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Ghédira M, Vieira TM, Cerone GL, Gazzoni M, Gracies JM, Hutin E. Antagonist Activation Measurement in Triceps Surae Using High-Density and Bipolar Surface EMG in Chronic Hemiparesis. SENSORS (BASEL, SWITZERLAND) 2024; 24:3701. [PMID: 38931485 PMCID: PMC11207549 DOI: 10.3390/s24123701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
After a stroke, antagonist muscle activation during agonist command impedes movement. This study compared measurements of antagonist muscle activation using surface bipolar EMG in the gastrocnemius medialis (GM) and high-density (HD) EMG in the GM and soleus (SO) during isometric submaximal and maximal dorsiflexion efforts, with knee flexed and extended, in 12 subjects with chronic hemiparesis. The coefficients of antagonist activation (CAN) of GM and SO were calculated according to the ratio of the RMS amplitude during dorsiflexion effort to the maximal agonist effort for the same muscle. Bipolar CAN (BipCAN) was compared to CAN from channel-specific (CsCAN) and overall (OvCAN) normalizations of HD-EMG. The location of the CAN centroid was explored in GM, and CAN was compared between the medial and lateral portions of SO. Between-EMG system differences in GM were observed in maximal efforts only, between BipCAN and CsCAN with lower values in BipCAN (p < 0.001), and between BipCAN and OvCAN with lower values in OvCAN (p < 0.05). The CAN centroid is located mid-height and medially in GM, while the CAN was similar in medial and lateral SO. In chronic hemiparesis, the estimates of GM hyperactivity differ between bipolar and HD-EMGs, with channel-specific and overall normalizations yielding, respectively, higher and lower CAN values than bipolar EMG. HD-EMG would be the way to develop personalized rehabilitation programs based on individual antagonist activations.
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Affiliation(s)
- Mouna Ghédira
- Laboratoire Analyse et Restauration du Mouvement (ARM), Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 94000 Créteil, France; (M.G.); (J.-M.G.)
| | - Taian Martins Vieira
- Laboratory for Engineering of the Neuromuscular System, Politecnico di Torino, 10129 Turin, Italy; (T.M.V.); (G.L.C.); (M.G.)
| | - Giacinto Luigi Cerone
- Laboratory for Engineering of the Neuromuscular System, Politecnico di Torino, 10129 Turin, Italy; (T.M.V.); (G.L.C.); (M.G.)
| | - Marco Gazzoni
- Laboratory for Engineering of the Neuromuscular System, Politecnico di Torino, 10129 Turin, Italy; (T.M.V.); (G.L.C.); (M.G.)
| | - Jean-Michel Gracies
- Laboratoire Analyse et Restauration du Mouvement (ARM), Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 94000 Créteil, France; (M.G.); (J.-M.G.)
| | - Emilie Hutin
- Laboratoire Analyse et Restauration du Mouvement (ARM), Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 94000 Créteil, France; (M.G.); (J.-M.G.)
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Boulay C, Gracies JM, Garcia L, Authier G, Ulian A, Pradines M, Vieira TM, Pinto T, Gazzoni M, Desnous B, Parratte B, Pesenti S. Serious Game with Electromyography Feedback and Physical Therapy in Young Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: A Prospective Open-Label Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:1513. [PMID: 38475049 DOI: 10.3390/s24051513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
The clinical effects of a serious game with electromyography feedback (EMGs_SG) and physical therapy (PT) was investigated prospectively in children with unilateral spastic cerebral palsy (USCP). An additional aim was to better understand the influence of muscle shortening on function. Thirty children with USCP (age 7.6 ± 2.1 years) received four weeks of EMGs_SG sessions 2×/week including repetitive, active alternating training of dorsi- and plantar flexors in a seated position. In addition, each child received usual PT treatment ≤ 2×/week, involving plantar flexor stretching and command strengthening on dorsi- and plantar flexors. Five-Step Assessment parameters, including preferred gait velocity (normalized by height); plantar flexor extensibility (XV1); angle of catch (XV3); maximal active ankle dorsiflexion (XA); and derived coefficients of shortening, spasticity, and weakness for both soleus and gastrosoleus complex (GSC) were compared pre and post treatment (t-tests). Correlations were explored between the various coefficients and gait velocities at baseline. After four weeks of EMGs_SG + PT, there was an increase in normalized gait velocity from 0.72 ± 0.13 to 0.77 ± 0.13 m/s (p = 0.025, d = 0.43), a decrease in coefficients of shortening (soleus, 0.10 ± 0.07 pre vs. 0.07 ± 0.08 post, p = 0.004, d = 0.57; GSC 0.16 ± 0.08 vs. 0.13 ± 0.08, p = 0.003, d = 0.58), spasticity (soleus 0.14 ± 0.06 vs. 0.12 ± 0.07, p = 0.02, d = 0.46), and weakness (soleus 0.14 ± 0.07 vs. 0.11 ± 0.07, p = 0.005, d = 0.55). At baseline, normalized gait velocity correlated with the coefficient of GSC shortening (R = -0.43, p = 0.02). Four weeks of EMGs_SG and PT were associated with improved gait velocity and decreased plantar flexor shortening. A randomized controlled trial comparing EMGs_SG and conventional PT is needed.
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Affiliation(s)
- Christophe Boulay
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Jean-Michel Gracies
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
| | - Lauren Garcia
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Guillaume Authier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Alexis Ulian
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Maud Pradines
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
| | - Taian Martins Vieira
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, 10129 Turin, Italy
- PoliToBIOMed Laboratory, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Talita Pinto
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro 22281-100, Brazil
| | - Marco Gazzoni
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, 10129 Turin, Italy
- PoliToBIOMed Laboratory, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Béatrice Desnous
- Pediatric Neurology Department, Timone Children Hospital, 13005 Marseille, France
| | - Bernard Parratte
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
| | - Sébastien Pesenti
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
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Hutin E, Ghédira M, Vinti M, Tazi S, Gracies JM, Decq P. Comparing the Effect of Implanted Peroneal Nerve Stimulation and Ankle-Foot Orthosis on Gait Kinematics in Chronic Hemiparesis: A Randomized Controlled Trial. J Rehabil Med 2023; 55:jrm7130. [PMID: 37548420 PMCID: PMC10424098 DOI: 10.2340/jrm.v55.7130] [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: 01/11/2023] [Accepted: 05/31/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Impaired ankle dorsiflexion in hemiparesis may be treated with ankle-foot orthosis or functional electrical stimulation. Semi-implanted selective functional electrical stimulation uses independent stimulations of deep and superficial peroneal nerves. The aim of this study was to compare gait kinematics using ankle-foot orthosis or semi-implanted selective functional electrical stimulation over 6 months in hemiparesis. METHODS Subjects with chronic hemiparesis, randomized into ankle-foot orthosis or semi-implanted selective functional electrical stimulation groups, underwent comfortable gait analysis without and with device OFF and ON, before, and 3 and 6 months after treatment onset. The effects of condition, visit and group on gait kinematics (analysis of variance; ANOVA) were analysed. RESULTS A total of 27 subjects were included (ankle-foot orthosis, n = 13; semi-implanted selective functional electrical stimulation, n = 14). The only between-group difference in changes from OFF to ON conditions was a deteriorated ankle dorsiflexion speed with ankle-foot orthosis at month 6 (condition*group, p = 0.04; ankle-foot orthosis, -60%, p = 0.02; semi-implanted selective functional electrical stimulation, non significant). Both groups pooled, from OFF to ON gait speed (+ 0.07 m/s; + 10%), cadence (+ 4%), step length (+ 6%) and peak ankle dorsiflexion (+ 6°) increased, and peak ankle inversion (-5°) and peak knee flexion (-2°) decreased (p < 0.001); finally, peak knee flexion in the OFF condition increased (+ 2°, p = 0.03). CONCLUSION Semi-implanted selective functional electrical stimulation and ankle-foot orthosis similarly impacted gait kinematics in chronic hemiparesis after 6 months of use. Ankle dorsiflexion speed in swing deteriorated markedly with ankle-foot orthosis.
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Affiliation(s)
- Emilie Hutin
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France.
| | - Mouna Ghédira
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Maria Vinti
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France
| | - Sanaa Tazi
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Jean-Michel Gracies
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France
| | - Philippe Decq
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France
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Pradines M, Poitou T, Gál O, Hoskovcová M, Bayle N, Baude M, Gracies JM. Where is the zero of Tardieu for proximal trans-joint lower limb muscles? The relevance for the estimation of muscle shortening and weakness. Front Neurol 2023; 14:1108535. [PMID: 37188305 PMCID: PMC10175661 DOI: 10.3389/fneur.2023.1108535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Maud Pradines
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
- *Correspondence: Maud Pradines
| | - Tymothée Poitou
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Ota Gál
- Department of Neurology, Charles University, Prague, Czechia
| | | | - Nicolas Bayle
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Marjolaine Baude
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jean-Michel Gracies
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
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Pradines M, Ghédira M, Bignami B, Vielotte J, Bayle N, Marciniak C, Burke D, Hutin E, Gracies JM. Do Muscle Changes Contribute to the Neurological Disorder in Spastic Paresis? Front Neurol 2022; 13:817229. [PMID: 35370894 PMCID: PMC8964436 DOI: 10.3389/fneur.2022.817229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background At the onset of stroke-induced hemiparesis, muscle tissue is normal and motoneurones are not overactive. Muscle contracture and motoneuronal overactivity then develop. Motor command impairments are classically attributed to the neurological lesion, but the role played by muscle changes has not been investigated. Methods Interaction between muscle and command disorders was explored using quantified clinical methodology-the Five Step Assessment. Six key muscles of each of the lower and upper limbs in adults with chronic poststroke hemiparesis were examined by a single investigator, measuring the angle of arrest with slow muscle stretch (XV1) and the maximal active range of motion against the resistance of the tested muscle (XA). The coefficient of shortening CSH = (XN-XV1)/XN (XN, normally expected amplitude) and of weakness CW = (XV1-XA)/XV1) were calculated to estimate the muscle and command disorders, respectively. Composite CSH (CCSH) and CW (CCW) were then derived for each limb by averaging the six corresponding coefficients. For the shortened muscles of each limb (mean CSH > 0.10), linear regressions explored the relationships between coefficients of shortening and weakness below and above their median coefficient of shortening. Results A total of 80 persons with chronic hemiparesis with complete lower limb assessments [27 women, mean age 47 (SD 17), time since lesion 8.8 (7.2) years], and 32 with upper limb assessments [18 women, age 32 (15), time since lesion 6.4 (9.3) years] were identified. The composite coefficient of shortening was greater in the lower than in the upper limb (0.12 ± 0.04 vs. 0.08 ± 0.04; p = 0.0002, while the composite coefficient of weakness was greater in the upper limb (0.28 ± 0.12 vs. 0.15 ± 0.06, lower limb; p < 0.0001). In the lower limb shortened muscles, the coefficient of weakness correlated with the composite coefficient of shortening above the 0.15 median CSH (R = 0.43, p = 0.004) but not below (R = 0.14, p = 0.40). Conclusion In chronic hemiparesis, muscle shortening affects the lower limb particularly, and, beyond a threshold of severity, may alter descending commands. The latter might occur through chronically increased intramuscular tension, and thereby increased muscle afferent firing and activity-dependent synaptic sensitization at the spinal level.
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Affiliation(s)
- Maud Pradines
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Mouna Ghédira
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Blaise Bignami
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jordan Vielotte
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nicolas Bayle
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University and the Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Neurology, Northwestern University and the Shirley Ryan AbilityLab, Chicago, IL, United States
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Emilie Hutin
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jean-Michel Gracies
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
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