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Lee JH, Jung HW, Jang WY. Proprioception and neuromuscular control at return to sport after ankle surgery with the modified Broström procedure. Sci Rep 2022; 12:610. [PMID: 35022508 PMCID: PMC8755731 DOI: 10.1038/s41598-021-04567-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/24/2021] [Indexed: 12/25/2022] Open
Abstract
The modified Broström procedure (MBP) is an initial treatment for symptomatic chronic ankle instability (CAI) patients. This study aimed to compare the proprioception and neuromuscular control ability of both affected and unaffected ankles at the time of return to sports after MBP for patients with scores of normal controls. 75 individuals (40 who underwent MBP, 35 normal controls) participated. The dynamic balance test scores were significantly higher in the affected ankle of the patients than in the controls (1.5 ± 0.6° vs. 1.1 ± 0.4°, p < 0.003). The time to peak torque for dorsiflexion (60.8 ± 13.9 ms vs. 52.2 ± 17.5 ms, p < 0.022) and eversion (68.9 ± 19.1 ms vs. 59.3 ± 21.1 ms, p < 0.043) was significantly delayed in the affected ankle of the patients than in the controls. The dynamic balance test and time to peak torque in CAI patients remained significantly reduced at the time of return-to-sport after MBP. Clinicians and therapists should be aware of potential deficits in proprioception and neuromuscular control when determining the timing of return to sports after MBP.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Woo Young Jang
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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A distinct functional distribution of α and γ motoneurons in the rat trigeminal motor nucleus. Brain Struct Funct 2017; 222:3231-3239. [PMID: 28326439 DOI: 10.1007/s00429-017-1400-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
Gamma-motoneurons (γMNs) play a crucial role in regulating isometric muscle contraction. The slow jaw-closing during mastication is one of the most functional isometric contractions, which is developed by the rank-order recruitment of alpha-motoneurons (αMNs) in a manner that reflects the size distribution of αMNs. In a mouse spinal motor nucleus, there are two populations of small and large MNs; the former was identified as a population of γMNs based on the positive expression of the transcription factor estrogen-related receptor 3 (Err3) and negative expression of the neuronal DNA-binding protein NeuN, and the latter as that of αMNs based on the opposite pattern of immunoreactivity. However, the differential identification of αMNs and γMNs in the trigeminal motor nucleus (TMN) remains an assumption based on the size of cell bodies that were retrogradely stained with HRP. We here examined the size distributions of αMNs and γMNs in the dorsolateral TMN (dl-TMN) by performing immunohistochemistry using anti-Err3 and anti-NeuN antibodies. The dl-TMN was identified by immunopositivity for vesicular glutamate transporter-1. Immunostaining for choline acetyltransferase and Err3/NeuN revealed that the dl-TMN is composed of 65% αMNs and 35% γMNs. The size distribution of αMNs was bimodal, while that of γMNs was almost the same as that of the population of small αMNs, suggesting the presence of αMNs as small as γMNs. Consistent with the size concept of motor units, the presence of smaller jaw-closing αMNs was coherent with the inclusion of jaw-closing muscle fibers with smaller diameters compared to limb muscle fibers.
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Phillips CG. Hughlings Jackson Lecture. Cortical Localization and “sensori Motor Processes” at the “middle Level” in Primates. Proc R Soc Med 2016. [DOI: 10.1177/003591577306601015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C G Phillips
- University Laboratory of Physiology, Oxford, OX] 3PT, and Trinity College, Oxford
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Sato H, Kawano T, Saito M, Toyoda H, Maeda Y, Türker KS, Kang Y. Teeth clenching reduces arm abduction force. Exp Brain Res 2014; 232:2281-91. [DOI: 10.1007/s00221-014-3919-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/15/2014] [Indexed: 12/19/2022]
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Gemes G, Koopmeiners A, Rigaud M, Lirk P, Sapunar D, Bangaru ML, Vilceanu D, Garrison SR, Ljubkovic M, Mueller SJ, Stucky CL, Hogan QH. Failure of action potential propagation in sensory neurons: mechanisms and loss of afferent filtering in C-type units after painful nerve injury. J Physiol 2013; 591:1111-31. [PMID: 23148321 PMCID: PMC3591718 DOI: 10.1113/jphysiol.2012.242750] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/09/2012] [Indexed: 01/03/2023] Open
Abstract
The T-junction of sensory neurons in the dorsal root ganglion (DRG) is a potential impediment to action potential (AP) propagation towards the CNS. Using intracellular recordings from rat DRG neuronal somata during stimulation of the dorsal root, we determined that the maximal rate at which all of 20 APs in a train could successfully transit the T-junction (following frequency) was lowest in C-type units, followed by A-type units with inflected descending limbs of the AP, and highest in A-type units without inflections. In C-type units, following frequency was slower than the rate at which AP trains could be produced in either dorsal root axonal segments or in the soma alone, indicating that the T-junction is a site that acts as a low-pass filter for AP propagation. Following frequency was slower for a train of 20 APs than for two, indicating that a cumulative process leads to propagation failure. Propagation failure was accompanied by diminished somatic membrane input resistance, and was enhanced when Ca(2+)-sensitive K(+) currents were augmented or when Ca(2+)-sensitive Cl(-) currents were blocked. After peripheral nerve injury, following frequencies were increased in axotomized C-type neurons and decreased in axotomized non-inflected A-type neurons. These findings reveal that the T-junction in sensory neurons is a regulator of afferent impulse traffic. Diminished filtering of AP trains at the T-junction of C-type neurons with axotomized peripheral processes could enhance the transmission of activity that is ectopically triggered in a neuroma or the neuronal soma, possibly contributing to pain generation.
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Affiliation(s)
- Geza Gemes
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Reciprocal inhibition versus unloading response during stretch reflex in humans. Exp Brain Res 2013; 226:33-43. [PMID: 23354665 DOI: 10.1007/s00221-013-3408-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/03/2013] [Indexed: 01/08/2023]
Abstract
Rotation of an upper limb joint produces excitatory stretch reflex peaks M1 and M2 in the stretched muscles and simultaneous decrease in electromyographic (EMG) activity in the shortened muscles. The objective of this study was to examine whether the decreased activity in the antagonists (rINHIB) is purely from unloading of the spindles or receives active inhibition involving inhibitory interneurons. If rINHIB is due only to unloading, then the termination of rINHIB should vary with the duration of perturbation used to elicit stretch reflex, namely shorter stretches should result in shorter values of decreased periods of EMG. To examine this question, rectangular pulses, ranging in duration from 25 to 150 ms, were used to stretch wrist flexors or extensors with a torque motor. These rectangular pulses resulted in joint rotations which peaked at times (T(peak)) ranging from approximately 75-160 ms. As shown by previous authors, when the duration of rotation was shortened, the magnitude of M1 did not change, while the magnitude of M2 decreased. However, termination time of rINHIB in the shortened muscles did not change with change in T(peak), implying thereby that unloading of spindles of the antagonist muscles is not the only mechanism for the reduction in activity and that inhibitory reflex pathways most likely contribute. Possible sources of inhibition are discussed for the short- and long-latency inhibition.
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Abstract
Several studies about noise-enhanced balance control in humans support the hypothesis that stochastic resonance can enhance the detection and transmission in sensorimotor system during a motor task. The purpose of the present study was to extend these findings in a simpler and controlled task. We explored whether a particular level of a mechanical Gaussian noise (0-15 Hz) applied on the index finger can improve the performance during compensation for a static force generated by a manipulandum. The finger position was displayed on a monitor as a small white point in the center of a gray circle. We considered a good performance when the subjects exhibited a low deviation from the center of this circle and when the performance had less variation over time. Several levels of mechanical noise were applied on the manipulandum. We compared the performance between zero noise (ZN), optimal noise (ON), and high noise (HN). In all subjects (8 of 8) the data disclosed an inverted U-like graph between the inverse of the mean variation in position and the input noise level. In other words, the mean variation was significantly smaller during ON than during ZN or HN. The findings suggest that the application of a tactile-proprioceptive noise can improve the stability in sensorimotor performance via stochastic resonance. Possible explanations for this improvement in motor precision are an increase of the peripheral receptors sensitivity and of the internal stochastic resonance, causing a better sensorimotor integration and an increase in corticomuscular synchronization.
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Tsukiboshi T, Sato H, Tanaka Y, Saito M, Toyoda H, Morimoto T, Türker KS, Maeda Y, Kang Y. Illusion caused by vibration of muscle spindles reveals an involvement of muscle spindle inputs in regulating isometric contraction of masseter muscles. J Neurophysiol 2012; 108:2524-33. [PMID: 22914653 DOI: 10.1152/jn.00997.2011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spindle Ia afferents may be differentially involved in voluntary isometric contraction, depending on the pattern of synaptic connections in spindle reflex pathways. We investigated how isometric contraction of masseter muscles is regulated through the activity of their muscle spindles that contain the largest number of intrafusal fibers among skeletal muscle spindles by examining the effects of vibration of muscle spindles on the voluntary isometric contraction. Subjects were instructed to hold the jaw at resting position by counteracting ramp loads applied on lower molar teeth. In response to the increasing-ramp load, the root mean square (RMS) of masseter EMG activity almost linearly increased under no vibration, while displaying a steep linear increase followed by a slower increase under vibration. The regression line of the relationship between the load and RMS was significantly steeper under vibration than under no vibration, suggesting that the subjects overestimated the ramp load and excessively counteracted it as reflected in the emergence of bite pressure. In response to the decreasing-ramp load applied following the increasing one, the RMS hardly decreased under vibration unlike under no vibration, leading to a generation of bite pressure even after the offset of the negative-ramp load until the vibration was ceased. Thus the subjects overestimated the increasing rate of the load while underestimating the decreasing rate of the load, due to the vibration-induced illusion of jaw opening. These observations suggest that spindle Ia/II inputs play crucial roles both in estimating the load and in controlling the isometric contraction of masseter muscles in the jaw-closed position.
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Affiliation(s)
- Taisuke Tsukiboshi
- Department of Neuroscience and Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Which type of repetitive muscle contractions induces a greater acute impairment of position sense? J Electromyogr Kinesiol 2010; 20:298-304. [DOI: 10.1016/j.jelekin.2009.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 04/01/2009] [Accepted: 04/01/2009] [Indexed: 11/17/2022] Open
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Abstract
AbstractThis article describes a series of experiments directed toward the following questions: (1) Do signals from musculotendinous receptors reach consciousness? (2) Does feed-forward information of muscular force and expected extent of voluntary movement exist? To answer these questions data from voluntary compression of springs and strain-gauge have been analysed in healthy young subjects and in patients with unilateral focal lesions of the cerebral hemispheres.By successive elimination of information from other sources it was possible to verify that receptors in muscles and tendons do signal movement magnitude and muscular tension to the cerebral cortex, and that this information does indeed reach consciousness. There also exists a feed-forward mechanism signalling parameters of voluntary contraction. However, it is unclear whether peripheral, subcortical, or intracortical loops are directly involved. Perception of signals of muscular tension is abolished by lesions of the contralateral cortex near the central sulcus. It is possible that there exist separate cortical projection areas for kinaesthetic signals from muscles and from joints.
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Rank-ordered Recruitment of Masseter Motoneurons during Slow Closing Phase of Mastication Cycle Presumably by the Activity of Mesencephalic Trigeminal Neurons. J Oral Biosci 2010. [DOI: 10.1016/s1349-0079(10)80013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kang Y, Saito M, Toyoda H, Sato H. Recruitment of masseter motoneurons by the presumed spindle Ia inputs. PROGRESS IN BRAIN RESEARCH 2010; 187:163-71. [PMID: 21111207 DOI: 10.1016/b978-0-444-53613-6.00011-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The slow-closing phase of the mastication cycle plays a major role in the mastication of foods. However, the neuronal mechanism underlying the slow-closing phase remains unknown. The isometric contraction of jaw-closing muscles is developed through the recruitment of jaw-closing motoneurons during the slow-closing phase. It is well established that motor units are recruited depending on the order of sizes or input resistances (IRs) of motoneurons, which is known as the size principle. Two-pore-domain acid-sensitive K(+) (TASK1/3) channels are recently found to be the molecular correlates of the IR, and also found to be expressed in the masseter motoneurons. Here, we addressed the question whether spindle Ia inputs onto masseter motoneurons can induce the orderly recruitment of motoneurons in slice preparations of the rat brain using voltage-sensitive dye imaging and whole-cell patch-clamp methods. Voltage-sensitive dye imaging revealed the recruitment of many motoneurons in the whole nucleus of masseter in response to repetitive stimulation of the presumed spindle Ia inputs. Dual whole-cell recordings obtained from two adjacent motoneurons revealed the IR-ordered recruitment of motoneurons in response to repetitive stimulation of the presumed spindle Ia inputs. Thus, Ia inputs are likely to play a crucial role in the orderly recruitment of motoneurons of the trigeminal motor nucleus, which would be progressed during the slow-closing phase of the mastication cycle. Possible involvements of TASK channels in the orderly recruitment are discussed.
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Affiliation(s)
- Youngnam Kang
- Department of Neuroscience & Oral Physiology, Osaka University Graduate School of Dentistry,Yamadaoka, Suita, Osaka, Japan
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Macefield VG. Physiological characteristics of low-threshold mechanoreceptors in joints, muscle and skin in human subjects. Clin Exp Pharmacol Physiol 2005; 32:135-44. [PMID: 15730450 DOI: 10.1111/j.1440-1681.2005.04143.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
1. The development of microneurography, in which an insulated tungsten microelectrode is inserted into an accessible peripheral or cranial nerve in awake human subjects, has allowed detailed analyses of the signalling capacities of single mechanoreceptive afferents from the skin, muscles and joints. For example, we know much about how the two classes of rapidly adapting (Meissner and Pacinian) and two classes of slowly adapting (Merkel and Ruffini) cutaneous mechanoreceptors encode forces applied normal or tangential to the skin of the hand and the similarities and differences in glabrous versus non-glabrous skin (and receptors associated with hairs). We also know about stretch- and force-sensitive endings in muscle (the muscle spindle and Golgi tendon organ, respectively) and how they behave during passive or active movements or during isometric contractions. In addition, we have characterized the firing properties of mechanoreceptors in the joint capsules of the fingers. However, we know little about sensory nerves in the periosteum, other than that nociceptors and Pacinian corpuscles exist. 2. In addition to studies on the physiology of sensory endings in human subjects, microstimulation through the recording microelectrode has revealed how the brain deals with the sensory information conveyed by a single afferent. From this work, we know that there is specificity in the sensory channels: electrical stimulation of a single Meissner or Pacinian corpuscle generates frequency dependent illusions of 'flutter' or 'vibration', whereas microstimulation of a single Merkel afferent can produce a percept of 'pressure' and stimulation of a single joint afferent can evoke a sensation of 'joint rotation'. Interestingly, the input from a single Ruffini ending in the skin cannot be perceived and the same is true of muscle spindle afferents. So, where does this leave us with osseoperception from the mouth? Given that the periodontal receptors in the vicinity have been lost, which mechanoreceptive endings could encode forces applied to a bone-implanted prosthesis? 3. Meissner and Merkel endings have very small receptive fields and respond only to local forces. Pacinian corpuscles have an exquisite sensitivity to brisk mechanical events and could respond to such stimuli transmitted through the bone to a remote receptor, but would not be able to encode sustained forces. Ruffini endings also respond to forces applied remote to the receptive field and, unlike the Pacinian corpuscles, respond in a sustained fashion, but would their signals be perceived? Like muscle spindles, it is possible that the coactivation of many Ruffini endings could provide meaningful information. Finally, as we have seen, the input from a single joint receptor can be perceived, but they mostly respond at the limits of joint rotation, so it is unlikely that any associated with the temporomandibular joint could contribute to osseoperception.
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Affiliation(s)
- Vaughan G Macefield
- Prince of Wales Medical Research Institute and University of New South Wales, Sydney, New South Wales, Australia.
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Jones KE, Wessberg J, Vallbo A. Proprioceptive feedback is reduced during adaptation to a visuomotor transformation: preliminary findings. Neuroreport 2001; 12:4029-33. [PMID: 11742233 DOI: 10.1097/00001756-200112210-00035] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adapting movements in relation to visual feedback is a ubiquitous characteristic of sensorimotor control and involves the integration of multiple sources of sensory information. We recorded sensory feedback from muscle spindle afferents during visuomotor adaptation while subjects performed an aiming task to investigate whether the activity of the muscle spindles was modulated by the fusimotor system under these learning conditions. None of the muscle spindles showed an increase in activity, rather in 83% of the trials the firing rates were decreased. These preliminary results suggest that the CNS reduces the sensory signals arising from muscle spindles perhaps as a means of resolving the conflict between visual and proprioceptive feedback during the task.
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Affiliation(s)
- K E Jones
- Department of Physiology, Göteborg University, Göteborg, Sweden
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Abstract
Muscle fatigue is an exercise-induced reduction in maximal voluntary muscle force. It may arise not only because of peripheral changes at the level of the muscle, but also because the central nervous system fails to drive the motoneurons adequately. Evidence for "central" fatigue and the neural mechanisms underlying it are reviewed, together with its terminology and the methods used to reveal it. Much data suggest that voluntary activation of human motoneurons and muscle fibers is suboptimal and thus maximal voluntary force is commonly less than true maximal force. Hence, maximal voluntary strength can often be below true maximal muscle force. The technique of twitch interpolation has helped to reveal the changes in drive to motoneurons during fatigue. Voluntary activation usually diminishes during maximal voluntary isometric tasks, that is central fatigue develops, and motor unit firing rates decline. Transcranial magnetic stimulation over the motor cortex during fatiguing exercise has revealed focal changes in cortical excitability and inhibitability based on electromyographic (EMG) recordings, and a decline in supraspinal "drive" based on force recordings. Some of the changes in motor cortical behavior can be dissociated from the development of this "supraspinal" fatigue. Central changes also occur at a spinal level due to the altered input from muscle spindle, tendon organ, and group III and IV muscle afferents innervating the fatiguing muscle. Some intrinsic adaptive properties of the motoneurons help to minimize fatigue. A number of other central changes occur during fatigue and affect, for example, proprioception, tremor, and postural control. Human muscle fatigue does not simply reside in the muscle.
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Affiliation(s)
- S C Gandevia
- Prince of Wales Medical Research Institute, Prince of Wales Hospital and University of New South Wales, Randwick, Sydney, Australia.
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Mussa-Ivaldi FA, Bizzi E. Motor learning through the combination of primitives. Philos Trans R Soc Lond B Biol Sci 2000; 355:1755-69. [PMID: 11205339 PMCID: PMC1692905 DOI: 10.1098/rstb.2000.0733] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this paper we discuss a new perspective on how the central nervous system (CNS) represents and solves some of the most fundamental computational problems of motor control. In particular, we consider the task of transforming a planned limb movement into an adequate set of motor commands. To carry out this task the CNS must solve a complex inverse dynamic problem. This problem involves the transformation from a desired motion to the forces that are needed to drive the limb. The inverse dynamic problem is a hard computational challenge because of the need to coordinate multiple limb segments and because of the continuous changes in the mechanical properties of the limbs and of the environment with which they come in contact. A number of studies of motor learning have provided support for the idea that the CNS creates, updates and exploits internal representations of limb dynamics in order to deal with the complexity of inverse dynamics. Here we discuss how such internal representations are likely to be built by combining the modular primitives in the spinal cord as well as other building blocks found in higher brain structures. Experimental studies on spinalized frogs and rats have led to the conclusion that the premotor circuits within the spinal cord are organized into a set of discrete modules. Each module, when activated, induces a specific force field and the simultaneous activation of multiple modules leads to the vectorial combination of the corresponding fields. We regard these force fields as computational primitives that are used by the CNS for generating a rich grammar of motor behaviours.
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Affiliation(s)
- F A Mussa-Ivaldi
- Department of Physiology, Northwestern University Medical School, Chicago, IL, USA
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Hagbarth KE, Nordin M. Postural after-contractions in man attributed to muscle spindle thixotropy. J Physiol 1998; 506 ( Pt 3):875-83. [PMID: 9503345 PMCID: PMC2230743 DOI: 10.1111/j.1469-7793.1998.875bv.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
1. It is an old observation that non-volitional arm abduction movements accompanied by a sensation of arm lightness often occur as an after-effect following forceful voluntary arm abductor contractions against a restraint. In the present study we have tested the hypothesis that such non-volitional, so-called 'postural after-contractions' are tonic reflex responses to an enhanced resting discharge in primary muscle spindle afferents which in turn is a consequence of thixotropy-dependent enhanced stiffness of intrafusal muscle fibres. 2. Results obtained in ten volunteers show that the arm abductor after-contraction phenomenon in man is most readily evoked by a type of conditioning procedure which in various respects mimics the procedure proven in animal experiments to be particularly effective in producing thixotropy-dependent excitation of primary spindle endings. 3. It is also shown that changes in arm abductor intramuscular temperature affect the strength of the after-contractions in a direction predicted by the thixotropy hypothesis. 4. Attention is drawn to several similarities between the after-contraction phenomenon with accompanying sensory illusions and the tonic reflex responses and illusions that can be induced when primary spindle endings are excited by muscle vibration. 5. The results support our hypothesis that postural after-contractions are induced by activity in primary muscle spindle afferents as a consequence of thixotropic properties of intrafusal muscle fibres. Central excitability changes following the conditioning voluntary effort may contribute to the phenomenon.
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Affiliation(s)
- K E Hagbarth
- Department of Clinical Neurophysiology, University Hospital, Uppsala, Sweden
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The signalling of touch, finger movements and manipulation forces by mechanoreceptors in human skin. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0166-4115(98)80065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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Inglis JT, Leeper JB, Burke D, Gandevia SC. Morphology of action potentials recorded from human nerves using microneurography. Exp Brain Res 1996; 110:308-14. [PMID: 8836694 DOI: 10.1007/bf00228561] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study investigated the morphology of action potentials and the frequency of occurrence of the various waveforms encountered when using microneurography to record single-unit muscle afferent activity in humans. With 75% of the afferents recorded in this study (55 of 73 afferents), action potentials had a double-peaked morphology. For action potentials with an initial, positive double-peaked morphology, the relevant afferent conducts impulses past the microelectrode, with the second peak representing current fluctuations at the node of Ranvier proximal to the electrode. Accordingly, in the majority of recordings, the afferent is capable of conducting impulses to the spinal cord. The mean interpeak interval for these double-peaked units was 168 microseconds (range 90-310 microseconds). This represents marked prolongation of conduction time across the impaled internode. When the interpeak interval was relatively short (90-120 microseconds), the double-peaked morphology could be recognized only if the low-pass filter was high (> or = 10 kHz). The probability of recording a double-peaked unit was the same whether the recording was acquired early or late in a 3-h experiment. Conduction block developed in 6 of 73 single units during the recordings. These findings indicate that the majority of isolated single afferents and, indeed, the majority of afferents within the relevant fascicle are capable of transmitting impulses across the recording site, even though conduction across the impaled internode is slow. Conduction block due to direct injury or pressure is relatively uncommon.
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Affiliation(s)
- J T Inglis
- Department of Physical Therapy, Elborn College, University of Western Ontario, Canada
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Thomas CK. Human motor units studied by spike-triggered averaging and intraneural motor axon stimulation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1995; 384:147-60. [PMID: 8585447 DOI: 10.1007/978-1-4899-1016-5_12] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
When low-threshold motor units are activated at low rates during sustained, weak voluntary contractions, most unit force profiles exhibit fatigue but some force potentiation. These data, obtained by spike-triggered averaging, are compared to the fatigue resistance of human motor units activated at twitch and tetanic rates by intraneural motor axon stimulation. With the latter technique, representative sampling of the motor units from one muscle group shows that unit force fatigue or potentiation at submaximal frequencies, and contractile rate changes, dictate the shifts in unit force-frequency relationships. More diverse fatigue protocols, and when possible, careful comparisons of data obtained by both these techniques, are needed to further our understanding of the force and frequency changes of single motor units during voluntary and stimulated exercise.
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Affiliation(s)
- C K Thomas
- Miami Project to Cure Paralysis, University of Miami School of Medicine, Florida 33136, USA
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Macefield G, Hagbarth KE, Gorman R, Gandevia SC, Burke D. Decline in spindle support to alpha-motoneurones during sustained voluntary contractions. J Physiol 1991; 440:497-512. [PMID: 1839558 PMCID: PMC1180165 DOI: 10.1113/jphysiol.1991.sp018721] [Citation(s) in RCA: 221] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
1. To address whether the muscle spindle support to alpha-motoneurones is maintained during prolonged isometric voluntary contractions, the discharge of eighteen muscle spindle afferents, originating in the dorsiflexors of the ankle or toes, was recorded from the common peroneal nerve in eight subjects. Isometric contractions were generally sustained for 1 min, usually below 30% of the maximal voluntary dorsiflexion force. 2. Once the afferent had been identified, subjects were instructed to dorsiflex the foot slowly to recruit the spindle ending, to continue the ramp contraction until a predetermined target force was reached, and then to hold that force until requested to relax. 3. Five muscle spindle afferents maintained a constant discharge frequency during the hold phase of the isometric contraction. Following relaxation of the contraction two spindle afferents from tibialis anterior, exhibited a post-contraction discharge despite the absence of detectable electromyographic activity (EMG). 4. The discharge frequency of most of the spindle afferents (72%) declined progressively during the isometric contraction. The mean firing rates had declined to two-thirds of those at the onset of the contraction by 30 s, and to half after 1 min. The decline in spindle firing rate commenced during the ramp phase of the contraction and was statistically significant by 10 s, when force was held constant. The extent of the decline was greater for those units with the higher initial firing rates and for those units studied after many preceding contractions. 5. In the same contractions a progressive increase in EMG was required to maintain force and consequently the change in EMG was inversely related to the change in spindle discharge. While many mechanisms may contribute to the decline in spindle discharge during a sustained isometric contraction, it is argued that the result will be a progressive disfacilitation of alpha-motoneurones, which may contribute to the decline in motor unit firing rates during a sustained contraction.
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Affiliation(s)
- G Macefield
- Department of Clinical Neurophysiology, Institute of Neurological Sciences, Prince Henry Hospital, Sydney, Australia
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Abstract
Empirical and theoretical reasons were given to investigate operant conditioning in a new, integrative approach within motor control physiology. Elements of inborn and learned behavior were presented in a framework specifying their stimuli and responses. The operant was redefined as a controlling discriminative stimulus, Sd, together with the response, R, it produces, on the basis of a previous literature of operant and instrumental research. Complex motor and neural activity were reviewed in accordance with partitioning of: responses, controlling stimulation, reinforcement, and functions of movement-produced stimulation. Schematics portrayed reinforcement principles through analysis of a fast pathway from Ia muscle spindle afferents to motor outflow. Methods were suggested to minimize operant units through selective reinforcement and establish them to defined end points of learning within composite, ongoing behavior. It was argued that operant neural mechanisms can be investigated efficiently only by starting with individual operants that are thoroughly characterized.
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Appenteng K, Prochazka A. Tendon organ firing during active muscle lengthening in awake, normally behaving cats. J Physiol 1984; 353:81-92. [PMID: 6237191 PMCID: PMC1193294 DOI: 10.1113/jphysiol.1984.sp015323] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Recordings were obtained of the discharge of single tendon organ (Ib) and muscle spindle (Ia) afferents of the ankle extensor muscles during movement in normal cats. During very slow, smooth increases and decreases in muscle force, Ib afferents showed from one to five stepwise changes in firing rate, attributable to the recruitment of motor units inserting into the receptor capsule. These 'recruitment steps' in Ib firing rate became smoothed and tended to merge during faster variations in muscle force, and were rarely discernible in normal movements such as slow stepping. Rapid imposed stretches resulted in Ib firing patterns which fitted well a dynamic function of whole muscle force. Comparisons were made between the responses of Ib and Ia afferents during rapid, imposed muscle stretch. The segmentation of discharge typical of Ia afferents was not present in Ib afferents, despite segmentation of the e.m.g. of the receptor-bearing muscles. This would imply that Ib afferents exert a rapidly fluctuating reflex action against a relatively steady background of Ib input. Ankle extensor Ib firing during stepping was characterized by feeble firing during the swing phase and substantial, smoothly modulated firing during the stance phase. Taken together with previous chronic recordings, the data support the view that the ensemble of Ib afferents from a muscle signals a dynamic, non-linear function of whole muscle force over a wide range of normal movement.
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Nordh E, Hulliger M, Vallbo AB. The variability of inter-spike intervals of human spindle afferents in relaxed muscles. Brain Res 1983; 271:89-99. [PMID: 6883123 DOI: 10.1016/0006-8993(83)91367-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The impulse discharge in single afferent units was recorded in waking human subjects. Tungsten needle electrodes were percutaneously inserted in the left radial nerve, and activity in muscle spindle afferents from the extensor muscles of the forearm were studied while the subjects remained relaxed. Thirty-six spontaneously discharging single units were studied, 16 primaries, 10 secondaries and 10 non-classified. The regularity of afferent discharge and the shape of the inter-spike interval histograms was assessed by off-line statistical analysis of stationary segments of afferent discharge. The mean discharge rate of both primary and secondary afferents was generally low. Secondaries predominantly fired with low variability, whereas primaries showed high as well as low variability, but the median values for the two groups differed significantly. However, the individual unit values of coefficient of variation showed a considerable overlap between the two groups. The size of the coefficient of variation in the human spindle afferents was between that of de-efferented and of intact afferents in decerebrated cats. Determination of the coefficient of variation may therefore help, as a complementary criterion, to differentiate between primary and secondary afferents in man.
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Riise C, Sheikholeslam A. The influence of experimental interfering occlusal contacts on the postural activity of the anterior temporal and masseter muscles in young adults. J Oral Rehabil 1982; 9:419-25. [PMID: 6957573 DOI: 10.1111/j.1365-2842.1982.tb01031.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The effects of an intercuspal occlusal interference on the pattern of postural activity of the anterior temporal and masseter muscles were studied in eleven volunteers with complete, natural dentitions. The results indicate that, in man, there is postural activity in the anterior temporal and sometimes in the masseter muscles. The pattern of postural activity is influenced by the occurrence of an experimental occlusal interference, sometimes as early as 1 h after the insertion. After 48 h there was a significant increase of the activity in the anterior temporal muscles. This increased activity persisted until the interference was removed 1 week later and had almost disappeared 1 week after the removal.
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Gandevia SC, Mahutte CK. Theoretical requirements for the interpretation of signals of intramuscular tension. J Theor Biol 1982; 97:141-53. [PMID: 7132389 DOI: 10.1016/0022-5193(82)90095-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kato M, Murakami S, Takahashi K, Hirayama H. Motor unit activities during maintained voluntary muscle contraction at constant levels in man. Neurosci Lett 1981; 25:149-54. [PMID: 7279310 DOI: 10.1016/0304-3940(81)90323-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Activities of motor units of human tibialis anterior muscle were studied when the subject maintained the force of the muscle at a constant level voluntarily. Motor units were classified into two main groups according to their discharge frequencies and their tensions. Those units which were recruited from the beginning of the contraction and discharged tonically throughout yielded low tensions and units which showed discharge only for a limited period produced higher tensions.
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Morimoto T, Ozaki M, Yoshimura Y, Kawamura Y. Effects of the interpolated vibratory stimulation on the interdental dimension discrimination in normal and joint defect subjects. J Dent Res 1979; 58:560-7. [PMID: 153918 DOI: 10.1177/00220345790580020401] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
No significant differences in the interdental dimension discrimination (IDD) ability were found between normal and joint defect subjects. Furthermore, vibration onto the mandible gave similar effects on the nature of IDD in both subject groups. Thus, the muscle spindles of masticatory muscles may contribute to IDD, but temporomandibular receptors may not.
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Abstract
The recently developed technique provides a precise assessment of neutral activity via intrafascicular axonal recordings from human peripheral nerves. With this technique it is possible to record from cutaneous afferent fibers. Receptive fields belonging to cutaneous afferents are readily perceived by patients due to orthodromic conduction of activity induced by mechanical activation of appropriate fibers. Temporal synchrony between peripherally applied stimuli and the proximally placed recording electrode assure continuity of the nerve. By sampling axonal activity from cutaneous fasciles at regular intervals following trauma of undefined etiology, a definite appraisal can be made concerning the integrity of a nerve and, hence, the need for surgical intervention. This is a preliminary report of the first such applications of this technique.
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Järvilehto T. Neural basis of cutaneous sensations analyzed by microelectrode measurements from human peripheral nerves--a review. Scand J Psychol 1977; 18:348-59. [PMID: 339334 DOI: 10.1111/j.1467-9450.1977.tb00298.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
In standing human subjects, muscle spindle activity was recorded from peroneal nerve fascicles innervating anterior compartment muscles. Provided that the receptor-bearing muscle remained relaxed, the basal activity and responses to stretch seen in multi-unit and single unit afferent recordings were stable and not altered by eye-closures of assistance to balance. The discharge frequencies of single afferent fibres were similar to those recorded at comparable muscle lengths in relaxed reclining subjects. By analogy to findings in reclining subjects, these results suggest that, during standing, the background fusimotor drive to relaxed muscles is neglibible. Backward body sway can induce a sway-stabilizing reflex contraction in the muscles of the anterior compartment. Such reflex contractions were accompanied by increased muscle spindle activity, the intensity of which appeared to be related to the intensity of the skeletomotor contraction. When balance was assisted by holding a support, swaying movements of similar or greater amplitude and velocity did not produce reflex activity, and the spindle response was of low frequency. It is concluded that the sway-stabilizing reflex contraction operates in alpha-gamma linkage, and that these contractions are not generated by segmental stretch reflex pathways.
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Eldred E, Yellin H, DeSantis M, Smith CM. Supplement to bibliography on muscle receptors: their morphology, pathology, physiology, and pharmacology. Exp Neurol 1977; 55:1-118. [PMID: 323027 DOI: 10.1016/0014-4886(77)90360-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sjöström A, Zangger P. Muscle spindle control during locomotor movements generated by the deafferented spinal cord. ACTA PHYSIOLOGICA SCANDINAVICA 1976; 97:281-91. [PMID: 134622 DOI: 10.1111/j.1748-1716.1976.tb10265.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In acute spinalized (Th 12) cats, treated with DOPA, curarized or with all lumbosacral dorsal roots transected, stepping patterns were elicited in the hindlimbs by continuous electrical stimulation of the dorsal roots. Single primary endings in dorsal root filaments or single gamma and alpha efferents in muscle nerve filaments from flexors and extensors were recorded together with the efferent nerve activity to various hindlimb muscles. The experiments showed a clear coactivation of the intra- and extrafusal system to the same muscle. The alpha efferent discharges typically started with a very short first interspike interval. It is concluded that there exists a central spinal alpha-gamma-linkage for locomotion in the hindlimbs.
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Gurfinkel VS, Lipshits MI, Mori S, Popov KE. The state of stretch reflex during quiet standing in man. PROGRESS IN BRAIN RESEARCH 1976; 44:473-86. [PMID: 1005730 DOI: 10.1016/s0079-6123(08)60753-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hultborn H. Transmission in the pathway of reciprocal Ia inhibition to motoneurones and its control during the tonic stretch reflex. PROGRESS IN BRAIN RESEARCH 1976; 44:235-55. [PMID: 188072 DOI: 10.1016/s0079-6123(08)60736-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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41
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Hagbarth KE, Wallin G, Burke D, Löfstedt L. Effects of the Jendrassik manoeuvre on muscle spindle activity in man. J Neurol Neurosurg Psychiatry 1975; 38:1143-53. [PMID: 130466 PMCID: PMC492180 DOI: 10.1136/jnnp.38.12.1143] [Citation(s) in RCA: 74] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Twenty-eight mechanoreceptive units identified as primary or secondary spindle afferents were sampled from muscle nerve fascicles in the median, peroneal, and tibial nerves of healthy adult subjects. The responses of these units to sustained passive muscle stretch, to passive stretching movements, to tendon taps, and electrically-induced muscle twitches were studied while the subject performed repeated Jendrassik manoeuvres involving strong voluntary contractions in distant muscle groups. The manoeuvres had no effect upon the afferent spindle discharges as long as there were no EMG signs of unintentional contractions occurring in the receptor-bearing muscle and no mechanotransducer signs of unintentional positional changes altering the load on that muscle. Unintentional contractions in the receptor-bearing muscle frequently occurred during the manoeuvres, however, and then coactivation of the spindle afferents was observed. Multiunit afferent responses to Achilles tendon taps, led off from tibial nerve fascicles, were in a similar way uninfluenced by the Jendrassik manoeuvres, even when these resulted in marked reinforcement of the calf muscle tendon jerk. The results provide no evidence for fusimotor sensitization of spindles in muscles remaining relaxed during the Jendrassik manoeuvre, and reflex reinforcement occurring without concomitant signs of active tension rise in the muscles tested is presumed to depend upon altered processing of the afferent volleys within the cord.
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Abstract
It is certainly a mark of great wisdom to the organizer of this meeting to have chosen Charles Phillips as our Guest Lecturer for this meeting.Whilst I am grateful for this opportunity of saying a few words of introduction, I am sure it can be said of Charles Phillips that very little introduction is necessary, since we meet him at the most important meetings in Neurophysiology around the world. Any meeting on the motor system, of course, is not complete without the participation of Dr. Phillips. However, some of the less old-timers than myself, and the students, might be interested in the beginnings of Dr. Phillips’ career in neurophysiology and to know that he was first a clinical neurologist beginning his medical studies in Oxford just before the war, where he came under the influence of Sir Charles Sherrington with Jack Eccles as his tutor.
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Szumski AJ, Burg D, Struppler A, Velho F. Activity of muscle spindles during muscle twitch and clonus in normal and spastic human subjects. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1974; 37:589-97. [PMID: 4140072 DOI: 10.1016/0013-4694(74)90072-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Burg D, Szumski AJ, Struppler A, Velho F. Assessment of fusimotor contribution to reflex reinforcement in humans. Journal of Neurology, Neurosurgery and Psychiatry 1974. [DOI: 10.1136/jnnp.37.9.1012] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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45
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Poppele RE, Kennedy WR. Comparison between behavior of human and cat muscle spindles recorded in vitro. Brain Res 1974; 75:316-9. [PMID: 4276333 DOI: 10.1016/0006-8993(74)90753-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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46
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Binder MD, Rosenberg JR, McWilliams PN, Moore GP. Correlation analysis of neuromuscular spike trains. Brain Res 1974; 72:300-4. [PMID: 4275658 DOI: 10.1016/0006-8993(74)90869-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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47
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Vallbo AB. Afferent discharge from human muscle spindles in non-contracting muscles. Steady state impulse frequency as a function of joint angle. ACTA PHYSIOLOGICA SCANDINAVICA 1974; 90:303-18. [PMID: 4274637 DOI: 10.1111/j.1748-1716.1974.tb05593.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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48
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Vallbo AB. Human muscle spindle discharge during isometric voluntary contractions. Amplitude relations between spindle frequency and torque. ACTA PHYSIOLOGICA SCANDINAVICA 1974; 90:319-36. [PMID: 4274638 DOI: 10.1111/j.1748-1716.1974.tb05594.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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49
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Burg D, Szumski AJ, Struppler A, Velho F. Afferent and efferent activation of human muscle receptors involved in reflex and voluntary contraction. Exp Neurol 1973; 41:754-68. [PMID: 4271379 DOI: 10.1016/0014-4886(73)90066-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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50
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Appelberg B. Muscle spindles in a flexion reflex elicited by natural stimulation. ACTA PHYSIOLOGICA SCANDINAVICA 1973; 89:145-53. [PMID: 4271825 DOI: 10.1111/j.1748-1716.1973.tb05506.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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