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Lencioni T, Bandini V, Schenone C, Lagostina M, Aiello A, Schenone A, Ferrarin M, Trompetto C, Mori L. Upper Limbs Muscle Co-Contraction Changes Correlate With The Physical Motor Impairments in CMT. J Neuromuscul Dis 2024; 11:815-828. [PMID: 38669555 PMCID: PMC11307089 DOI: 10.3233/jnd-240006] [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] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Background Subjects with Charcot-Marie-Tooth (CMT) disease show hands impairment which is a relevant problem affecting the quality of life. This symptom is related to muscle weakness and reduced motor coordination of the upper limb. However, most studies focus on lower limb impairment, therefore the investigation of upper limb disability is necessary to identify biomarkers able to monitor disease-specific features and to tailor rehabilitation. Objective This study aimed at characterizing upper limb muscle co-contraction using the co-contraction index (CCI) in CMT population. Methods Upper limb kinematic and electromyography (EMG) data were collected from fourteen CMT subjects (6-CMT1A and 8-CMT1X) during motor tasks typical of daily living activities. Rudolph's CCI was used to quantify muscle co-contraction of four muscle pairs acting on shoulder, elbow and wrist. All CMT subjects underwent clinical examination. Thirteen healthy subjects served as the normative reference (HC). Results CMT1X and CMT1A showed a significant reduction in CCI for distal and proximal muscle pairs compared to HC. Furthermore, CMT1A showed greater values of CCI compared to CMT1X mainly for the axial and axial-to-proximal muscle pairs. Movement speed and smoothness were not altered compared to HC. In addition, EMG metrics showed moderate-to-strong significant correlations with clinical outcomes. Conclusions CCI was able to quantify disease-specific deficits with respect to the normative reference, highlighting motor control alterations even before motor output impairment. CCI was also sensitive in detecting CMT subtypes-based differences and adopted compensatory strategies. Our findings suggest that CCI can be an outcome measure for CMT disease monitoring and interventional studies.
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Affiliation(s)
| | | | - Cristina Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Lagostina
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessia Aiello
- UOC Medicina Fisica e Riabilitazione, Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Bora M, Yalçin A, Bulut N, Yilmaz Ö, Karaduman A, Topuz S, Alemdaroğlu-Gürbüz İ. Investigation of surface electromyography amplitude values during stair climbing task in children with Duchenne muscular dystrophy. Neurol Sci 2021; 43:2791-2801. [PMID: 34608577 DOI: 10.1007/s10072-021-05643-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aims of this study were (a) to examine the surface electromyography (sEMG) amplitude values of the lower limb muscles during stair climbing both between different functional levels of Duchenne muscular dystrophy (DMD), in comparison with healthy children, and (b) to investigate the relationships between sEMG amplitudes and physical performance. METHODS sEMG amplitudes of the lower limbs of twenty-one children with DMD between levels I and III according to the Brooke Lower Extremity Functional Classification Scale and eleven healthy peers were evaluated by using sEMG during stair climbing task. Physical performance was evaluated by 6-min walk test and ascending 4-step timed performance test. RESULTS The lower limb sEMG amplitude values of children with DMD were statistically higher than healthy children (p < 0.001). sEMG amplitudes of the right (p = 0.01) and left (p = 0.003) biceps femoris, the right (p < 0.001) and left (p = 0.001) gastrocnemius medialis, and the right vastus lateralis (p = 0.02) muscles were higher in children with levels 2-3 than those in level 1. Moderate-to-strong relations were found between the gastrocnemius medialis and biceps femoris sEMG amplitudes and physical performance assessments (p < 0.05). CONCLUSION Increased sEMG amplitude values in the lower limbs during stair climbing task are thought to be caused by the effort to compensate for progressive muscle weakness and are associated with lower physical performance in children with DMD. Further, sEMG amplitude values are determined to increase as the functional level deteriorates. CLINICAL TRIAL REGISTRATION NUMBER AND URL NCT04287582 ( https://clinicaltrials.gov/ct2/show/NCT04287582?term=merve+bora&draw=2&rank=1 ).
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Affiliation(s)
- Merve Bora
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Talatpaşa Bulvarı, 06100, Altındağ/Ankara, Turkey
| | - Ali Yalçin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Talatpaşa Bulvarı, 06100, Altındağ/Ankara, Turkey
| | - Numan Bulut
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Talatpaşa Bulvarı, 06100, Altındağ/Ankara, Turkey
| | - Öznur Yilmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Talatpaşa Bulvarı, 06100, Altındağ/Ankara, Turkey
| | - Ayşe Karaduman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Lokman Hekim University, Sogutozu, 06510, Çankaya/Ankara, Turkey
| | - Semra Topuz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Talatpaşa Bulvarı, 06100, Altındağ/Ankara, Turkey
| | - İpek Alemdaroğlu-Gürbüz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Talatpaşa Bulvarı, 06100, Altındağ/Ankara, Turkey.
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Felicetti G, Thoumie P, Do MC, Schieppati M. Cutaneous and muscular afferents from the foot and sensory fusion processing: Physiology and pathology in neuropathies. J Peripher Nerv Syst 2021; 26:17-34. [PMID: 33426723 DOI: 10.1111/jns.12429] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022]
Abstract
The foot-sole cutaneous receptors (section 2), their function in stance control (sway minimisation, exploratory role) (2.1), and the modulation of their effects by gait pattern and intended behaviour (2.2) are reviewed. Experimental manipulations (anaesthesia, temperature) (2.3 and 2.4) have shown that information from foot sole has widespread influence on balance. Foot-sole stimulation (2.5) appears to be a promising approach for rehabilitation. Proprioceptive information (3) has a pre-eminent role in balance and gait. Reflex responses to balance perturbations are produced by both leg and foot muscle stretch (3.1) and show complex interactions with skin input at both spinal and supra-spinal levels (3.2), where sensory feedback is modulated by posture, locomotion and vision. Other muscles, notably of neck and trunk, contribute to kinaesthesia and sense of orientation in space (3.3). The effects of age-related decline of afferent input are variable under different foot-contact and visual conditions (3.4). Muscle force diminishes with age and sarcopenia, affecting intrinsic foot muscles relaying relevant feedback (3.5). In neuropathy (4), reduction in cutaneous sensation accompanies the diminished density of viable receptors (4.1). Loss of foot-sole input goes along with large-fibre dysfunction in intrinsic foot muscles. Diabetic patients have an elevated risk of falling, and vision and vestibular compensation strategies may be inadequate (4.2). From Charcot-Marie-Tooth 1A disease (4.3) we have become aware of the role of spindle group II fibres and of the anatomical feet conditions in balance control. Lastly (5) we touch on the effects of nerve stimulation onto cortical and spinal excitability, which may participate in plasticity processes, and on exercise interventions to reduce the impact of neuropathy.
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Affiliation(s)
- Guido Felicetti
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Neuromotor Rehabilitation, Institute of Montescano, Pavia, Italy
| | - Philippe Thoumie
- Service de rééducation neuro-orthopédique, Hôpital Rothschild APHP, Université Sorbonne, Paris, France.,Agathe Lab ERL Inserm U-1150, Paris, France
| | - Manh-Cuong Do
- Université Paris-Saclay, CIAMS, Orsay, France.,Université d'Orléans, CIAMS, Orléans, France
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Jonsdottir J, Lencioni T, Gervasoni E, Crippa A, Anastasi D, Carpinella I, Rovaris M, Cattaneo D, Ferrarin M. Improved Gait of Persons With Multiple Sclerosis After Rehabilitation: Effects on Lower Limb Muscle Synergies, Push-Off, and Toe-Clearance. Front Neurol 2020; 11:668. [PMID: 32793100 PMCID: PMC7393214 DOI: 10.3389/fneur.2020.00668] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction: Persons with MS (PwMS) have markedly reduced push-off and toe-clearance during gait compared to healthy subjects (HS). These deficits may result from alterations in neuromotor control at the ankle. To optimize rehabilitation interventions for PwMS, a crucial step is to evaluate if and how altered neuromotor control, as represented by muscle synergies, improves with rehabilitation. In this study we investigated changes in ankle motor control and associated biomechanical parameters during gait in PwMS, occurring with increase in speed after gait rehabilitation. Methods: 3D motion and EMG data were collected while 11 PwMS (age 50.3 + 11.1; EDSS 5.2 + 1.2) walked overground at self-selected speed before (T0) and after 20 sessions (T1) of intensive treadmill training. Muscle synergies were extracted using non-negative matrix factorization. Gait parameters were computed according to the LAMB protocol. Pearson's correlation coefficient was used to evaluate the similarity of motor modules between PwMS and HS. To assess differences in distal module activations representing neuromotor control at the ankle [Forward Propulsion (FPM) and Ground Clearance modules (GCM)], each module's activation timing was integrated over 100% of the gait cycle and the activation percentage index (API) was computed in six phases. Ten age matched HS provided two separate speed-matched normative datasets for T0 and T1. For speed independent comparison for the PwMs Z scores were calculated for all their gait variables. Results: In PwMS velocity increased significantly from T0 to T1 (0.74-0.90 m/s, p < 0.05). The activation profiles (API) of FPM and GCM of PwMS improved in pre-swing (p < 0.05): FPM (Mean [95% CI] [%]: T0: 12.5 [5.7-19.3] vs. T1: 9.0 [2.7-15.3]); GCM (T0: 26.7 [18.2-35.3] vs. T1: 24.5 [18.2-30.7]). This was associated with an increase in toe clearance (80.3 to 103.6 mm, p < 0.05) and a higher ankle power peak in pre-swing (1.53-1.93 W/kg, p < 0.05). Conclusion: Increased gait speed of PwMS after intensive gait training was consistent with improvements in spatio-temporal gait parameters. The most important finding of this study was the re-organization of distal leg modules related to neurophysiological changes induced by rehabilitation. This was associated with an improved ankle performance.
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Lencioni T, Carpinella I, Rabuffetti M, Marzegan A, Ferrarin M. Human kinematic, kinetic and EMG data during different walking and stair ascending and descending tasks. Sci Data 2019; 6:309. [PMID: 31811148 PMCID: PMC6897988 DOI: 10.1038/s41597-019-0323-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/15/2019] [Indexed: 01/21/2023] Open
Abstract
This paper reports the kinematic, kinetic and electromyographic (EMG) dataset of human locomotion during level walking at different velocities, toe- and heel-walking, stairs ascending and descending. A sample of 50 healthy subjects, with an age between 6 and 72 years, is included. For each task, both raw data and computed variables are reported including: the 3D coordinates of external markers, the joint angles of lower limb in the sagittal, transversal and horizontal anatomical planes, the ground reaction forces and torques, the center of pressure, the lower limb joint mechanical moments and power, the displacement of the whole body center of mass, and the surface EMG signals of the main lower limb muscles. The data reported in the present study, acquired from subjects with different ages, represents a valuable dataset useful for future studies on locomotor function in humans, particularly as normative reference to analyze pathological gait, to test the performance of simulation models of bipedal locomotion, and to develop control algorithms for bipedal robots or active lower limb exoskeletons for rehabilitation.
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