Cyclical passive stretch influences the mechanical properties of the inactive cat soleus

Effects of Ankle Continuous Passive Motion on Soleus Hypertonia in Individuals with Cerebral Palsy: A Case Series

Background

Continuous passive motion device (CPM) provides repetitive movement over extended periods of time for those who have low functional ability. The purpose of this research was to evaluate the effects of a four-week program of continuous passive motion of the ankle joint on the changes in soleus hypertonia in individuals with cerebral palsy who suffered from life-long hypertonia.

Methods

A single group, repeated-measures study was conducted. Eight individuals (7 males and 1 female with a mean age of 21.8 ± 8.5 years) with spastic cerebral palsy underwent bilateral ankle CPM for 1 h a day, 5 days a week, for 4 weeks. The outcome measures included the Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle, the ratio of maximum H reflex to maximum soleus M-response (H/M ratio), and post-activation depression (PAD). All outcomes were measured before and after the intervention. A paired t-test was used to examine treatment effects pre-versus post-intervention.

Results

Paired t-tests showed that the CPM program significantly decreased the MAS score (p = 0.006), decreased the maximum H/M ratio (p=0.001), improved PAD (p = 0.003, p = 0.040, and p = 0.032 at 0.2 Hz, 1 Hz, and 2 Hz, respectively), and increased the passive ankle range of motion (p = 0.049).

Conclusion

Ankle CPM not only reduced soleus hypertonia but also improved the PROM in individuals with cerebral palsy. The results of this study show ankle CPM to be an effective intervention for individuals with cerebral palsy.

Unexpected Fascicle Length Changes In Denervated Feline Soleus Muscle During Stance Phase Of Walking

After surgical repair of traumatically severed peripheral nerves, associated muscles are paralyzed for weeks. Little is known about fascicle length changes in paralyzed muscles during locomotion. The aim of this study was to investigate to what extent, if any, muscle fascicles of denervated feline soleus (SO) change length during stance of walking when intact SO synergists are actively contracting. Hindlimb kinematics, SO fascicle and muscle-tendon unit (MTU) length, and EMG activity of SO, lateral gastrocnemius (LG) and medial gastrocnemius (MG) were measured during level and slope walking in adult cats. Measurements were taken before and 1–2 weeks following SO-LG denervation. Unexpectedly, SO fascicle lengthening and shortening during stance in all walking conditions were evident after denervation. The greatest SO fascicle shortening (17.3 ± 2.2% of a reference length) and least fascicle lengthening (1.5 ± 0.8%) after denervation were found during upslope walking, where MG EMG activity was greatest across slopes (P < 0.05) and greatest discrepancies between post denervation SO fascicle and MTU length changes occurred. These findings suggest that myofascial linkages between denervated SO and its active synergists might affect its fascicle length changes. Further studies are needed to directly test this suggestion.

Motoneurons derived from induced pluripotent stem cells develop mature phenotypes typical of endogenous spinal motoneurons

Induced pluripotent cell-derived motoneurons (iPSCMNs) are sought for use in cell replacement therapies and treatment strategies for motoneuron diseases such as amyotrophic lateral sclerosis (ALS). However, much remains unknown about the physiological properties of iPSCMNs and how they compare with endogenous spinal motoneurons or embryonic stem cell-derived motoneurons (ESCMNs). In the present study, we first used a proteomic approach and compared protein expression profiles between iPSCMNs and ESCMNs to show that <4% of the proteins identified were differentially regulated. Like ESCs, we found that mouse iPSCs treated with retinoic acid and a smoothened agonist differentiated into motoneurons expressing the LIM homeodomain protein Lhx3. When transplanted into the neural tube of developing chick embryos, iPSCMNs selectively targeted muscles normally innervated by Lhx3 motoneurons. In vitro studies showed that iPSCMNs form anatomically mature and functional neuromuscular junctions (NMJs) when cocultured with chick myofibers for several weeks. Electrophysiologically, iPSCMNs developed passive membrane and firing characteristic typical of postnatal motoneurons after several weeks in culture. Finally, iPSCMNs grafted into transected mouse tibial nerve projected axons to denervated gastrocnemius muscle fibers, where they formed functional NMJs, restored contractile force. and attenuated denervation atrophy. Together, iPSCMNs possess many of the same cellular and physiological characteristics as ESCMNs and endogenous spinal motoneurons. These results further justify using iPSCMNs as a source of motoneurons for cell replacement therapies and to study motoneuron diseases such as ALS.

Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI). Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. A mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain) pathways in the spinal cord may emerge in response to various noxious inputs, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord below the level of SCI. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Prior work from our group has shown that stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after SCI. We review these basic phenomena, how these findings relate to the broader spinal plasticity literature, discuss the cellular and molecular mechanisms, and finally discuss implications of these and other findings for improved rehabilitative therapies after SCI.

Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors

BACKGROUND

The objective of this study was to investigate changes in active and passive biomechanical properties of the calf muscle-tendon unit induced by controlled ankle stretching in stroke survivors.

METHODS

Ten stroke survivors with ankle spasticity/contracture and ten healthy control subjects received intervention of 60-min ankle stretching. Joint biomechanical properties including resistance torque, stiffness and index of hysteresis were evaluated pre- and post-intervention. Achilles tendon length was measured using ultrasonography. The force output of the triceps surae muscles was characterized via the torque-angle relationship, by stimulating the calf muscles at a controlled intensity across different ankle positions.

FINDINGS

Compared to healthy controls, the ankle position corresponding to the peak torque of the stroke survivors was shifted towards plantar flexion (P<0.001). Stroke survivors showed significantly higher resistance torques and joint stiffness (P<0.05), and these higher resistances were reduced significantly after the stretching intervention, especially in dorsiflexion (P=0.013). Stretching significantly improved the force output of the impaired calf muscles in stroke survivors under matched stimulations (P<0.05). Ankle range of motion was also increased by stretching (P<0.001).

INTERPRETATION

At the joint level, repeated stretching loosened the ankle joint with increased passive joint range of motion and decreased joint stiffness. At the muscle-tendon level, repeated stretching improved calf muscle force output, which might be associated with decreased muscle fascicle stiffness, increased fascicle length and shortening of the Achilles tendon. The study provided evidence of improvement in muscle tendon properties through stretching intervention.

Na v1.4 and Na v1.5 are modulated differently during muscle immobilization and contractile phenotype conversion

Muscle immobilization leads to modification in its fast/slow contractile phenotype. Since the properties of voltage-gated sodium channels (Na(v)) are different between "fast" and "slow" muscles, we studied the effects of immobilization on the contractile properties and the Na(v) of rat peroneus longus (PL). The distal tendon of PL was cut and fixed to the adjacent bone at neutral muscle length. After 4 or 8 wk of immobilization, the contractile and the Na(v) properties were studied and compared with muscles from control animals (Student's t-test). After 4 wk of immobilization, PL showed a faster phenotype with a rightward shift of the force-frequency curve and a decrease in both the Burke's index of fatigability and the tetanus-to-twitch ratio. These parameters showed opposite changes between 4 and 8 wk of immobilization. The maximal sodium current in 4-wk immobilized fibers was higher compared with that of control fibers (11.5 ± 1.2 vs. 7.8 ± 0.8 nA, P = 0.008), with partial recovery to the control values in 8-wk immobilized fibers (8.6 ± 0.7 nA, P = 0.48). In the presence of tetrodotoxin, the maximal residual sodium current decreased continuously throughout immobilization. Using the Western blot analysis, Na(v)1.4 expression showed a transient increase in 4-wk muscle, whereas Na(v)1.5 expression decreased during immobilization. Our results indicate that a muscle immobilized at optimal functional length with the preservation of neural inputs exhibits a transient fast phenotype conversion. Na(v)1.4 expression and current are related to the contractile phenotype variation.

Physical activity and motor decline in older persons

We tested the hypothesis that physical activity modifies the course of age-related motor decline. More than 850 older participants of the Rush Memory and Aging Project underwent baseline assessment of physical activity and annual motor testing for up to 8 years. Nine strength measures and nine motor performance measures were summarized into composite measures of motor function. In generalized estimating equation models, global motor function declined during follow-up (estimate, -0.072; SE, 0.008; P < 0.001). Each additional hour of physical activity at baseline was associated with about a 5% decrease in the rate of global motor function decline (estimate, 0.004; SE, 0.001; P = 0.007). Secondary analyses suggested that the association of physical activity with motor decline was mostly due to the effect of physical activity on the rate of motor performance decline. Thus, higher levels of physical activity are associated with a slower rate of motor decline in older persons.

The role of neural and mechanical influences in maintaining normal fast and slow muscle properties

The relative importance of neural and mechanical influences in maintaining normal slow and fast muscle properties remains unclear. To address this issue, we studied the effects of 10 days of hindlimb unloading (HU) with or without tenotomy and/or denervation on the cross-sectional area (CSA), myosin heavy chain (MHC) expression (immunohistochemistry) and composition (gel electrophoresis), and myonuclear number in soleus and plantaris fibers in adult male Wistar rats. In general, the adaptations in fiber type and size were similar using either single fiber gel or immunohistochemical analyses. HU resulted in atrophy of type I and I+IIa/x MHC fibers in the soleus and in type I, I+IIa/x, IIa/x, IIa/x+IIb, and IIb MHC fibers in the plantaris. Addition of tenotomy and/or denervation in HU rats had minimal effects on fiber CSA in the soleus, but fiber CSA in the plantaris further decreased, particularly in fibers expressing only fast MHCs. HU resulted in a de novo appearance of type I+IIa/x+IIb and IIa/x+IIb MHC fibers in the soleus and of type I+IIa/x+IIb MHC fibers in the plantaris. Tenotomy and/or denervation in HU rats had no further effect on the fiber type composition of either muscle. Mean myonuclear number/mm of type I fibers was decreased in the soleus of HU rats, and increased in type I and I+IIa/x fibers in HU plus tenotomy (HU+Ten) rats. In the plantaris, mean myonuclear number/mm of type IIa/x, IIa/x+IIb, and IIb fibers was lower after HU with or without tenotomy and/or denervation. Mean cytoplasmic volume/myonucleus ratio of type I and I+IIa/x fibers in the soleus of the HU group tended to be smaller than in controls. The largest decrease was noted in the HU+Ten group. In the plantaris, this ratio was unaffected by HU alone, but was decreased by addition of tenotomy and/or denervation when all fiber types were combined. These data indicate that the major cause of fiber atrophy and adaptations in myonuclear domain size in the slow soleus of HU rats is the chronic reduction in force generation, whereas the elimination of neuromuscular contact via denervation results in additional fiber atrophy and adaptations in myonuclear domain size in the fast plantaris.

Plasticity from muscle to brain

Recognition that the entire central nervous system (CNS) is highly plastic, and that it changes continually throughout life, is a relatively new development. Until very recently, neuroscience has been dominated by the belief that the nervous system is hardwired and changes at only a few selected sites and by only a few mechanisms. Thus, it is particularly remarkable that Sir John Eccles, almost from the start of his long career nearly 80 years ago, focused repeatedly and productively on plasticity of many different kinds and in many different locations. He began with muscles, exploring their developmental plasticity and the functional effects of the level of motor unit activity and of cross-reinnervation. He moved into the spinal cord to study the effects of axotomy on motoneuron properties and the immediate and persistent functional effects of repetitive afferent stimulation. In work that combined these two areas, Eccles explored the influences of motoneurons and their muscle fibers on one another. He studied extensively simple spinal reflexes, especially stretch reflexes, exploring plasticity in these reflex pathways during development and in response to experimental manipulations of activity and innervation. In subsequent decades, Eccles focused on plasticity at central synapses in hippocampus, cerebellum, and neocortex. His endeavors extended from the plasticity associated with CNS lesions to the mechanisms responsible for the most complex and as yet mysterious products of neuronal plasticity, the substrates underlying learning and memory. At multiple levels, Eccles' work anticipated and helped shape present-day hypotheses and experiments. He provided novel observations that introduced new problems, and he produced insights that continue to be the foundation of ongoing basic and clinical research. This article reviews Eccles' experimental and theoretical contributions and their relationships to current endeavors and concepts. It emphasizes aspects of his contributions that are less well known at present and yet are directly relevant to contemporary issues.

Enhancement of motor rehabilitation through the use of information technologies

The recent development of information technologies has dramatically increased the tools available for facilitating motor rehabilitation. This review focuses on technologies which can be used to augment movement-related information both to patients as well as to their therapists. A brief outline of the motor system emphasizes the role of spinal motor neurons in the control of voluntary movement and rehabilitative efforts. Technologies which induce passive motion to stimulate spinal motor output as well as technologies that stimulate active voluntary movements are discussed. Finally, we review technologies and notational methods that can be used to quantify and assess the quality of movement for evaluating the efficacy of motor rehabilitation efforts. We conclude that stronger evidence is necessary to determine the applicability of the wide range of technologies now available to clinical rehabilitation efforts.

Passive exercise and fetal spinal cord transplant both help to restore motoneuronal properties after spinal cord transection in rats

Spinal cord transection influences the properties of motoneurons and muscles below the lesion, but the effects of interventions that conserve muscle mass of the paralyzed limbs on these motoneuronal changes are unknown. We examined the electrophysiological properties of rat lumbar motoneurons following spinal cord transection, and the effects of two interventions shown previously to significantly attenuate the associated hindlimb muscle atrophy. Adult rats receiving a complete thoracic spinal cord transection (T-10) were divided into three groups receiving: (1) no further treatment; (2) passive cycling exercise for 5 days/week; or (3) acute transplantation of fetal spinal cord tissue. Intracellular recording of motoneurons was carried out 4-5 weeks following transection. Transection led to a significant change in the rhythmic firing patterns of motoneurons in response to injected currents, as well as a decrease in the resting membrane potential and spike trigger level. Transplants of fetal tissue and cycling exercise each attenuated these changes, the latter having a stronger effect on maintenance of motoneuron properties, coinciding with the reported maintenance of structural and biochemical features of hindlimb muscles. The mechanisms by which these distinct treatments affect motoneuron properties remain to be uncovered, but these changes in motoneuron excitability are consistent with influences on ion conductances at or near the initial segment. The results may support a therapeutic role for passive limb manipulation and transplant of stem cells in slowing the deleterious responses of motoneurons to spinal cord injury, such that they remain more viable for subsequent alternative strategies.

Adaptations in skeletal muscle disuse or decreased-use atrophy

Those factors that seem to play some role in inducing adaptations of skeletal muscle in vivo are discussed. The role of myogenesis in maintaining and repairing muscle during atrophic and hypertrophic states is discussed, including pointing out that the modulation of myonuclear number is one means of adapting to varying chronic levels of neuromuscular activity. Finally, we point out the potential consequences of muscle atrophy on the control of movement and the susceptibility to fatigue.

Mechanical properties of the electrically silent adult rat soleus muscle

The isometric and isotonic in situ mechanical properties of the soleus muscle of adult female rats were determined after 60 days of inactivity induced by spinal cord isolation (SI). Compared to control, the absolute muscle mass, physiological cross-sectional area, and maximum tetanic tension of the soleus in SI rats were reduced by 69%, 66%, and 77%, respectively. Isometric twitch time-to-peak-tension and half-relaxation times were 41% and 60% shorter in SI than control rats. The maximum velocity of shortening (mm/s), as determined using the afterloaded technique, was 66% faster in SI than control rats, whereas unloaded shortening velocity was similar in the two groups (9% faster in SI rats). Peak power was 48% lower in SI than control rats. The SI soleus was 39% more fatigable than control. Thus, the soleus became a smaller, faster, and more fatigable muscle following 60 days of inactivity. In general, the results indicate that the adaptations are of a lesser magnitude than those reported previously following denervation for the same duration. These data provide a baseline for future efforts to experimentally define the mechanisms of neurally mediated, but activity-independent, regulation of the mechanical properties of the rat soleus muscle.

Influences of electromechanical events in defining skeletal muscle properties

Inactivity of the cat soleus muscle was induced via spinal cord isolation (SI), and the cats were maintained for 4 months. The soleus was electrically stimulated while lengthening (SI-L) or shortening (SI-S) during a simulated step cycle or during isometric (SI-I) contractions. For the SI, SI-S, SI-L, and SI-I groups, the soleus weights were 33, 55, 55, and 64% of the control, respectively, and the maximum tetanic tensions were 15, 30, 36, and 44% of the control, respectively. The specific tension was lower in all SI groups than in the control. Absolute forces at stimulation frequencies of 5-200 Hz were smaller in all SI groups than in the control. The SI-I group tended to have higher values for all force-related parameters than the other SI groups. Fatigue resistance was similar among all groups. The isometric twitch time-to-peak tension was shorter, and the frequency of the stimulation-tension response was shifted to the right in all SI groups with respect to the control. Maximum shortening velocities were 70, 59, and 73% faster for the SI, SI-S, and SI-L groups and similar to the control for the SI-I group. Inactivity resulted in an increased percentage of faster myosin heavy chains (MHCs) that was blunted in the SI-I and SI-L groups but not in the SI-S group. Pure type I MHC fibers atrophied by 80, 59, 58, and 47% in the SI, SI-S, SI-L, and SI-I groups. The data from the SI group quantify the contribution of activity-independent factors in maintaining the mechanical and phenotypic properties of the cat soleus. Relative to a fast-fatigable muscle, these results suggest that only 25% of the slowness (type I MHC) and none of the resistance to fatigue of the soleus muscle are dependent on activity-related factors. Short, daily bouts of electromechanical activation ameliorated several of these adaptations, with the isometric contractions being the most effective countermeasure. The clinical implications of these findings for rehabilitation strategies are discussed.

Activity-independent neural influences on cat soleus motor unit phenotypes

The physiological and phenotypic properties of motor units in the cat soleus muscle were studied after 4 months of inactivity induced by spinal cord isolation (SI). The soleus of some SI cats were stimulated for 30 min/day during an isometric (SI-I), shortening (SI-S), or lengthening (SI-L) phase of a simulated step cycle. Mean maximum tetanic tensions were approximately 15, 26, 32, and 51% of the control in the SI, SI-S, SI-L, and SI-I groups. Mean time-to-peak tension was approximately 50% shorter than the control in all SI groups. One motor unit was glycogen-depleted in each muscle via repetitive stimulation. Eighteen physiologically slow and 9 fast motor units from the spinal cord-isolated groups consisted of fibers that contained only slow myosin heavy chain (MHC) and sarco(endo)plasmic reticulum calcium-adenotriphosphatase (SERCA) isoforms. Two motor units (physiologically fast) consisted primarily of fibers that contained both fast and slow MHC and SERCA. These data reflect a dissociation between isometric speed-related properties and MHC and SERCA isoforms following inactivity. The predominance of fibers containing both fast and slow MHC and SERCA isoforms in 2 motor units demonstrates a strong motoneuronal influence on the muscle-fiber phenotype even when the motoneurons are silent.

Cycling Exercise and Fetal Spinal Cord Transplantation Act Synergistically on Atrophied Muscle following Chronic Spinal Cord Injury in Rats

The potential of two interventions, alone or in combination, to restore chronic spinal cord transection-induced changes in skeletal muscles of adult Sprague-Dawley rats was studied. Hind limb skeletal muscles were examined in the following groups of animals: rats with a complete spinal cord transection (Tx) for 8 weeks; Tx with a 4-week delay before initiation of a 4-week motor-assisted cycling exercise (Ex) program; Tx with a 4-week delay before transplantation (Tp) of fetal spinal cord tissue into the lesion cavity; Tx with a 4-week delay before Tp and Ex; and uninjured control animals. Muscle mass, muscle to body mass ratios, and mean myofiber cross-sectional areas were significantly reduced 8 weeks after transection. Whereas transplantation of fetal spinal cord tissue did not reverse this atrophy and exercise alone had only a modest effect in restoring lost muscle mass, the combination of exercise and transplantation significantly increased muscle mass, muscle to body mass ratios, and mean myofiber cross-sectional areas in both soleus and plantaris muscles. Spinal cord injury (SCI) also caused changes in myosin heavy chain (MyHC) expression toward faster isoforms in both soleus and plantaris and increased soleus myofiber succinate dehydrogenase (SDH) activity. Combined exercise and transplantation led to a change in the expression of the fastest MyHC isoform in soleus but had no effect in the plantaris. Exercise alone and in combination with transplantation reduced SDH activity to control levels in the soleus. These results suggest a synergistic action of exercise and transplantation of fetal spinal cord tissue on skeletal muscle properties following SCI, even after an extended post-injury period before intervention.