Karolinska Hospital, Stockholm, Sweden
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Ansved T, Ohlsson AL, Jakobsson F, Johansson BB. Enzyme-histochemical and morphological characteristics of fast- and slow-twitch skeletal muscle after brain infarction in the rat. J Neurol Sci 1996; 144:14-20. [PMID: 8994099 DOI: 10.1016/s0022-510x(96)00220-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The right middle cerebral artery was permanently occluded in 12-week-old male spontaneously hypertensive rats. After the surgery the rats were subjected to repeated behavioural tests during the observation period. Fourteen weeks after surgery the fast-twitch extensor digitorum longus (EDL) and the slow-twitch soleus muscle of both sides were removed and examined with regard to muscle fibre characteristics obtained by histochemical and morphometrical methods. Comparisons were made with age-matched controls. Limb placement and the ability to traverse a beam or a rotating pole were repeatedly tested 2-13 weeks after the operation. In spite of permanent sensorimotor deficits in limb placement and when traversing a rotating pole or beam, no increase in pathological changes was noted in either EDL or soleus. The number and proportion of fibre types remained unchanged in both muscles. There was no difference in muscle fibre size in either EDL or soleus. It is concluded that brain infarction in the rat, although causing marked impairment of contralateral motor function, does not have a major influence on the muscle-fibre morphology or fibre-type composition, irrespective of muscle type.
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Affiliation(s)
- T Ansved
- Department of Neurology, Karolinska Hospital, Stockholm, Sweden
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Rossi B, Siciliano G, Carboncini MC, Manca ML, Massetani R, Viacava P, Muratorio A. Muscle modifications in Parkinson's disease: myoelectric manifestations. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1996; 101:211-8. [PMID: 8647033 DOI: 10.1016/0924-980x(96)94672-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The muscle changes occurring in Parkinson's disease (PD) may come about as a consequence of the modified pattern of motor unit activation and rigidity, which are characteristic of the disease. A tendency towards hypertrophy of type I fibers and, in some instances, atrophy of type II fibers has been observed. Fourteen patients affected by PD and 10 age-matched controls were studied in order to investigate these muscle changes. We indirectly evaluated muscle modifications by measuring muscle fiber conduction velocity (CV) and median frequency (MDF) of the power spectrum using automatic analysis of surface EMG. The tibialis anterior muscle was selected for the study of contractions electrically induced by 35 Hz pulse trains lasting 30 s; the myoelectric signal was detected using the 4-bar electrode technique described by Broman et al. (Broman, H., Bilotto, G. and De Luca, C.J. Myoelectric signal conduction velocity and spectral parameters: influence of force and time. J. Appl. Physiol., 1985, 58: 1428-1437). Muscle biopsy specimens were obtained in 4 PD patients by surgical excision at the site where the EMG recording electrode had been placed. The main difference observed between PD subjects and controls was the rate of change of MDF and CV during the course of stimulated contraction; patients with PD sustained a smaller fatigue related decrease in both parameters compared to controls. According to our histological data, this result can be explained by a type I fiber percentage which accounts for 79% of the myofiber population on average. As expected, the CV basal values correlated directly with type I fiber diameter. These data suggest that non-invasive surface EMG techniques are useful in assessing the modifications of muscle characteristics that are observed in PD patients and for analyzing some aspects of the peripheral fatigue in this disease.
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Affiliation(s)
- B Rossi
- Institute of Neurology Clinic, University of Pisa, Italy
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Staron RS, Johnson P. Myosin polymorphism and differential expression in adult human skeletal muscle. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. B, COMPARATIVE BIOCHEMISTRY 1993; 106:463-75. [PMID: 8281747 DOI: 10.1016/0305-0491(93)90120-t] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
1. Myosin heavy chain (HC) and light chain (LC) isoforms are expressed in a tissue-specific and developmentally-regulated manner in human skeletal muscle. 2. At least seven myosin HC isoforms are expressed in skeletal muscle of the adult. 3. Histochemically-delineated fibre types (based on the stability of myofibrillar actomyosin adenosine triphosphatase activity) in limb muscles correlate with the myosin HC content. 4. Alterations in the phenotypic expression of myosin provides a mechanism of adaptation to stresses placed upon the muscle (e.g. increased and decreased usage).
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Affiliation(s)
- R S Staron
- College of Osteopathic Medicine, Department of Biological Sciences, Ohio University, Athens 45701
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37
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Post RM, Weiss SR, Fontana D, Pert A. Conditioned sensitization to the psychomotor stimulant cocaine. Ann N Y Acad Sci 1992; 654:386-99. [PMID: 1632592 DOI: 10.1111/j.1749-6632.1992.tb25983.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- R M Post
- Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892
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