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Kim Y, Smith BE, Shigo LM, Shaikh AG, Loparo KA, Ridgel AL. Utilizing Entropy of Cadence to Optimize Cycling Rehabilitation in Individuals With Parkinson's Disease. Neurorehabil Neural Repair 2024:15459683241268556. [PMID: 39104198 DOI: 10.1177/15459683241268556] [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: 08/07/2024]
Abstract
BACKGROUND Previous studies have established that increased Sample Entropy (SampEn) of cadence, a measure of non-linear variability, during dynamic cycling leads to greater improvements in motor function for individuals with Parkinson's disease (PD). However, there is significant variability in responses among individuals with PD due to symptoms and disease progression. OBJECTIVES The aim of this study was to develop and test a paradigm for adapting a cycling exercise intervention using SampEn of cadence and rider effort to improve motor function. METHODS Twenty-two participants were randomized into either patient-specific adaptive dynamic cycling (PSADC) or non-adaptive (NA) group. SampEn of cadence was calculated after each of the 12 sessions, and motor function was evaluated using the Kinesia test. Pearson's correlation coefficient was used to analyze the relationship between SampEn of cadence and motor function improvement. Multiple linear regression (MLR) was used to identify the strongest predictors of motor function improvement. RESULTS Pearson's correlation coefficient revealed a significant correlation between SampEn of cadence and motor function improvements (R2 = -.545, P = .009), suggesting that higher SampEn of cadence led to greater motor function improvement. MLR demonstrated that SampEn of cadence was the strongest predictor of motor function improvement (β = -8.923, t = -2.632, P = .018) over the BMI, Levodopa equivalent daily dose, and effort. CONCLUSIONS The findings show that PSADC paradigm promoted a greater improvement in motor function than NA dynamic cycling. These data will be used to develop a predictive model to optimize motor function improvement after cycling in individuals with PD.
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Affiliation(s)
- Younguk Kim
- Exercise Science and Exercise Physiology Program, Kent State University, Kent, OH, USA
- Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittany E Smith
- Exercise Science and Exercise Physiology Program, Kent State University, Kent, OH, USA
| | - Lara M Shigo
- Exercise Science and Exercise Physiology Program, Kent State University, Kent, OH, USA
| | - Aasef G Shaikh
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Kenneth A Loparo
- Institute for Smart, Secure and Connected Systems, Case Western Reserve University, Cleveland, OH, USA
| | - Angela L Ridgel
- Exercise Science and Exercise Physiology Program, Kent State University, Kent, OH, USA
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Simpson TG, Godfrey W, Torrecillos F, He S, Herz DM, Oswal A, Muthuraman M, Pogosyan A, Tan H. Cortical beta oscillations help synchronise muscles during static posture holding in healthy motor control. Neuroimage 2024; 298:120774. [PMID: 39103065 DOI: 10.1016/j.neuroimage.2024.120774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/07/2024] Open
Abstract
How cortical oscillations are involved in the coordination of functionally coupled muscles and how this is modulated by different movement contexts (static vs dynamic) remains unclear. Here, this is investigated by recording high-density electroencephalography (EEG) and electromyography (EMG) from different forearm muscles while healthy participants (n = 20) performed movement tasks (static and dynamic posture holding, and reaching) with their dominant hand. When dynamic perturbation was applied, beta band (15-35 Hz) activities in the motor cortex contralateral to the performing hand reduced during the holding phase, comparative to when there was no perturbation. During static posture holding, transient periods of increased cortical beta oscillations (beta bursts) were associated with greater corticomuscular coherence and increased phase synchrony between muscles (intermuscular coherence) in the beta frequency band compared to the no-burst period. This effect was not present when resisting dynamic perturbation. The results suggest that cortical beta bursts assist synchronisation of different muscles during static posture holding in healthy motor control, contributing to the maintenance and stabilisation of functional muscle groups. Theoretically, increased cortical beta oscillations could lead to exaggerated synchronisation in different muscles making the initialisation of movements more difficult, as observed in Parkinson's disease.
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Affiliation(s)
- Thomas G Simpson
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - William Godfrey
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Flavie Torrecillos
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shenghong He
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Damian M Herz
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ashwini Oswal
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Muthuraman Muthuraman
- Neural Engineering with Signal Analytics and Artificial Intelligence (NESA-AI), Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Junquera-Godoy I, Martinez-De-Juan JL, González-Lorente G, Carot-Sierra JM, Gomis-Tena J, Saiz J, García-Blasco S, Pertusa-Mazón I, Soler-Climent E, Prats-Boluda G. Muscle Network Connectivity Study in Diabetic Peripheral Neuropathy Patients. SENSORS (BASEL, SWITZERLAND) 2024; 24:4954. [PMID: 39124001 PMCID: PMC11314729 DOI: 10.3390/s24154954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a prevalent complication of chronic diabetes mellitus and has a significant impact on quality of life. DPN typically manifests itself as a symmetrical, length-dependent sensorimotor polyneuropathy with severe effects on gait. Surface electromyography (sEMG) is a valuable low-cost tool for assessing muscle activation patterns and precise identification of abnormalities. For the present study, we used information theory methods, such as cross-correlation (CC), normalized mutual information (NMI), conditional granger causality (CG-Causality), and transfer entropy (TE), to evaluate muscle network connectivity in three population groups: 33 controls (healthy volunteers, CT), 10 diabetic patients with a low risk of DPN (LW), and 17 moderate/high risk patients (MH). The results obtained indicated significant alterations in the intermuscular coupling mechanisms due to diabetes and DPN, with the TE group showing the best performance in detecting differences. The data revealed a significant increase in information transfer and muscle connectivity in the LW group over the CT group, while the MH group obtained significantly lower values for these metrics than the other two groups. These findings highlight the sEMG coupling metrics' potential to reveal neuromuscular mechanisms that could aid the development of targeted rehabilitation strategies and help monitor DPN patients.
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Affiliation(s)
- Isabel Junquera-Godoy
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València (UPV), 46022 Valencia, Spain; (I.J.-G.); (G.G.-L.); (J.G.-T.); (J.S.); (G.P.-B.)
| | - José Luís Martinez-De-Juan
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València (UPV), 46022 Valencia, Spain; (I.J.-G.); (G.G.-L.); (J.G.-T.); (J.S.); (G.P.-B.)
| | - Gemma González-Lorente
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València (UPV), 46022 Valencia, Spain; (I.J.-G.); (G.G.-L.); (J.G.-T.); (J.S.); (G.P.-B.)
| | - José Miguel Carot-Sierra
- Departamento de Estadística e Investigación Operativa Aplicadas y Calidad, Universitat Politècnica de València (UPV), 46022 Valencia, Spain;
| | - Julio Gomis-Tena
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València (UPV), 46022 Valencia, Spain; (I.J.-G.); (G.G.-L.); (J.G.-T.); (J.S.); (G.P.-B.)
| | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València (UPV), 46022 Valencia, Spain; (I.J.-G.); (G.G.-L.); (J.G.-T.); (J.S.); (G.P.-B.)
| | - Silvia García-Blasco
- Servicio de Rehabilitación, Departamento Salud Elche Hospital General de FISABIO, 03203 Elche, Spain; (S.G.-B.); (I.P.-M.)
| | - Isabel Pertusa-Mazón
- Servicio de Rehabilitación, Departamento Salud Elche Hospital General de FISABIO, 03203 Elche, Spain; (S.G.-B.); (I.P.-M.)
| | - Esther Soler-Climent
- Área de Investigación en Enfermería-Fisioterapia, Departamento Salud Elche Hospital General de FISABIO, 03203 Elche, Spain;
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València (UPV), 46022 Valencia, Spain; (I.J.-G.); (G.G.-L.); (J.G.-T.); (J.S.); (G.P.-B.)
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Bouchard-Tremblay J, Théberge M, Ayoub T, Martel-Brosseau G, Levasseur-Ouellet MP, Tremblay M, Houde-Thibeault A, Wotto EA, Carezolli FR, Hébert LJ, da Silva RA. Age- and Parkinson-related differences in trunk and lower-limb muscle activation during four balance tasks: A case-control pilot study. Clin Biomech (Bristol, Avon) 2024; 117:106298. [PMID: 38936292 DOI: 10.1016/j.clinbiomech.2024.106298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Poor postural control has been reported in people with Parkinson's disease, which could be explained by the changes in muscular activation patterns related to antigravitational muscles. This study aims to measure the muscle activation of antigravitational muscles during balance tasks in individuals, with and without Parkinson's. METHODS Sixteen (16) participants (9 with Parkinson's), aged ≥65 yrs., performed 2 × 30-s trials of 4 balance tasks (bipodal and semi-tandem opened eyes and closed eyes) on a force platform (center of pressure measurement); while surface electromyography measurements were obtained bilaterally on the multifidus at L5, biceps femoris and medialis gastrocnemius. Electromyography amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance task, to determine each muscle's activity level. FINDINGS The Parkinson's group reported lower muscle activation than control across tasks (in mean for multifidus = 8%, biceps femoris = 16%, gastrocnemius = 7%), although not statistically significant. Parkinson's reported significantly poorer postural control than control, mainly for the center of pressure sway ellipse area (p = 0.016) from challenge balance tasks such as semi-tandem. INTERPRETATION Poor postural control was confirmed in the Parkinson's group, but not significantly associated by the changes from muscle activation of trunk and lower limbs, during balance performance.
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Affiliation(s)
- Jérôme Bouchard-Tremblay
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1; Centre Intersectoriel en Santé Durable, Laboratoire de Recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Michael Théberge
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Tamami Ayoub
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Gabrielle Martel-Brosseau
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Marie-Pier Levasseur-Ouellet
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Maxim Tremblay
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Alexandra Houde-Thibeault
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Enafa Anais Wotto
- Centre Intersectoriel en Santé Durable, Laboratoire de Recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Fernando Rezende Carezolli
- Doctoral and Master Programs in Human Movement and Rehabilitation, University Center of Anapolis, Anapolis, GO, Brazil
| | - Luc J Hébert
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, Quebec, Canada, G1V 0A6
| | - Rubens A da Silva
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1; Centre Intersectoriel en Santé Durable, Laboratoire de Recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1; Doctoral and Master Programs in Human Movement and Rehabilitation, University Center of Anapolis, Anapolis, GO, Brazil; Centre Intégré de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics Services at La Baie Hospital, Saguenay, Quebec, Canada, G7H 7K9.
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Babeliowsky WA, Bot M, Potters WV, van den Munckhof P, Blok ER, de Bie RM, Schuurman R, van Rootselaar A. Deep Brain Stimulation for Orthostatic Tremor: An Observational Study. Mov Disord Clin Pract 2024; 11:676-685. [PMID: 38586984 PMCID: PMC11145120 DOI: 10.1002/mdc3.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Primary orthostatic tremor (OT) can affect patients' life. Treatment of OT with deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (Vim) is described in a limited number of patients. The Vim and posterior subthalamic area (PSA) can be targeted in a single trajectory, allowing both stimulation of the Vim and/or dentatorubrothalamic tract (DRT). In essential tremor this is currently often used with positive effects. OBJECTIVE To evaluate the efficacy of Vim/DRT-DBS in OT-patients, based on standing time and Quality of Life (QoL), also on the long-term. Furthermore, to relate stimulation of the Vim and DRT, medial lemniscus (ML) and pyramidal tract (PT) to beneficial clinical and side-effects. METHODS Nine severely affected OT-patients received bilateral Vim/DRT-DBS. Primary outcome measure was standing time; secondary measures included self-reported measures, neurophysiological measures, structural analyses, surgical complications, stimulation-induced side-effects, and QoL up to 56 months. Stimulation of volume of tissue activated (VTA) were related to outcome measures. RESULTS Average maximum standing time increased from 41.0 s ± 51.0 s to 109.3 s ± 65.0 s after 18 months, with improvements measured in seven of nine patients. VTA (n = 7) overlapped with the DRT in six patients and with the ML and/or PT in six patients. All patients experienced side-effects and QoL worsened during the first year after surgery, which improved again during long-term follow-up, although remaining below age-related normal values. Most patients reported a positive effect of DBS. CONCLUSION Vim/DRT-DBS improved standing time in patients with severe OT. Observed side-effects are possibly related to stimulation of the ML and PT.
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Affiliation(s)
- Wietske A. Babeliowsky
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Maarten Bot
- NeurosurgeryAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Wouter V. Potters
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | | | - Edwin R. Blok
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Rob M.A. de Bie
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Rick Schuurman
- NeurosurgeryAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Anne‐Fleur van Rootselaar
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
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Rong P, Heidrick L, Pattee GL. A multimodal approach to automated hierarchical assessment of bulbar involvement in amyotrophic lateral sclerosis. Front Neurol 2024; 15:1396002. [PMID: 38836001 PMCID: PMC11148322 DOI: 10.3389/fneur.2024.1396002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/01/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction As a hallmark feature of amyotrophic lateral sclerosis (ALS), bulbar involvement leads to progressive declines of speech and swallowing functions, significantly impacting social, emotional, and physical health, and quality of life. Standard clinical tools for bulbar assessment focus primarily on clinical symptoms and functional outcomes. However, ALS is known to have a long, clinically silent prodromal stage characterized by complex subclinical changes at various levels of the bulbar motor system. These changes accumulate over time and eventually culminate in clinical symptoms and functional declines. Detection of these subclinical changes is critical, both for mechanistic understanding of bulbar neuromuscular pathology and for optimal clinical management of bulbar dysfunction in ALS. To this end, we developed a novel multimodal measurement tool based on two clinically readily available, noninvasive instruments-facial surface electromyography (sEMG) and acoustic techniques-to hierarchically assess seven constructs of bulbar/speech motor control at the neuromuscular and acoustic levels. These constructs, including prosody, pause, functional connectivity, amplitude, rhythm, complexity, and regularity, are both mechanically and clinically relevant to bulbar involvement. Methods Using a custom-developed, fully automated data analytic algorithm, a variety of features were extracted from the sEMG and acoustic recordings of a speech task performed by 13 individuals with ALS and 10 neurologically healthy controls. These features were then factorized into 10 composite outcome measures using confirmatory factor analysis. Statistical and machine learning techniques were applied to these composite outcome measures to evaluate their reliability (internal consistency), validity (concurrent and construct), and efficacy for early detection and progress monitoring of bulbar involvement in ALS. Results The composite outcome measures were demonstrated to (1) be internally consistent and structurally valid in measuring the targeted constructs; (2) hold concurrent validity with the existing clinical and functional criteria for bulbar assessment; and (3) outperform the outcome measures obtained from each constituent modality in differentiating individuals with ALS from healthy controls. Moreover, the composite outcome measures combined demonstrated high efficacy for detecting subclinical changes in the targeted constructs, both during the prodromal stage and during the transition from prodromal to symptomatic stages. Discussion The findings provided compelling initial evidence for the utility of the multimodal measurement tool for improving early detection and progress monitoring of bulbar involvement in ALS, which have important implications in facilitating timely access to and delivery of optimal clinical care of bulbar dysfunction.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, United States
| | - Lindsey Heidrick
- Department of Hearing and Speech, University of Kansas Medical Center, Kansas City, KS, United States
| | - Gary L Pattee
- Neurology Associate P.C., Lincoln, NE, United States
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Lee DH, Woo BS, Park YH, Lee JH. General Treatments Promoting Independent Living in Parkinson's Patients and Physical Therapy Approaches for Improving Gait-A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:711. [PMID: 38792894 PMCID: PMC11123276 DOI: 10.3390/medicina60050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
This study delves into the multifaceted approaches to treating Parkinson's disease (PD), a neurodegenerative disorder primarily affecting motor function but also manifesting in a variety of symptoms that vary greatly among individuals. The complexity of PD symptoms necessitates a comprehensive treatment strategy that integrates surgical interventions, pharmacotherapy, and physical therapy to tailor to the unique needs of each patient. Surgical options, such as deep brain stimulation (DBS), have been pivotal for patients not responding adequately to medication, offering significant symptom relief. Pharmacotherapy remains a cornerstone of PD management, utilizing drugs like levodopa, dopamine agonists, and others to manage symptoms and, in some cases, slow down disease progression. However, these treatments often lead to complications over time, such as motor fluctuations and dyskinesias, highlighting the need for precise dosage adjustments and sometimes combination therapies to optimize patient outcomes. Physical therapy plays a critical role in addressing the motor symptoms of PD, including bradykinesia, muscle rigidity, tremors, postural instability, and akinesia. PT techniques are tailored to improve mobility, balance, strength, and overall quality of life. Strategies such as gait and balance training, strengthening exercises, stretching, and functional training are employed to mitigate symptoms and enhance functional independence. Specialized approaches like proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and the use of assistive devices are also integral to the rehabilitation process, aimed at improving patients' ability to perform daily activities and reducing the risk of falls. Innovations in technology have introduced robotic-assisted gait training (RAGT) and other assistive devices, offering new possibilities for patient care. These tools provide targeted support and feedback, allowing for more intensive and personalized rehabilitation sessions. Despite these advancements, high costs and accessibility issues remain challenges that need addressing. The inclusion of exercise and activity beyond structured PT sessions is encouraged, with evidence suggesting that regular physical activity can have neuroprotective effects, potentially slowing disease progression. Activities such as treadmill walking, cycling, and aquatic exercises not only improve physical symptoms but also contribute to emotional well-being and social interactions. In conclusion, treating PD requires a holistic approach that combines medical, surgical, and therapeutic strategies. While there is no cure, the goal is to maximize patients' functional abilities and quality of life through personalized treatment plans. This integrated approach, along with ongoing research and development of new therapies, offers hope for improving the management of PD and the lives of those affected by this challenging disease.
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Affiliation(s)
- Dae-Hwan Lee
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Bong-Sik Woo
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Yong-Hwa Park
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Jung-Ho Lee
- Department of Physical Therapy, University of Kyungdong, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Gangwon-do, Republic of Korea
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Mattila OP, Rantanen T, Rantakokko M, Karavirta L, Cronin N, Rantalainen T. Laboratory-assessed gait cycle entropy for classifying walking limitations among community-dwelling older adults. Exp Gerontol 2024; 188:112381. [PMID: 38382681 DOI: 10.1016/j.exger.2024.112381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Among older people, walking difficulty results from actual and perceived declines in physical capacities and environmental requirements for walking. We investigated whether the physiological complexity of the gait cycle covaries with experience of walking difficulty. Walking difficulty, gait speed, and gait cycle complexity were evaluated among 702 community-dwelling older people aged 75, 80, and 85 years who took part in the six-minute walking test in the research laboratory. Walking difficulty for 500 m was self-reported. Complexity was quantified as trunk acceleration multiscale entropy during the gait cycle. Complexity was then compared between those with no reported walking difficulty, walking with modifications but no difficulty, and those reporting walking difficulty. Higher entropy differentiated those reporting no difficulty walking from those reporting walking difficulties, while those reporting having modified their walking, but no difficulty formed an intermediate group that could not be clearly distinguished from the other categories. The higher complexity of the gait cycle is associated with slower gait speed and the presence of self-reported walking difficulty. Among older people, gait cycle complexity which primarily reflects the biomechanical dimensions of gait quality, could be a clinically meaningful measure reflecting specific features of the progression of walking decline. This encourages further investigation of the sensitivity of gait cycle complexity to detect early signs of gait deterioration and to support targeted interventions among older people.
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Affiliation(s)
- Olli-Pekka Mattila
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
| | - Taina Rantanen
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
| | - Merja Rantakokko
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland; Wellbeing Services County of Central Finlad, Finland.
| | - Laura Karavirta
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
| | - Neil Cronin
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
| | - Timo Rantalainen
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
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Carr JC, King AC. Sex differences in the fractal dynamics of force control during maximal handgrip. Neurosci Lett 2024; 820:137588. [PMID: 38086520 DOI: 10.1016/j.neulet.2023.137588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
This work examines the temporal structure of force fluctuations during maximal handgrip with detrended fluctuation analysis (DFA α). Here, we assess the influence of fatigue and sex on force complexity during unimanual handgrip for the fatigued and the contralateral, non-fatigued hand. Participants randomly completed experimental sessions requiring fatiguing handgrip contractions or control measurements only. Maximal unimanual forces of both hands were measured before and after the fatigue trial or a time-matched control visit. DFA revealed substantially lower alpha values for females (PRE = 1.15, POST = 1.25) compared to males (PRE = 1.30, POST = 1.33) regardless of fatigue (p < 0.01, d = 0.738) for the dominant hand with a similar pattern observed for the contralateral, non-fatigued hand (p = 0.045, d = 0.561). Females also showed greater alpha changes (Δ = 0.09) versus males (Δ = 0.01) following fatigue (p = 0.028, ηp2 = 0.151). The data provide evidence of reduced force complexity during successive maximal handgrip contractions for females, but not males. Our findings highlight task-specific factors involving force control and demonstrate the utility of complexity analyses to provide insights regarding the influence of sex on motor control strategies.
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Affiliation(s)
- Joshua C Carr
- Texas Christian University, Department of Kinesiology, Fort Worth, TX, United States; Anne Burnett Marion School of Medicine at Texas Christian University, Department of Medical Education, Fort Worth, TX, United States.
| | - Adam C King
- Texas Christian University, Department of Kinesiology, Fort Worth, TX, United States; Anne Burnett Marion School of Medicine at Texas Christian University, Department of Medical Education, Fort Worth, TX, United States.
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10
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Fleming JE, Senneff S, Lowery MM. Multivariable closed-loop control of deep brain stimulation for Parkinson's disease. J Neural Eng 2023; 20:056029. [PMID: 37733003 DOI: 10.1088/1741-2552/acfbfa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/21/2023] [Indexed: 09/22/2023]
Abstract
Objective. Closed-loop deep brain stimulation (DBS) methods for Parkinson's disease (PD) to-date modulate either stimulation amplitude or frequency to control a single biomarker. While good performance has been demonstrated for symptoms that are correlated with the chosen biomarker, suboptimal regulation can occur for uncorrelated symptoms or when the relationship between biomarker and symptom varies. Control of stimulation-induced side-effects is typically not considered.Approach.A multivariable control architecture is presented to selectively target suppression of either tremor or subthalamic nucleus beta band oscillations. DBS pulse amplitude and duration are modulated to maintain amplitude below a threshold and avoid stimulation of distal large diameter axons associated with stimulation-induced side effects. A supervisor selects between a bank of controllers which modulate DBS pulse amplitude to control rest tremor or beta activity depending on the level of muscle electromyographic (EMG) activity detected. A secondary controller limits pulse amplitude and modulates pulse duration to target smaller diameter axons lying close to the electrode. The control architecture was investigated in a computational model of the PD motor network which simulated the cortico-basal ganglia network, motoneuron pool, EMG and muscle force signals.Main results.Good control of both rest tremor and beta activity was observed with reduced power delivered when compared with conventional open loop stimulation, The supervisor avoided over- or under-stimulation which occurred when using a single controller tuned to one biomarker. When DBS amplitude was constrained, the secondary controller maintained the efficacy of stimulation by increasing pulse duration to compensate for reduced amplitude. Dual parameter control delivered effective control of the target biomarkers, with additional savings in the power delivered.Significance.Non-linear multivariable control can enable targeted suppression of motor symptoms for PD patients. Moreover, dual parameter control facilitates automatic regulation of the stimulation therapeutic dosage to prevent overstimulation, whilst providing additional power savings.
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Affiliation(s)
- John E Fleming
- Neuromuscular Systems Laboratory, UCD School of Electrical & Electronic Engineering, University College Dublin, Dublin, Ireland
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford OX1 3TH, United Kingdom
| | - Sageanne Senneff
- Neuromuscular Systems Laboratory, UCD School of Electrical & Electronic Engineering, University College Dublin, Dublin, Ireland
| | - Madeleine M Lowery
- Neuromuscular Systems Laboratory, UCD School of Electrical & Electronic Engineering, University College Dublin, Dublin, Ireland
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11
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Rong P, Benson J. Intergenerational choral singing to improve communication outcomes in Parkinson's disease: Development of a theoretical framework and an integrated measurement tool. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:722-745. [PMID: 36106430 DOI: 10.1080/17549507.2022.2110281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: This study presented an initial step towards developing the evidence base for intergenerational choral singing as a communication-focussed rehabilitative approach for Parkinson's disease (PD).Method: A theoretical framework was established to conceptualise the rehabilitative effect of intergenerational choral singing on four domains of communication impairments - motor drive, timing mechanism, sensorimotor integration, higher-level cognitive and affective functions - as well as activity/participation, and quality of life. A computer-assisted multidimensional acoustic analysis was developed to objectively assess the targeted domains of communication impairments. Voice Handicap Index and the World Health Organization's Quality of Life assessment-abbreviated version were used to obtain patient-reported outcomes at the activity/participation and quality of life levels. As a proof of concept, a single subject with PD was recruited to participate in 9 weekly 1-h intergenerational choir rehearsals. The subject was assessed before, 1 week post, and 8 weeks post-choir.Result: Notable trends of improvement were observed in multiple domains of communication impairments at 1 week post-choir. Some improvements were maintained at 8 weeks post-choir. Patient-reported outcomes exhibited limited pre-post changes.Conclusion: This study provided the theoretical groundwork and an empirical measurement tool for future validation of intergenerational choral singing as a novel rehabilitation for PD.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, KS, USA and
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12
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Smart RR, Toumi A, Harris OD, Cremoux S, Dalton BH, Wile DJ, Jakobi JM. Intermuscular coherence of plantar and dorsiflexor muscles in older adults with Parkinson's disease and age-matched controls during bipedal and unipedal stance. Front Aging Neurosci 2023; 15:1093295. [PMID: 36891558 PMCID: PMC9986294 DOI: 10.3389/fnagi.2023.1093295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Postural instability increases with age and is exacerbated in neurological disorders such as Parkinson's disease (PD). Reducing the base of support from bipedal to unipedal stance increases center of pressure (CoP) parameters and intermuscular coherence in lower-leg muscles of healthy older adults. To further develop an understanding of postural control in an altered state of neurological impairment, we explored intermuscular coherence in lower-leg muscles and CoP displacement in older adults with PD. Methods This study measured surface EMG from the medial (MG) and lateral (LG) gastrocnemii, soleus (SOL), and tibialis anterior (TA), and examined EMG amplitude and intermuscular coherence during bipedal and unipedal stance on a force plate with firm (no foam) and compliant (standing on foam) surface conditions in nine older adults with PD (70±5 years, 6 females) and 8 age-matched non-Parkinsonian older adults (5 females). Intermuscular coherence was analyzed between agonist-agonist and agonist-antagonist muscle pairs in the alpha (8-13 Hz) and beta (15-35 Hz) frequency bands. Results CoP parameters increased from bipedal to unipedal stance in both groups (p < 0.01), but did not increase from the firm to compliant surface condition (p > 0.05). During unipedal stance, CoP path length was shorter in older adults with PD (2027.9 ± 1074.1 mm) compared to controls (3128.5 ± 1198.7 mm) (p < 0.01). Alpha and beta agonist-agonist and agonist-antagonist coherence increased by 28% from bipedal to unipedal stance (p > 0.05), but did not differ between older adults with PD (0.09 ± 0.07) and controls (0.08 ± 0.05) (p > 0.05). The older adults with PD also had greater normalized EMG amplitude of the LG (63.5 ± 31.7%) and TA (60.6 ± 38.4%) during the balance tasks (p > 0.05) than the non-Parkinsonian counterparts. Discussion Older adults with PD had shorter path lengths during unipedal stance and required greater muscle activation than older adults without PD to perform the tasks, but intermuscular coherence did not differ between the groups. This may be attributable to their early disease stage and high motor function.
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Affiliation(s)
- Rowan R Smart
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Anis Toumi
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Owen D Harris
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Sylvain Cremoux
- Centre de Recherche Cerveau et Cognition, UMR CNRS, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Brian H Dalton
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Daryl J Wile
- Southern Medical Program, Centre for Chronic Disease Prevention and Management, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Jennifer M Jakobi
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
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13
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Rong P, Pattee GL. A multidimensional facial surface EMG analysis for objective assessment of bulbar involvement in amyotrophic lateral sclerosis. Clin Neurophysiol 2022; 135:74-84. [DOI: 10.1016/j.clinph.2021.11.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 11/03/2022]
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14
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Breu MS, Schneider M, Klemt J, Cebi I, Gharabaghi A, Weiss D. People With Parkinson’s Disease and Freezing of Gait Show Abnormal Low Frequency Activity of Antagonistic Leg Muscles. Front Hum Neurosci 2022; 15:733067. [PMID: 35153698 PMCID: PMC8825470 DOI: 10.3389/fnhum.2021.733067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Freezing of gait is detrimental to patients with idiopathic Parkinson’s disease (PD). Its pathophysiology represents a multilevel failure of motor processing in the cortical, subcortical, and brainstem circuits, ultimately resulting in ineffective motor output of the spinal pattern generator. Electrophysiological studies pointed to abnormalities of oscillatory activity in freezers that covered a broad frequency range including the theta, alpha, and beta bands. We explored muscular frequency domain activity with respect to freezing, and used deep brain stimulation to modulate these rhythms thereby evaluating the supraspinal contributions to spinal motor neuron activity. Methods We analyzed 9 PD freezers and 16 healthy controls (HC). We studied the patients after overnight withdrawal of dopaminergic medication with stimulation off, stimulation of the subthalamic nucleus (STN-DBSonly) or the substantia nigra pars reticulate (SNr-DBSonly), respectively. Patients performed a walking paradigm passing a narrow obstacle. We analyzed the frequency-domain spectra of the tibialis anterior (TA) and gastrocnemius (GA) muscles in ‘regular gait’ and during the ‘freezing’ episodes. Results In stimulation off, PD freezers showed increased muscle activity of the alpha and low-beta band compared to HC in both TA and GA. This activity increase was present during straight walking and during the freezes to similar extent. STN- but not SNr-DBS decreased this activity and paralleled the clinical improvement of freezing. Conclusion We found increased muscle activation of the alpha and lower beta band in PD freezers compared to HC, and this was attenuated with STN-DBS. Future studies may use combined recordings of local field potentials, electroencephalography (EEG), and electromyography (EMG) to interrogate the supraspinal circuit mechanisms of the pathological activation pattern of the spinal pattern generator.
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Affiliation(s)
- Maria-Sophie Breu
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
- *Correspondence: Maria-Sophie Breu,
| | - Marlieke Schneider
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Johannes Klemt
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Idil Cebi
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Alireza Gharabaghi
- Centre for Neurosurgery, Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Daniel Weiss
- Centre of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
- Daniel Weiss,
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15
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Flood MW, Grimm B. EntropyHub: An open-source toolkit for entropic time series analysis. PLoS One 2021; 16:e0259448. [PMID: 34735497 PMCID: PMC8568273 DOI: 10.1371/journal.pone.0259448] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
An increasing number of studies across many research fields from biomedical engineering to finance are employing measures of entropy to quantify the regularity, variability or randomness of time series and image data. Entropy, as it relates to information theory and dynamical systems theory, can be estimated in many ways, with newly developed methods being continuously introduced in the scientific literature. Despite the growing interest in entropic time series and image analysis, there is a shortage of validated, open-source software tools that enable researchers to apply these methods. To date, packages for performing entropy analysis are often run using graphical user interfaces, lack the necessary supporting documentation, or do not include functions for more advanced entropy methods, such as cross-entropy, multiscale cross-entropy or bidimensional entropy. In light of this, this paper introduces EntropyHub, an open-source toolkit for performing entropic time series analysis in MATLAB, Python and Julia. EntropyHub (version 0.1) provides an extensive range of more than forty functions for estimating cross-, multiscale, multiscale cross-, and bidimensional entropy, each including a number of keyword arguments that allows the user to specify multiple parameters in the entropy calculation. Instructions for installation, descriptions of function syntax, and examples of use are fully detailed in the supporting documentation, available on the EntropyHub website- www.EntropyHub.xyz. Compatible with Windows, Mac and Linux operating systems, EntropyHub is hosted on GitHub, as well as the native package repository for MATLAB, Python and Julia, respectively. The goal of EntropyHub is to integrate the many established entropy methods into one complete resource, providing tools that make advanced entropic time series analysis straightforward and reproducible.
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Affiliation(s)
- Matthew W. Flood
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Eich, Luxembourg
| | - Bernd Grimm
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Eich, Luxembourg
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16
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Pakniyat N, Namazi H. Complexity-Based Analysis of the Variations of Brain and Muscle Reactions in Walking and Standing Balance While Receiving Different Perturbations. Front Hum Neurosci 2021; 15:749082. [PMID: 34690727 PMCID: PMC8531105 DOI: 10.3389/fnhum.2021.749082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
In this article, we evaluated the variations of the brain and muscle activations while subjects are exposed to different perturbations to walking and standing balance. Since EEG and EMG signals have complex structures, we utilized the complexity-based analysis. Specifically, we analyzed the fractal dimension and sample entropy of Electroencephalogram (EEG) and Electromyogram (EMG) signals while subjects walked and stood, and received different perturbations in the form of pulling and rotation (via virtual reality). The results showed that the complexity of EEG signals was higher in walking than standing as the result of different perturbations. However, the complexity of EMG signals was higher in standing than walking as the result of different perturbations. Therefore, the alterations in the complexity of EEG and EMG signals are inversely correlated. This analysis could be extended to investigate simultaneous variations of rhythmic patterns of other physiological signals while subjects perform different activities.
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Affiliation(s)
| | - Hamidreza Namazi
- Incubator of Kinanthropology Research, Faculty of Sports Studies, Masaryk University, Brno, Czechia.,College of Engineering and Science, Victoria University, Melbourne, VIC, Australia
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17
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Pethick J, Winter SL, Burnley M. Physiological complexity: influence of ageing, disease and neuromuscular fatigue on muscle force and torque fluctuations. Exp Physiol 2021; 106:2046-2059. [PMID: 34472160 DOI: 10.1113/ep089711] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/26/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the topic of this review? Physiological complexity in muscle force and torque fluctuations, specifically the quantification of complexity, how neuromuscular complexityis altered by perturbations and the potential mechanism underlying changes in neuromuscular complexity. What advances does it highlight? The necessity to calculate both magnitude- and complexity-based measures for the thorough evaluation of force/torque fluctuations. Also the need for further research on neuromuscular complexity, particularly how it relates to the performance of functional activities (e.g. manual dexterity, balance, locomotion). ABSTRACT Physiological time series produce inherently complex fluctuations. In the last 30 years, methods have been developed to characterise these fluctuations, and have revealed that they contain information about the function of the system producing them. Two broad classes of metrics are used: (1) those which quantify the regularity of the signal (e.g. entropy metrics); and (2) those which quantify the fractal properties of the signal (e.g. detrended fluctuation analysis). Using these techniques, it has been demonstrated that ageing results in a loss of complexity in the time series of a multitude of signals, including heart rate, respiration, gait and, crucially, muscle force or torque output. This suggests that as the body ages, physiological systems become less adaptable (i.e. the systems' ability to respond rapidly to a changing external environment is diminished). More recently, it has been shown that neuromuscular fatigue causes a substantial loss of muscle torque complexity, a process that can be observed in a few minutes, rather than the decades it requires for the same system to degrade with ageing. The loss of torque complexity with neuromuscular fatigue appears to occur exclusively above the critical torque (at least for tasks lasting up to 30 min). The loss of torque complexity can be exacerbated with previous exercise of the same limb, and reduced by the administration of caffeine, suggesting both peripheral and central mechanisms contribute to this loss. The mechanisms underpinning the loss of complexity are not known but may be related to altered motor unit behaviour as the muscle fatigues.
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Affiliation(s)
- Jamie Pethick
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Samantha L Winter
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mark Burnley
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
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18
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Tian N, Chen Y, Sun W, Liu H, Wang X, Yan T, Song R. Investigating the Stroke- and Aging-Related Changes in Global and Instantaneous Intermuscular Coupling Using Cross-Fuzzy Entropy. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1573-1582. [PMID: 34329167 DOI: 10.1109/tnsre.2021.3101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Intermuscular coupling is essential in the coordination of agonist and antagonist muscles. However, its dynamic characteristics are not fully understood, especially the alterations of intermuscular coupling induced by stroke and aging. This study aimed to investigate the aging- and stroke-related changes in the global and instantaneous intermuscular coupling between agonist and antagonist muscles. In the experiment, 8 patients after stroke, 18 healthy young subjects and 10 healthy middle-aged subjects were recruited and instructed to finish the elbow flexion and extension tasks. Cross-fuzzy entropy (C-FuzzyEn) and instantaneous C-FuzzyEn ( [Formula: see text]-FuzzyEn) based on a sliding window were used to analyze the global and instantaneous intermuscular coupling, respectively. Instantaneous FuzzyEn ( i -FuzzyEn) based on a sliding window was also applied to investigate the dynamic complexity of the EMG segment. Pearson correlation analysis revealed that i -FuzzyEn values were negatively correlated with [Formula: see text]-FuzzyEn values in most cases, which implied that there was a positive correlation between EMG complexity and intermuscular coupling. The C-FuzzyEn values between agonist and antagonist muscles increased significantly in both tasks of the patients after stroke than those of the healthy subjects (p < 0.05), which might be due to the decrease in intermuscular coupling induced by the damage of the corticospinal pathways after stroke. The combined application of C-FuzzyEn, [Formula: see text]-FuzzyEn and i -FuzzyEn provides a more comprehensive understanding of the global and instantaneous intermuscular coupling.
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19
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Khan NC, Pandey V, Gajos KZ, Gupta AS. Free-Living Motor Activity Monitoring in Ataxia-Telangiectasia. THE CEREBELLUM 2021; 21:368-379. [PMID: 34302287 PMCID: PMC8302464 DOI: 10.1007/s12311-021-01306-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/12/2022]
Abstract
With disease-modifying approaches under evaluation in ataxia-telangiectasia and other ataxias, there is a need for objective and reliable biomarkers of free-living motor function. In this study, we test the hypothesis that metrics derived from a single wrist sensor worn at home provide accurate, reliable, and interpretable information about neurological disease severity in children with A-T. A total of 15 children with A-T and 15 age- and sex-matched controls wore a sensor with a triaxial accelerometer on their dominant wrist for 1 week at home. Activity intensity measures, derived from the sensor data, were compared with in-person neurological evaluation on the Brief Ataxia Rating Scale (BARS) and performance on a validated computer mouse task. Children with A-T were inactive the same proportion of each day as controls but produced more low intensity movements (p < 0.01; Cohen’s d = 1.48) and fewer high intensity movements (p < 0.001; Cohen’s d = 1.71). The range of activity intensities was markedly reduced in A-T compared to controls (p < 0.0001; Cohen’s d = 2.72). The activity metrics correlated strongly with arm, gait, and total clinical severity (r: 0.71–0.87; p < 0.0001), correlated with specific computer task motor features (r: 0.67–0.92; p < 0.01), demonstrated high reliability (r: 0.86–0.93; p < 0.00001), and were not significantly influenced by age in the healthy control group. Motor activity metrics from a single, inexpensive wrist sensor during free-living behavior provide accurate and reliable information about diagnosis, neurological disease severity, and motor performance. These low-burden measurements are applicable independent of ambulatory status and are potential digital behavioral biomarkers in A-T.
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Affiliation(s)
- Nergis C Khan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,School of Medicine, Stanford University, Stanford, CA, USA
| | - Vineet Pandey
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - Krzysztof Z Gajos
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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20
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Laine CM, Cohn BA, Valero-Cuevas FJ. Temporal control of muscle synergies is linked with alpha-band neural drive. J Physiol 2021; 599:3385-3402. [PMID: 33963545 DOI: 10.1113/jp281232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/21/2021] [Indexed: 12/19/2022] Open
Abstract
KEY POINTS It is theorized that the nervous system controls groups of muscles together as functional units, or 'synergies', resulting in correlated electromyographic (EMG) signals among muscles. However, such correlation does not necessarily imply group-level neural control. Oscillatory synchronization (coherence) among EMG signals implies neural coupling, but it is not clear how this relates to control of muscle synergies. EMG was recorded from seven arm muscles of 10 adult participants rotating an upper limb ergometer, and EMG-EMG coherence, EMG amplitude correlations and their relationship with each other were characterized. A novel method to derive multi-muscle synergies from EMG-EMG coherence is presented and these are compared with classically defined synergies. Coherent alpha-band (8-16 Hz) drive was strongest among muscles whose gross activity levels are well correlated within a given task. The cross-muscle distribution and temporal modulation of coherent alpha-band drive suggests a possible role in the neural coordination/monitoring of synergies. ABSTRACT During movement, groups of muscles may be controlled together by the nervous system as an adaptable functional entity, or 'synergy'. The rules governing when (or if) this occurs during voluntary behaviour in humans are not well understood, at least in part because synergies are usually defined by correlated patterns of muscle activity without regard for the underlying structure of their neural control. In this study, we investigated the extent to which comodulation of muscle output (i.e. correlation of electromyographic (EMG) amplitudes) implies that muscles share intermuscular neural input (assessed via EMG-EMG coherence analysis). We first examined this relationship among pairs of upper limb muscles engaged in an arm cycling task. We then applied a novel multidimensional EMG-EMG coherence analysis allowing synergies to be characterized on the basis of shared neural drive. We found that alpha-band coherence (8-16 Hz) is related to the degree to which overall muscle activity levels correlate over time. The extension of this coherence analysis to describe the cross-muscle distribution and temporal modulation of alpha-band drive revealed a close match to the temporal and structural features of traditionally defined muscle synergies. Interestingly, the coherence-derived neural drive was inversely associated with, and preceded, changes in EMG amplitudes by ∼200 ms. Our novel characterization of how alpha-band neural drive is dynamically distributed among muscles is a fundamental step forward in understanding the neural origins and correlates of muscle synergies.
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Affiliation(s)
- Christopher M Laine
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Brian A Cohn
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Francisco J Valero-Cuevas
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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21
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Relationship between Muscular Activity and Postural Control Changes after Proprioceptive Focal Stimulation (Equistasi ®) in Middle-Moderate Parkinson's Disease Patients: An Explorative Study. SENSORS 2021; 21:s21020560. [PMID: 33466838 PMCID: PMC7830724 DOI: 10.3390/s21020560] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/28/2022]
Abstract
The aim of this study was to investigate the effects of Equistasi®, a wearable device, on the relationship between muscular activity and postural control changes in a sample of 25 Parkinson’s disease (PD) subjects. Gait analysis was carried out through a six-cameras stereophotogrammetric system synchronized with two force plates, an eight-channel surface electromyographic system, recording the activity of four muscles bilaterally: Rectus femoris, tibialis anterior (TA), biceps femoris, and gastrocnemius lateralis (GL). The peak of the envelope (PoE) and its occurrence within the gait cycle (position of the peak of the envelope, PPoE) were calculated. Frequency-domain posturographic parameters were extracted while standing still on a force plate in eyes open and closed conditions for 60 s. After the treatment with Equistasi®, the mid-low (0.5–0.75) Hz and mid-high (0.75–1 Hz) components associated with the vestibular and somatosensory systems, PoE and PPoE, displayed a shift toward the values registered on the controls. Furthermore, a correlation was found between changes in proprioception (power spectrum frequencies during the Romberg Test) and the activity of GL, BF (PoE), and TA (PPoE). Results of this study could provide a quantitative estimation of the effects of a neurorehabilitation device on the peripheral and central nervous system in PD.
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McManus L, De Vito G, Lowery MM. Analysis and Biophysics of Surface EMG for Physiotherapists and Kinesiologists: Toward a Common Language With Rehabilitation Engineers. Front Neurol 2020; 11:576729. [PMID: 33178118 PMCID: PMC7594523 DOI: 10.3389/fneur.2020.576729] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022] Open
Abstract
Recent decades have seen a move toward evidence-based medicine to inform the clinical decision-making process with reproducible findings from high-quality research studies. There is a need for objective, quantitative measurement tools to increase the reliability and reproducibility of studies evaluating the efficacy of healthcare interventions, particularly in the field of physical and rehabilitative medicine. Surface electromyography (sEMG) is a non-invasive measure of muscle activity that is widely used in research but is under-utilized as a clinical tool in rehabilitative medicine. Other types of electrophysiological signals (e.g., electrocardiography, electroencephalography, intramuscular EMG) are commonly recorded by healthcare practitioners, however, sEMG has yet to successfully transition to clinical practice. Surface EMG has clear clinical potential as an indicator of muscle activation, however reliable extraction of information requires knowledge of the appropriate methods for recording and analyzing sEMG and an understanding of the underlying biophysics. These concepts are generally not covered in sufficient depth in the standard curriculum for physiotherapists and kinesiologists to encourage a confident use of sEMG in clinical practice. In addition, the common perception of sEMG as a specialized topic means that the clinical potential of sEMG and the pathways to application in practice are often not apparent. The aim of this paper is to address barriers to the translation of sEMG by emphasizing its benefits as an objective clinical tool and by overcoming its perceived complexity. The many useful clinical applications of sEMG are highlighted and examples provided to illustrate how it can be implemented in practice. The paper outlines how fundamental biophysics and EMG signal processing concepts could be presented to a non-technical audience. An accompanying tutorial with sample data and code is provided which could be used as a tool for teaching or self-guided learning. The importance of observing sEMG in routine use in clinic is identified as an essential part of the effective communication of sEMG recording and signal analysis methods. Highlighting the advantages of sEMG as a clinical tool and reducing its perceived complexity could bridge the gap between theoretical knowledge and practical application and provide the impetus for the widespread use of sEMG in clinic.
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Affiliation(s)
- Lara McManus
- Neuromuscular Systems Laboratory, School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | - Giuseppe De Vito
- Neuromuscular Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Madeleine M Lowery
- Neuromuscular Systems Laboratory, School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
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Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review. NPJ PARKINSONS DISEASE 2020; 6:22. [PMID: 32964107 PMCID: PMC7481232 DOI: 10.1038/s41531-020-00119-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.
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Usler ER, Wei X, Simione M, Richburg B, Stipancic KL, Green JR. Modulation of Intermuscular Beta Coherence in Different Rhythmic Mandibular Behaviors. Front Hum Neurosci 2020; 14:302. [PMID: 32848676 PMCID: PMC7406789 DOI: 10.3389/fnhum.2020.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Jaw movement during chewing and speech is facilitated by neural activation patterns for opening and closing movements of the mandible. This study investigated anatomic- and task-dependent differences in intermuscular coherence (IMC) and their association with the parameters of jaw muscle activity using surface electromyography (sEMG). Methods We recorded sEMG activation from bilateral and ipsilateral jaw-closing muscle pairs during non-nutritive and nutritive chewing, and during a syllable repetition task. IMC and cross-correlational analyses between bilateral and ipsilateral muscle pairs were performed. Results Intermuscular coherence in the beta band was statistically significant between agonist jaw-closing muscle pairs, with beta IMC weaker for rapid syllable repetition compared to chewing tasks. Cross-correlational analysis of muscle co-activation, as well as sEMG burst amplitude, was positively associated with beta IMC strength. Discussion Beta IMC was influenced heavily by task-dependent behavioral goals and physiologic demands, which was interpreted as evidence of shared neural drive among jaw-closing muscles.
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Affiliation(s)
- Evan R. Usler
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Delaware, Newark, DE, United States
- *Correspondence: Evan R. Usler,
| | - Xiaomei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meg Simione
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Brian Richburg
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, United States
| | - Kaila L. Stipancic
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, United States
| | - Jordan R. Green
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, United States
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McManus K, McGrath D, Greene BR, Lennon O, McMahon L, Caulfield B. Impact of Exercise Intervention in Parkinson's Disease can be Quantified Using Inertial Sensor Data and Clinical Tests. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3507-3510. [PMID: 31946634 DOI: 10.1109/embc.2019.8857162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Parkinson's Disease (PD) has the second-highest prevalence rate of all neurodegenerative disorders. It effects approximately 1% of the population over the age of 60, with this proportion rising further, in more elderly cohorts. PD manifests as several motor and non-motor disfunctions, which develop progressively over time. Gait and mobility problems are amongst the most debilitating symptoms for people with PD. They severely affect a person's ability to carry out daily activities of living and can lead to a decreased quality of life. However, recent research has shown exercise intervention to be effective in improving gait, and overall functional mobility, in persons with PD. In this paper, we study the effect of an exercise intervention, comprised of three separate methods of exercise - all which have been shown previously to be effective individually - on a cohort with early-to-moderate stage PD. We also examine the ability of the Timed Up and Go (TUG) test - instrumented with inertial sensors (QTUG) - and the Unified Parkinson's Disease Rating Scale (UPDRS) Part III in measuring the response to the exercise intervention. We found that TUG time and the QTUG-derived frailty index - along with many additional parameters derived from QTUG - showed a significant change between baseline and post-intervention, while the UPDRS Part III score did not. The direction of the changes in the QTUG parameters also align with the expected exercise effect from the literature. Our results suggest QTUG may be a more sensitive measure than UPDRS Part III for assessing the effect of exercise intervention on functional mobility in people with early-to-moderate stage PD.
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Laine CM, Valero-Cuevas FJ. Parkinson's Disease Exhibits Amplified Intermuscular Coherence During Dynamic Voluntary Action. Front Neurol 2020; 11:204. [PMID: 32308641 PMCID: PMC7145888 DOI: 10.3389/fneur.2020.00204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/09/2020] [Indexed: 12/29/2022] Open
Abstract
Parkinson's disease (PD) is typically diagnosed and evaluated on the basis of overt motor dysfunction, however, subtle changes in the frequency spectrum of neural drive to muscles have been reported as well. During dynamic actions, coactive muscles of healthy adults often share a common source of 6-15 Hz (alpha-band) neural drive, creating synchronous alpha-band activity in their EMG signals. Individuals with PD commonly exhibit kinetic action tremor at similar frequencies, but the potential relationship between the intermuscular alpha-band neural drive seen in healthy adults and the action tremor associated with PD is not well-understood. A close relationship is most tenable during voluntary dynamic tasks where alpha-band neural drive is strongest in healthy adults, and where neural circuits affected by PD are most engaged. In this study, we characterized the frequency spectrum of EMG synchronization (intermuscular coherence) in 16 participants with PD and 15 age-matched controls during two dynamic motor tasks: (1) rotation of a dial between the thumb and index finger, and (2) dynamic scaling of isometric precision pinch force. These tasks produce different profiles of coherence between the first dorsal interosseous and abductor pollicis brevis muscles. We sought to determine if alpha-band intermuscular coherence would be amplified in participants with PD relative to controls, if such differences would be task-specific, and if they would correlate with symptom severity. We found that relative to controls, the PD group displayed amplified, but similarly task-dependent, coherence in the alpha-band. The magnitude of coherence during the rotation task correlated with overall symptom severity as per the UPDRS rating scale. Finally, we explored the potential for our coherence measures, with no additional information, to discriminate individuals with PD from controls. The area under the Receiver Operating Characteristic curve (AUC) indicated a clear separation between groups (AUC = 0.96), even though participants with PD were on their typical medication and displayed only mild-moderate symptoms. We conclude that a task-dependent, intermuscular neural drive within the alpha-band is amplified in PD. Its quantification via intermuscular coherence analysis may provide a useful tool for detecting the presence of PD, or assessing its progression.
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Affiliation(s)
- Christopher M Laine
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Francisco J Valero-Cuevas
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
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Schaefer LV, Bittmann FN. Parkinson patients without tremor show changed patterns of mechanical muscle oscillations during a specific bilateral motor task compared to controls. Sci Rep 2020; 10:1168. [PMID: 31980683 PMCID: PMC6981166 DOI: 10.1038/s41598-020-57766-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
The pathophysiology of Parkinson's disease (PD) is still not understood. There are investigations which show a changed oscillatory behaviour of brain circuits or changes in variability of, e.g., gait parameters in PD. The aim of this study was to investigate whether or not the motor output differs between PD patients and healthy controls. Thereby, patients without tremor are investigated in the medication off state performing a special bilateral isometric motor task. The force and accelerations (ACC) were recorded as well as the Mechanomyography (MMG) of the biceps brachii, the brachioradialis and of the pectoralis major muscles using piezoelectric-sensors during the bilateral motor task at 60% of the maximal isometric contraction. The frequency, a specific power ratio, the amplitude variation and the slope of amplitudes were analysed. The results indicate that the oscillatory behaviour of motor output in PD patients without tremor deviates from controls: thereby, the 95%-confidence-intervals of power ratio and of amplitude variation of all signals are disjoint between PD and controls and show significant differences in group comparisons (power ratio: p = 0.000-0.004, r = 0.441-0.579; amplitude variation: p = 0.000-0.001, r = 0.37-0.67). The mean frequency shows a significant difference for ACC (p = 0.009, r = 0.43), but not for MMG. It remains open, whether this muscular output reflects changes of brain circuits and whether the results are reproducible and specific for PD.
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Affiliation(s)
- Laura V Schaefer
- Regulative Physiology and Prevention, Department Sports and Health Sciences, University of Potsdam, Potsdam, Germany.
| | - Frank N Bittmann
- Regulative Physiology and Prevention, Department Sports and Health Sciences, University of Potsdam, Potsdam, Germany
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McManus L, Botelho DP, Flood MW, Lowery MM. The Influence of Force Level and Motor Unit Coherence on Nonlinear Surface EMG Features Examined Using Model Simulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6616-6619. [PMID: 31947358 DOI: 10.1109/embc.2019.8857299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Nonlinear features extracted from surface EMG signals have been previously used to infer information on coherent or synchronous activity in the underlying motor unit discharges. However, it has not yet been assessed how these features are affected by the density of the surface EMG signal, and whether changes in the level of muscle activation can influence the effective detection of correlated motor unit firing. To examine this, a motoneuron pool model receiving a beta-band modulated cortical input was used to generate correlated motor unit firing trains. These firing trains were convolved with motor unit action potentials generated from an anatomically accurate electrophysiological model of the first dorsal interosseous muscle. The sample entropy (SampEn) and percentage determinism (%DET) of recurrence quantification analysis were calculated from the composite surface EMG signals, for signals comprised of both correlated and uncorrelated motor unit firing trains. The results show that although both SampEn and %DET are influenced by motor unit coherence, they are differentially affected by muscle activation and motor unit distribution. The results also suggest that sample entropy may provide a more accurate assessment of the underlying motor unit coherence than percentage determinism, as it is less sensitive to factors unrelated to motor unit synchrony.
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Slope Entropy: A New Time Series Complexity Estimator Based on Both Symbolic Patterns and Amplitude Information. ENTROPY 2019. [PMCID: PMC7514512 DOI: 10.3390/e21121167] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The development of new measures and algorithms to quantify the entropy or related concepts of a data series is a continuous effort that has brought many innovations in this regard in recent years. The ultimate goal is usually to find new methods with a higher discriminating power, more efficient, more robust to noise and artifacts, less dependent on parameters or configurations, or any other possibly desirable feature. Among all these methods, Permutation Entropy (PE) is a complexity estimator for a time series that stands out due to its many strengths, with very few weaknesses. One of these weaknesses is the PE’s disregarding of time series amplitude information. Some PE algorithm modifications have been proposed in order to introduce such information into the calculations. We propose in this paper a new method, Slope Entropy (SlopEn), that also addresses this flaw but in a different way, keeping the symbolic representation of subsequences using a novel encoding method based on the slope generated by two consecutive data samples. By means of a thorough and extensive set of comparative experiments with PE and Sample Entropy (SampEn), we demonstrate that SlopEn is a very promising method with clearly a better time series classification performance than those previous methods.
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McManus L, Flood MW, Lowery MM. Beta-band motor unit coherence and nonlinear surface EMG features of the first dorsal interosseous muscle vary with force. J Neurophysiol 2019; 122:1147-1162. [PMID: 31365308 DOI: 10.1152/jn.00228.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Motor unit firing times are weakly coupled across a range of frequencies during voluntary contractions. Coherent activity within the beta-band (15-35 Hz) has been linked to oscillatory cortical processes, providing evidence of functional connectivity between the motoneuron pool and motor cortex. The aim of this study was to investigate whether beta-band motor unit coherence is altered with increasing abduction force in the first dorsal interosseous muscle. Coherence between motor unit firing times, extracted from decomposed surface electromyography (EMG) signals, was investigated in 17 subjects at 10, 20, 30, and 40% of maximum voluntary contraction. Corresponding changes in nonlinear surface EMG features (specifically sample entropy and determinism, which are sensitive to motor unit synchronization) were also examined. A reduction in beta-band and alpha-band coherence was observed as force increased [F(3, 151) = 32, P < 0.001 and F(3, 151) = 27, P < 0.001, respectively], accompanied by corresponding changes in nonlinear surface EMG features. A significant relationship between the nonlinear features and motor unit coherence was also detected (r = -0.43 ± 0.1 and r = 0.45 ± 0.1 for sample entropy and determinism, respectively; both P < 0.001). The reduction in beta-band coherence suggests a change in the relative contribution of correlated and uncorrelated presynaptic inputs to the motoneuron pool, and/or a decrease in the responsiveness of the motoneuron pool to synchronous inputs at higher forces. The study highlights the importance of considering muscle activation when investigating changes in motor unit coherence or nonlinear EMG features and examines other factors that can influence coherence estimation.NEW & NOTEWORTHY Intramuscular alpha- and beta-band coherence decreased as muscle contraction force increased. Beta-band coherence was higher in groups of high-threshold motor units than in simultaneously active lower threshold units. Alterations in motor unit coherence with increases or decreases in force and with the onset of fatigue were accompanied by corresponding changes in surface electromyography sample entropy and determinism. Mixed-model analysis indicated mean firing rate and number of motor units also influenced the coherence estimate.
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Affiliation(s)
- Lara McManus
- School of Electrical and Electronic Engineering, University College Dublin, Belfield, Dublin, Ireland
| | - Matthew W Flood
- School of Electrical and Electronic Engineering, University College Dublin, Belfield, Dublin, Ireland
| | - Madeleine M Lowery
- School of Electrical and Electronic Engineering, University College Dublin, Belfield, Dublin, Ireland
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