Inter-individual variability of forces and modular muscle coordination in cycling: A study on untrained subjects

Muscle Synergy Analysis as a Tool for Assessing the Effectiveness of Gait Rehabilitation Therapies: A Methodological Review and Perspective

According to the modular hypothesis for the control of movement, muscles are recruited in synergies, which capture muscle coordination in space, time, or both. In the last two decades, muscle synergy analysis has become a well-established framework in the motor control field and for the characterization of motor impairments in neurological patients. Altered modular control during a locomotion task has been often proposed as a potential quantitative metric for characterizing pathological conditions. Therefore, the purpose of this systematic review is to analyze the recent literature that used a muscle synergy analysis of neurological patients' locomotion as an indicator of motor rehabilitation therapy effectiveness, encompassing the key methodological elements to date. Searches for the relevant literature were made in Web of Science, PubMed, and Scopus. Most of the 15 full-text articles which were retrieved and included in this review identified an effect of the rehabilitation intervention on muscle synergies. However, the used experimental and methodological approaches varied across studies. Despite the scarcity of studies that investigated the effect of rehabilitation on muscle synergies, this review supports the utility of muscle synergies as a marker of the effectiveness of rehabilitative therapy and highlights the challenges and open issues that future works need to address to introduce the muscle synergies in the clinical practice and decisional process.

Influence of Pedal Interface During Pedaling With the Upper Versus Lower Limbs: A Pilot Analysis of Torque Performance and Muscle Synergies

Pedaling is a physical exercise practiced with either the upper or the lower limbs. Muscle coordination during these exercises has been previously studied using electromyography and synergy analysis, and three to four synergies have been identified for the lower and upper limbs. The question of synergy adaptabilities has not been investigated during pedaling with the upper limbs, and the impact of various modalities is yet not known. This study investigates the effect of pedal type (either clipped/gripped or flat) on the torque performance and the synergy in both upper and lower limbs. Torques applied by six participants while pedaling at 30% of their maximal power have been recorded for both upper and lower limbs. Electromyographic data of 11 muscles on the upper limbs and 11 muscles on the lower limbs have been recorded and synergies extracted and compared between pedal types. Results showed that the torques were not modified by the pedal types for the lower limbs while a deep adaptation is observable for the upper limbs. Participants indeed used the additional holding possibility by pulling the pedals on top of the pushing action. Synergies were accordingly modified for upper limbs while they remain stable for the lower limbs. In both limbs, the synergies showed a good reproducibility even if larger variabilities were observed for the upper limbs. This pilot study highlights the adaptability of muscle synergies according to the condition of movement execution, especially observed for the upper limbs, and can bring some new insights for the rehabilitation exercises.

Transferring Sensor-Based Assessments to Clinical Practice: The Case of Muscle Synergies

Sensor-based assessments in medical practice and rehabilitation include the measurement of physiological signals such as EEG, EMG, ECG, heart rate, and NIRS, and the recording of movement kinematics and interaction forces. Such measurements are commonly employed in clinics with the aim of assessing patients' pathologies, but so far some of them have found full exploitation mainly for research purposes. In fact, even though the data they allow to gather may shed light on physiopathology and mechanisms underlying motor recovery in rehabilitation, their practical use in the clinical environment is mainly devoted to research studies, with a very reduced impact on clinical practice. This is especially the case for muscle synergies, a well-known method for the evaluation of motor control in neuroscience based on multichannel EMG recordings. In this paper, considering neuromotor rehabilitation as one of the most important scenarios for exploiting novel methods to assess motor control, the main challenges and future perspectives for the standard clinical adoption of muscle synergy analysis are reported and critically discussed.

Muscle synergy analysis of eight inter-limb coordination modes during human hands-knees crawling movement

In order to reveal in-depth the neuromuscular control mechanism of human crawling, this study carries out muscle synergy extraction and analysis on human hands-knees crawling under eight specific inter-limb coordination modes, which are defined according to the swing sequence of limbs and includes two-limb swing crawling modes and six single-limb swing crawling modes. Ten healthy adults participate in crawling data collection, and surface electromyography (sEMG) signals are recorded from 30 muscles of limbs and trunk. Non-negative matrix factorization (NNMF) algorithm is adopted for muscle synergy extraction, and a three-step muscle synergy analysis scheme is implemented by using the hierarchical clustering method. Based on results of muscle synergy extraction, 4 to 7 synergies are extracted from each participant in each inter-limb coordination mode, which supports the muscle synergy hypothesis to some extent, namely, central nervous system (CNS) controls the inter-limb coordination modes during crawling movement by recruiting a certain amount of muscle synergies, rather than a single muscle. In addition, when different participants crawl in the same inter-limb coordination mode, they share more temporal features in recruiting muscle synergies. Further, by extracting and analyzing intra-mode shared synergies among participants and inter-mode shared synergies among the eight inter-limb coordination modes, the CNS is found to realize single-limb swing crawling modes by recruiting the four inter-mode shared synergy structures related to the swing function of each limb in different orders, and realize the two-limb swing crawling modes by recruiting synchronously two intra-mode shared synergy structures. The research results of the muscle synergy analysis on the eight specific inter-limb coordination modes, on the one hand, provide a basis for muscle synergy hypothesis from the perspective of crawling motion, on the other hand, also provide a possible explanation for the choice of the inter-limb coordination mode in human crawling.

The Influence of the sEMG Amplitude Estimation Technique on the EMG–Force Relationship

The estimation of the sEMG–force relationship is an open problem in the scientific literature; current methods show different limitations and can achieve good performance only on limited scenarios, failing to identify a general solution to the optimization of this kind of analysis. In this work, this relationship has been estimated on two different datasets related to isometric force-tracking experiments by calculating the sEMG amplitude using different fixed-time constant moving-window filters, as well as an adaptive time-varying algorithm. Results show how the adaptive methods might be the most appropriate choice for the estimation of the correlation between the sEMG signal and the force time course. Moreover, the comparison between adaptive and standard filters highlights how the time constants exploited in the estimation strategy is not the only influence factor on this kind of analysis; a time-varying approach is able to constantly capture more information with respect to fixed stationary approaches with comparable window lengths.

Subject specific muscle synergies and mechanical output during cycling with arms or legs

Background

Upper (UL) and lower limb (LL) cycling is extensively used for several applications, especially for rehabilitation for which neuromuscular interactions between UL and LL have been shown. Nevertheless, the knowledge on the muscular coordination modality for UL is poorly investigated and it is still not known whether those mechanisms are similar or different to those of LL. The aim of this study was thus to put in evidence common coordination mechanism between UL and LL during cycling by investigating the mechanical output and the underlying muscle coordination using synergy analysis.

Methods

Twenty-five revolutions were analyzed for six non-experts' participants during sub-maximal cycling with UL or LL. Crank torque and muscle activity of eleven muscles UL or LL were recorded. Muscle synergies were extracted using nonnegative matrix factorization (NNMF) and group- and subject-specific analysis were conducted.

Results

Four synergies were extracted for both UL and LL. UL muscle coordination was organized around several mechanical functions (pushing, downing, and pulling) with a proportion of propulsive torque almost 80% of the total revolution while LL muscle coordination was organized around a main function (pushing) during the first half of the cycling revolution. LL muscle coordination was robust between participants while UL presented higher interindividual variability.

Discussion

We showed that a same principle of muscle coordination exists for UL during cycling but with more complex mechanical implications. This study also brings further results suggesting each individual has unique muscle signature.

Chronic Adaptations of Shoulder Muscle Synergies in Healthy Baseball Players

BACKGROUND

Previous research has demonstrated that muscle synergy structure can adapt owing to training and injury; however, muscle synergies have not been evaluated in baseball players.

HYPOTHESIS

The throwing arm would have a similar muscle synergy structure but different levels of individual muscle activity within each synergy, relative to the nonthrowing arm.

STUDY DESIGN

Cross-sectional study in a controlled laboratory setting.

METHODS

Fourteen healthy competitive baseball players were included. Participants were tested bilaterally during a center-out planar reaching task using the KINARM robot, where kinematic data and surface electromyography data from 14 glenohumeral and scapular muscles were synchronized. Principal component analysis was used to extract muscle synergies, the variance accounted for (VAF) of each synergy, and individual muscle coefficients. The dominant (DOM) arm was compared with the nondominant (NDOM) arm using paired t tests for all dependent variables.

RESULTS

The same number of muscle synergies were extracted on the DOM and NDOM arms, along with no differences in VAF. In the first synergy, the infraspinatus (DOM 0.798 vs NDOM 0.587, P = 0.038) and lower trapezius (DOM 0.872 vs NDOM 0.480, P = 0.005) muscle coefficients significantly increased on the DOM arm. The second synergy had a significantly increased anterior deltoid (DOM 0.764 vs NDOM 0.374, P = 0.003) and a significantly decreased posterior deltoid (DOM -0.069 vs NDOM 0.197, P = 0.041) muscle coefficient on the DOM arm.

CONCLUSION

The DOM shoulder exhibits a higher proportion of infraspinatus and lower trapezius muscle activation during the external rotation and abduction synergy. Also, the DOM shoulder has increased muscle activation of the teres major and latissimus dorsi during the internal rotation synergy, and increased muscle activation of the pectoralis major during the cross-body adduction synergy, compared with the NDOM shoulder.

CLINICAL RELEVANCE

By exploring these neuromuscular adaptations, the improved understanding of muscle synergy adaptations in baseball players will help optimize injury prevention and rehabilitation techniques.

An Objective, Information-Based Approach for Selecting the Number of Muscle Synergies to be Extracted via Non-Negative Matrix Factorization

Muscle synergy analysis is a useful tool for the evaluation of the motor control strategies and for the quantification of motor performance. Among the parameters that can be extracted, most of the information is included in the rank of the modular control model (i.e. the number of muscle synergies that can be used to describe the overall muscle coordination). Even though different criteria have been proposed in literature, an objective criterion for the model order selection is needed to improve reliability and repeatability of MSA results. In this paper, we propose an Akaike Information Criterion (AIC)-based method for model order selection when extracting muscle synergies via the original Gaussian Non-Negative Matrix Factorization algorithm. The traditional AIC definition has been modified based on a correction of the likelihood term, which includes signal dependent noise on the neural commands, and a Discrete Wavelet decomposition method for the proper estimation of the number of degrees of freedom of the model, reduced on a synergy-by-synergy and event-by-event basis. We tested the performance of our method in comparison with the most widespread ones, proving that our criterion is able to yield good and stable performance in selecting the correct model order in simulated EMG data. We further evaluated the performance of our AIC-based technique on two distinct experimental datasets confirming the results obtained with the synthetic signals, with performances that are stable and independent from the nature of the analysed task, from the signal quality and from the subjective EMG pre-processing steps.

Intra-Subject and Inter-Subject Movement Variability Quantified with Muscle Synergies in Upper-Limb Reaching Movements

Quantifying movement variability is a crucial aspect for clinical and laboratory investigations in several contexts. However, very few studies have assessed, in detail, the intra-subject variability across movements and the inter-subject variability. Muscle synergies are a valuable method that can be used to assess such variability. In this study, we assess, in detail, intra-subject and inter-subject variability in a scenario based on a comprehensive dataset, including multiple repetitions of multi-directional reaching movements. The results show that muscle synergies are a valuable tool for quantifying variability at the muscle level and reveal that intra-subject variability is lower than inter-subject variability in synergy modules and related temporal coefficients, and both intra-subject and inter-subject similarity are higher than random synergy matching, confirming shared underlying control structures. The study deepens the available knowledge on muscle synergy-based motor function assessment and rehabilitation applications, discussing their applicability to real scenarios.

Intermuscular Coordination in the Power Clean Exercise: Comparison between Olympic Weightlifters and Untrained Individuals-A Preliminary Study

Muscle coordination in human movement has been assessed through muscle synergy analysis. In sports science, this procedure has been mainly applied to the comparison between highly trained and unexperienced participants. However, the lack of knowledge regarding strength training exercises led us to study the differences in neural strategies to perform the power clean between weightlifters and untrained individuals. Synergies were extracted from electromyograms of 16 muscles of ten unexperienced participants and seven weightlifters. To evaluate differences, we determined the pairwise correlations for the synergy components and electromyographic profiles. While the shape of activation patterns presented strong correlations across participants of each group, the weightings of each muscle were more variable. The three extracted synergies were shifted in time with the unexperienced group anticipating synergy #1 (−2.46 ± 18.7%; p < 0.001) and #2 (−4.60 ± 5.71%; p < 0.001) and delaying synergy #3 (1.86 ± 17.39%; p = 0.01). Moreover, muscle vectors presented more inter-group variability, changing the composition of synergy #1 and #3. These results may indicate an adaptation in intermuscular coordination with training, and athletes in an initial phase of training should attempt to delay the hip extension (synergy #1), as well as the upper-limb flexion (synergy #2).

Reorganization of Muscle Coordination Underlying Motor Learning in Cycling Tasks

The hypothesis of modular control, which stands on the existence of muscle synergies as building blocks of muscle coordination, has been investigated in a great variety of motor tasks and species. Yet, its role during learning processes is still largely unexplored. To what extent is such modular control flexible, in terms of spatial structure and temporal activation, to externally or internally induced adaptations, is a debated issue. To address this question, we designed a biofeedback experiment to induce changes in the timing of muscle activations during leg cycling movements. The protocol consisted in delaying the peak of activation of one target muscle and using its electromyography (EMG) envelope as visual biofeedback. For each of the 10 healthy participants, the protocol was repeated for three different target muscles: Tibialis Anterioris (TA), Gastrocnemius Medialis (GM), and Vastus Lateralis (VL). To explore the effects of the conditioning protocol, we analyzed changes in the activity of eight lower limb muscles by applying different models of modular motor control [i.e., fixed spatial components (FSC) and fixed temporal components (FTC)]. Our results confirm the hypothesis that visual EMG biofeedback is able to induce changes in muscle coordination. Subjects were able to shift the peak of activation of the target muscle, with a delay of (49 ± 27°) across subjects and conditions. This time shift generated a reorganization of all the other muscles in terms of timing and amplitude. By using different models of modular motor control, we demonstrated that neither spatially invariant nor temporally invariant muscle synergies alone were able to account for these changes in muscle coordination after learning, while temporally invariant muscle synergies with adjustments in timing could capture most of muscle activity adaptations observed after the conditioning protocol. These results suggest that short-term learning in rhythmic tasks is built upon synergistic temporal commands that are robust to changes in the task demands.

Reproducibility of lower limb motion and forces during stationary submaximal pedalling using wearable motion tracking sensors

In order to address gaps in the literature, this study assessed the reproducibility (i.e., difference between and within sessions) of joint and muscle forces using wearable sensors during stationary cycling. Seventeen male cyclists performed two sessions on a cycle ergometer cycling at a combination of three power outputs (1.5, 2.5 and 3.5 W/kg) and three pedalling cadences (60, 80 and 100 rpm) in two sessions (2-7 days apart). The first trial from each session was repeated at the end of the session for assessment of within-session reproducibility. Three-dimensional (3D) full-body motion and 3D bilateral pedal forces were collected using an inertial motion tracking system and a pair of instrumented pedals, respectively. Joint angles, muscle forces and knee joint forces were computed using OpenSim. Poor to excellent agreement (ICCs = 0.31-0.99) was observed and differences were trivial to small and non-significant between trials within-session. Poor to excellent agreement (ICCs = 0.05-0.97) was observed and differences were trivial to large between sessions. Variability can be attributed to changes in muscle recruitment strategies (within and between-sessions) and to repositioning of sensors (between-sessions).

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Modular motor control of the sound limb in gait of people with trans-femoral amputation

Background

The above-knee amputation of a lower limb is a severe impairment that affects significantly the ability to walk; considering this, a complex adaptation strategy at the neuromuscular level is needed in order to be able to move safely with a prosthetic knee. In literature, it has been demonstrated that muscle activity during walking can be described via the activation of a small set of muscle synergies. The analysis of the composition and the time activation profiles of such synergies have been found to be a valid tool for the description of the motor control schemes in pathological subjects.

Methods

In this study, we used muscle synergy analysis techniques to characterize the differences in the modular motor control schemes between a population of 14 people with trans-femoral amputation and 12 healthy subjects walking at two different (slow and normal self-selected) speeds. Muscle synergies were extracted from a 12 lower-limb muscles sEMG recording via non-negative matrix factorization. Equivalence of the synergy vectors was quantified by a cross-validation procedure, while differences in terms of time activation coefficients were evaluated through the analysis of the activity in the different gait sub-phases.

Results

Four synergies were able to reconstruct the muscle activity in all subjects. The spatial component of the synergy vectors did not change in all the analysed populations, while differences were present in the activity during the sound limb’s stance phase. Main features of people with trans-femoral amputation’s muscle synergy recruitment are a prolonged activation of the module composed of calf muscles and an additional activity of the hamstrings’ module before and after the prosthetic heel strike.

Conclusions

Synergy-based results highlight how, although the complexity and the spatial organization of motor control schemes are the same found in healthy subjects, substantial differences are present in the synergies’ recruitment of people with trans femoral amputation. In particular, the most critical task during the gait cycle is the weight transfer from the sound limb to the prosthetic one. Future studies will integrate these results with the dynamics of movement, aiming to a complete neuro-mechanical characterization of people with trans-femoral amputation’s walking strategies that can be used to improve the rehabilitation therapies.

Muscle force adaptation to changes in upper body position during seated sprint cycling

Sprint cycling performance depends upon the balance between muscle and drag forces. This study assessed the influence of upper body position on muscle forces and aerodynamics during seated sprint cycling. Thirteen competitive cyclists attended two sessions. The first session was used to determine handlebar positions to achieve pre-determined hip flexion angles (70-110° in 10° increments) using dynamic bicycle fitting. In the second session, full body kinematics and pedal forces were recorded throughout 2x6-s seated sprints at the pre-determined handlebar positions, and frontal plane images were used to determine the projected frontal area. Leg work, joint work, muscle forces and frontal area were compared at three upper body positions, being optimum (maximum leg work), optimal+10° and optimal-10° of hip flexion. Larger hip (p = 0.01-0.02) and reduced knee (p = 0.02-0.03) contribution to leg work were observed at the optimal+10° position without changes at the ankle joint (p = 0.39). No differences were observed in peak muscle forces across the three body positions (p = 0.06-0.48). Frontal area was reduced at optimum+10° of hip flexion when compared to optimum (p = 0.02) and optimum-10° (p < 0.01). These findings suggest that large changes in upper body position can influence aerodynamics and alter contributions from the knee and hip joints, without influencing peak muscle forces.

Comparison of muscle synergies extracted from both legs during cycling at different mechanical conditions

Muscle synergies are the building blocks for generating movement by the central nervous system (CNS). According to this hypothesis, CNS decreases the complexity of motor control by combination of a small number of muscle synergies. The aim of this work is to investigate similarity of muscle synergies during cycling across various mechanical conditions. Twenty healthy subjects performed three 6- min cycling tasks at over a range of rotational speed (40, 50, and 60 rpm) and resistant torque (3, 5, and 7 N/m). Surface electromyography (sEMG) signals were recorded during pedaling from eight muscles of the right and left legs. We extracted four synchronous muscle synergies by using the non-negative matrix factorization (NMF) method. Mean and standard deviation of the goodness of the signal reconstruction (R²) for all subjects was obtained 0.9898 ± 0.0535. We investigated the functional roles of both leg muscles during cycling by synchronous muscle synergy extraction. We compared the muscle synergies extracted from all subjects in all mechanical conditions. The total mean and standard deviation of the similarity of synergy vectors for all subjects in all mechanical conditions was obtained 0.8788 ± 0.0709. We found the high degrees of similarity among the sets of synchronous muscle synergies across mechanical conditions and also across different subjects. Our results demonstrated that different subjects at different mechanical conditions use the same motor control strategies for cycling, despite inter-individual variability of muscle patterns.

On the Reliability and Repeatability of Surface Electromyography Factorization by Muscle Synergies in Daily Life Activities

Muscle synergy theory is a new appealing approach for different research fields. This study is aimed at evaluating the robustness of EMG reconstruction via muscle synergies and the repeatability of muscle synergy parameters as potential neurophysiological indices. Eight healthy subjects performed walking, stepping, running, and ascending and descending stairs' trials for five repetitions in three sessions. Twelve muscles of the dominant leg were analyzed. The “nonnegative matrix factorization” and “variability account for” were used to extract muscle synergies and to assess EMG goodness reconstruction, respectively. Intraclass correlation was used to quantify methodology reliability. Cosine similarity and coefficient of determination assessed the repeatability of the muscle synergy vectors and the temporal activity patterns, respectively. A 4-synergy model was selected for EMG signal factorization. Intraclass correlation was excellent for the overall reconstruction, while it ranged from fair to excellent for single muscles. The EMG reconstruction was found repeatable across sessions and subjects. Considering the selection of neurophysiological indices, the number of synergies was not repeatable neither within nor between subjects. Conversely, the cosine similarity and coefficient of determination values allow considering the muscle synergy vectors and the temporal activity patterns as potential neurophysiological indices due to their similarity both within and between subjects. More specifically, some synergies in the 4-synergy model reveal themselves as more repeatable than others, suggesting focusing on them when seeking at the neurophysiological index identification.

Comparison of Initialization Techniques for the Accurate Extraction of Muscle Synergies from Myoelectric Signals via Nonnegative Matrix Factorization

The main goal of this work was to assess the performance of different initializations of matrix factorization algorithms for an accurate identification of muscle synergies. Currently, nonnegative matrix factorization (NNMF) is the most commonly used method to identify muscle synergies. However, it has been shown that NNMF performance might be affected by different kinds of initialization. The present study aims at optimizing the traditional NNMF initialization for data with partial or complete temporal dependencies. For this purpose, three different initializations are used: random, SVD-based, and sparse. NNMF was used to identify muscle synergies from simulated data as well as from experimental surface EMG signals. Simulated data were generated from synthetic independent and dependent synergy vectors (i.e., shared muscle components), whose activation coefficients were corrupted by simulating controlled degrees of correlation. Similarly, EMG data were artificially modified, making the extracted activation coefficients temporally dependent. By measuring the quality of identification of the original synergies underlying the data, it was possible to compare the performance of different initialization techniques. Simulation results demonstrate that sparse initialization performs significantly better than all other kinds of initialization in reconstructing muscle synergies, regardless of the correlation level in the data.

Feasibility of Muscle Synergy Outcomes in Clinics, Robotics, and Sports: A Systematic Review

In the last years, several studies have been focused on understanding how the central nervous system controls muscles to perform a specific motor task. Although it still remains an open question, muscle synergies have come to be an appealing theory to explain the modular organization of the central nervous system. Even though the neural encoding of muscle synergies remains controversial, a large number of papers demonstrated that muscle synergies are robust across different tested conditions, which are within a day, between days, within a single subject, and between subjects that have similar demographic characteristics. Thus, muscle synergy theory has been largely used in several research fields, such as clinics, robotics, and sports. The present systematical review aims at providing an overview on the applications of muscle synergy theory in clinics, robotics, and sports; in particular, the review is focused on the papers that provide tangible information for (i) diagnosis or pathology assessment in clinics, (ii) robot-control design in robotics, and (iii) athletes' performance assessment or training guidelines in sports.

Effects of wobble board training on single-leg landing neuromechanics

Balance training programs have been shown to reduce ankle sprain injuries in sports, but little is known about the transfer from this training modality to motor coordination and ankle joint biomechanics in sport-specific movements. This study aimed to investigate the effects of wobble board training on motor coordination and ankle mechanics during early single-leg landing from a lateral jump. Twenty-two healthy men were randomly assigned to either a control or a training group, who engaged in 4 weeks of wobble board training. Full-body kinematics, ground reaction force, and surface electromyography (EMG) from 12 lower limb muscles were recorded during landing. Ankle joint work in the sagittal, frontal, and transverse plane was calculated from 0 to 100 ms after landing. Non-negative matrix factorization (NMF) was applied on the concatenated EMG Pre- and Post-intervention. Wobble board training increased the ankle joint eccentric work 1.2 times in the frontal (P < .01) and 4.4 times in the transverse plane (P < .01) for trained participants. Wobble board training modified the modular organization of muscle recruitment in the early landing phase by separating the activation of plantar flexors and mediolateral ankle stabilizers. Furthermore, the activation of secondary muscles across motor modules was reduced after training, refocusing the activation on the main muscles involved in the mechanical main subfunctions for each module. These results suggest that wobble board training may modify motor coordination when landing from a lateral jump, focusing on the recruitment of specific muscles/muscle groups that optimize ankle joint stability during early ground contact in single-leg landing.

Shared and task-specific muscle synergies of Nordic walking and conventional walking

Nordic walking is a form of walking that includes a poling action, and therefore an additional subtask, with respect to conventional walking. The aim of this study was to assess whether Nordic walking required a task-specific muscle coordination with respect to conventional walking. We compared the electromyographic (EMG) activity of 15 upper- and lower-limb muscles of 9 Nordic walking instructors, while executing Nordic walking and conventional walking at 1.3 ms^-1 on a treadmill. Non-negative matrix factorization method was applied to identify muscle synergies, representing the spatial and temporal organization of muscle coordination. The number of muscle synergies was not different between Nordic walking (5.2 ± 0.4) and conventional walking (5.0 ± 0.7, P = .423). Five muscle synergies accounted for 91.2 ± 1.1% and 92.9 ± 1.2% of total EMG variance in Nordic walking and conventional walking, respectively. Similarity and cross-reconstruction analyses showed that 4 muscle synergies, mainly involving lower-limb and trunk muscles, are shared between Nordic walking and conventional walking. One synergy acting during upper limb propulsion is specific to Nordic walking, modifying the spatial organization and the magnitude of activation of upper limb muscles compared to conventional walking. The inclusion of the poling action in Nordic walking does not increase the complexity of movement control and does not change the coordination of lower limb muscles. This makes Nordic walking a physical activity suitable also for people with low motor skill.

A multi-channel biomimetic neuroprosthesis to support treadmill gait training in stroke patients

This study presents an innovative multi-channel neuroprosthesis that induces a biomimetic activation of the main lower-limb muscles during treadmill gait training to be used in the rehabilitation of stroke patients. The electrostimulation strategy replicates the physiological muscle synergies used by healthy subjects to walk on a treadmill at their self-selected speed. This strategy is mapped to the current gait sub-phases, which are identified in real time by a custom algorithm. This algorithm divides the gait cycle into six sub-phases, based on two inertial sensors placed laterally on the shanks. Therefore, the pre-defined stimulation profiles are expanded or stretched based on the actual gait pattern of each single subject. A preliminary experimental protocol, involving 10 healthy volunteers, was carried out to extract the muscle synergies and validate the gait-detection algorithm, which were afterwards used in the development of the neuroprosthesis. The feasibility of the neuroprosthesis was tested on one healthy subject who simulated different gait patterns, and a chronic stroke patient. The results showed the correct functioning of the system. A pilot study of the neurorehabilitation treatment for stroke patients is currently being carried out.

Neuro-Mechanics of Recumbent Leg Cycling in Post-Acute Stroke Patients

Cycling training is strongly applied in post-stroke rehabilitation, but how its modular control is altered soon after stroke has been not analyzed yet. EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls. Patients were asked to walk over a GaitRite mat and standard gait parameters were computed. Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs. Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index (Spearman’s coefficient = 0.521). The reduced coordination complexity resulted in a reduced biomechanical performance, with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side. These patients also exhibited locomotor impairments (reduced gait speed, asymmetrical stance time, prolonged double support time). Significant correlations were found between cycling-based metrics and gait parameters, suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions. Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke, mainly in the early phase, when patients can be unable to perform a safe and active gait training.

Neuro-mechanics of muscle coordination during recumbent pedaling in post-acute stroke patients

Motor impairment after stroke has been hypothesized to be related, among others, to impairments in the modular control of movement. In this study we analyzed muscle coordination and pedal forces during a recumbent pedaling exercise from a sample of post-acute stroke patients (n=5) and a population of age-matched healthy individuals (n=4). Healthy subjects and the less impaired patients showed a shared modular organization of pedaling based on 4 similar muscle synergies. The most impaired patient, characterized by a Motricity Index of 52/100, showed a reduced complexity (only 2 muscle synergies for the affected side). Differences between healthy subjects and post-stroke patients in the execution of the task were identified in terms of unbalance in mechanical work production, which well corresponded to the level of impairment. This pedaling unbalance could be traced back to different activation strategies of the 4 identified modules. Investigation on a more representative sample will provide a full characterization of the neuro-mechanics of pedaling after stroke, helping our understandings of the disruption of motor coordination at central level after stroke and of the most effective solutions for functional recovery.

Muscle coordination limits efficiency and power output of human limb movement under a wide range of mechanical demands

This study investigated the influence of cycle frequency and workload on muscle coordination and the ensuing relationship with mechanical efficiency and power output of human limb movement. Eleven trained cyclists completed an array of cycle frequency (cadence)-power output conditions while excitation from 10 leg muscles and power output were recorded. Mechanical efficiency was maximized at increasing cadences for increasing power outputs and corresponded to muscle coordination and muscle fiber type recruitment that minimized both the total muscle excitation across all muscles and the ineffective pedal forces. Also, maximum efficiency was characterized by muscle coordination at the top and bottom of the pedal cycle and progressive excitation through the uniarticulate knee, hip, and ankle muscles. Inefficiencies were characterized by excessive excitation of biarticulate muscles and larger duty cycles. Power output and efficiency were limited by the duration of muscle excitation beyond a critical cadence (120-140 rpm), with larger duty cycles and disproportionate increases in muscle excitation suggesting deteriorating muscle coordination and limitations of the activation-deactivation capabilities. Most muscles displayed systematic phase shifts of the muscle excitation relative to the pedal cycle that were dependent on cadence and, to a lesser extent, power output. Phase shifts were different for each muscle, thereby altering their mechanical contribution to the pedaling action. This study shows that muscle coordination is a key determinant of mechanical efficiency and power output of limb movement across a wide range of mechanical demands and that the excitation and coordination of the muscles is limited at very high cycle frequencies.

On voluntary rhythmic leg movement behaviour and control during pedalling

The overall purpose of the present dissertation was to contribute to the understanding of voluntary human rhythmic leg movement behaviour and control. This was achieved by applying pedalling as a movement model and exposing healthy and recreationally active individuals as well as trained cyclists to for example cardiopulmonary and mechanical loading, fatiguing exercise, and heavy strength training. As a part of the background, the effect of pedalling frequency on diverse relevant biomechanical, physiological, and psychophysiological variables as well as on performance was initially explored. Freely chosen pedalling frequency is considerably higher than the energetically optimal pedalling frequency. This has been shown by others and was confirmed in the present work. As a result, pedal force is relatively low while rates of VO2 and energy turnover are relatively high during freely chosen pedalling as compared to a condition where a lower and more efficient pedalling frequency is imposed. The freely chosen pedalling frequency was in the present work, and by others, found to most likely be less advantageous than the lower energetically optimal pedalling frequency with respect to performance during intensive cycling following prolonged submaximal cycling. This stimulates the motivation to understand the behaviour and control of the freely chosen pedalling frequency during cycling. Freely chosen pedalling frequency was in the present work shown to be highly individual. In addition, the pedalling frequency was shown to be steady in a longitudinal perspective across 12 weeks. Further, it was shown to be unaffected by both fatiguing hip extension exercise and hip flexion exercise as well as by increased loading on the cardiopulmonary system at constant mechanical loading, and vice versa. Based on this, the freely chosen pedalling frequency is considered to be characterised as a highly individual, steady, and robust innate voluntary motor rhythm under primary influence of central pattern generators. The last part of the characterisation is largely based on, and supported by, work of other researchers in the field. Despite the robustness of the freely chosen pedalling frequency, it may be affected by some particular factors. As an example from the present work, freely chosen pedalling frequency during treadmill cycling increased by on average 15 to 17 rpm when power output was increased from a value corresponding to 86% and up to 165% of Wmax . This phenomenon is supported by other studies. As another example from the present work, freely chosen pedalling frequency decreased by on average 9 to 14 rpm following heavy strength training that involved both hip extension and hip flexion. Further, the present work suggested that the latter phenomenon occurred within the first week of training and was caused by in particular the hip extension strength training rather than the hip flexion strength training. The fast response to the strength training indicated that neural adaptations presumably caused the observed changes in movement behaviour. The internal organisation of the central pattern generator is by some other researchers in the field considered to be functionally separated into two components, in which, one is responsible for movement frequency and another is responsible for movement pattern. For the present dissertation, the freely chosen pedalling frequency was considered to reflect the rhythmic movement frequency of the voluntary rhythmic leg movement of pedalling. The tangential pedal force profile was considered to reflect the rhythmic movement pattern. The present work showed that fatiguing hip flexion exercise in healthy and recreationally active individuals modified the tangential pedal force profile during cycling at a pre-set target pedalling frequency in a way that the minimum tangential pedal force became more negative, the maximum tangential pedal force increased, and the phase with negative tangential pedal force increased. In other words, the legs were "actively lifted" to a lesser extent in the upstroke phase. Fatiguing hip extension exercise did not have that effect. And none of the fatiguing exercises affected the freely chosen pedalling frequency. The present work furthermore showed that the primary effect of hip extension strength training was that it decreased the freely chosen pedalling frequency. An interpretation of this could be that the hip extension strength training, in particular, influenced the output from the component of the central pattern generator that may be responsible for rhythmic movement frequency.

A texture analysis approach for objective uniformity evaluation in diagnostic ultrasound imaging: A preliminary study

Ultrasound image uniformity is an important parameter for quality assurance in diagnostic ultrasounds, but it is usually assessed by a qualitative judgement of technicians so its estimation is rough and subjective. In this work a novel method is developed to give an objective measurement of the Bmode image uniformity over the whole field of view or some of its part: the Texture Distribution Analysis Method (TDAM) is based on a segmentation of the Region of Interest, depending on some texture features calculated from co-occurrence matrices. Results on a set of 10 test images with different non-uniformities (Uniformity Image Test Set or UITS) show a good sensitivity and agreement of TDAM with the mean judgment by 5 human observers (TUV): TDAM and TUV uniformity values are coherent for the whole UITS, nevertheless a high uncertainty in uniformity values has been observed (up to 28 percent). Preliminary results look encouraging and more efforts are worth to refine the method.

Coordination among thigh muscles including the vastus intermedius and adductor magnus at different cycling intensities

Although many studies have been focused on muscle synergies in the lower limbs, synergies of the thigh muscles during cycling have not been investigated in detail. We examined synergies of the thigh muscles including the vastus intermedius (VI) and adductor magnus (AM) while cycling. Eight healthy men pedaled at 20%, 40%, 60%, 80% and 100% of maximal aerobic power output at a constant cadence of 60 rpm. Surface electromyography (EMG) recorded signals from the deep VI and the three superficial quadriceps femoris (QF) muscles, the two hamstrings and the AM. The root mean square of the EMG signal was averaged every 2° of crank rotation and normalized by the peak value for each muscle. We used factor analysis to assess normalized EMG recordings while cycling and to identify thigh muscle synergies. The VI, the superficial QF muscles and the AM dominated the first muscle synergy at all power output levels. The AM also formed a second synergy with the two hamstrings at all power output levels. These results suggest that the VI coordinates with the other QF and AM muscles, and that the AM coordinates with the QF and hamstring muscles while cycling.

Shared muscle synergies in human walking and cycling

The motor system may rely on a modular organization (muscle synergies activated in time) to execute different tasks. We investigated the common control features of walking and cycling in healthy humans from the perspective of muscle synergies. Three hypotheses were tested: 1) muscle synergies extracted from walking trials are similar to those extracted during cycling; 2) muscle synergies extracted from one of these motor tasks can be used to mathematically reconstruct the electromyographic (EMG) patterns of the other task; 3) muscle synergies of cycling can result from merging synergies of walking. A secondary objective was to identify the speed (and cadence) at which higher similarities emerged. EMG activity from eight muscles of the dominant leg was recorded in eight healthy subjects during walking and cycling at four matched cadences. A factorization technique [nonnegative matrix factorization (NNMF)] was applied to extract individual muscle synergy vectors and the respective activation coefficients behind the global muscular activity of each condition. Results corroborated hypotheses 2 and 3, showing that 1) four synergies from walking and cycling can successfully explain most of the EMG variability of cycling and walking, respectively, and 2) two of four synergies from walking appear to merge together to reconstruct one individual synergy of cycling, with best reconstruction values found for higher speeds. Direct comparison of the muscle synergy vectors of walking and the muscle synergy vectors of cycling (hypothesis 1) produced moderated values of similarity. This study provides supporting evidence for the hypothesis that cycling and walking share common neuromuscular mechanisms.

Frequency and pattern of voluntary pedalling is influenced after one week of heavy strength training

Changes in voluntary rhythmic leg movement characteristics of freely chosen cadence (reflecting movement frequency) and tangential pedal force profile (reflecting movement pattern) were investigated during 4weeks of (i) heavy hip extension strength training (HET, n=9), (ii) heavy hip flexion strength training (HFT, n=9), and (iii) no intervention (CON, n=9). Training consisted of three 5RM-10RM sets per session, with two sessions/week. Submaximal ergometer cycling was performed before the training period (pretest) and after every week of training (test A1, A2, A3, and posttest). Strength increased by on average 25% in HET and 33% in HFT. Freely chosen cadence was only changed in HET, occurring already after 1week of training. Thus, percentage reductions of cadence in HET at test A1, A2, A3, and posttest, with respect to the pretest value, amounted for maximally on average 17%, or 14rpm, and were larger than the corresponding changes in CON (p=.037). Percentage increases in minimum tangential pedal force in HET at test A1, A2, A3, and posttest, with respect to the pretest value, were larger than the corresponding changes in CON (p=.024). Heavy hip flexion strength training did not cause such alterations.

Gastrocnemius and soleus are selectively activated when adding knee extensor activity to plantar flexion

The gastrocnemius is a biarticular muscle that acts not only as a plantar flexor, but also as a knee flexor, meaning that it is an antagonist during knee extension. In contrast, the soleus is a monoarticular plantar flexor. Based on this anatomical difference, these muscles' activities should be selectively activated during simultaneous plantar flexion and knee extension, which occur during many activities of daily living. This study examined the selective activation of gastrocnemius and soleus activities when voluntary isometric activation of knee extensors was added to voluntary isometric plantar flexion. Ten male volunteers performed isometric plantar flexion at 10%, 20%, and 30% of maximum effort. During each plantar flexion task, isometric knee extension was added at 0%, 50%, and 100% of maximum effort. When knee extension was added, the average rectified value of the electromyographic activity of the medial gastrocnemius was significantly depressed (P=.002), whereas that of the soleus was significantly increased (P<.001) regardless of the plantar flexion level. These results suggest that plantar flexion with concurrent knee extensor activity leads to selective activation of the soleus and depression of the synergistic activity of the gastrocnemius.