Childhood development of common drive to a human leg muscle during ankle dorsiflexion and gait

Intrinsic motoneuron properties in typical human development

Motoneuron properties and their firing patterns undergo significant changes throughout development and in response to neuromodulators such as serotonin. Here, we examined the age-related development of self-sustained firing and general excitability of tibialis anterior motoneurons in a young development (7-17 years), young adult (18-28 years) and adult (32-53 years) group, as well as in a separate group of participants taking selective serotonin reuptake inhibitors (SSRIs, aged 11-28 years). Self-sustained firing, as measured by ΔF, was larger in the young development (∼5.8 Hz, n = 20) compared to the young adult (∼4.9 Hz, n = 13) and adult (∼4.8 Hz, n = 8) groups, consistent with a developmental decrease in self-sustained firing mediated by persistent inward currents (PIC). ΔF was also larger in participants taking SSRIs (∼6.5 Hz, n = 9) compared to their age-matched controls (∼5.3 Hz, n = 26), consistent with increased levels of spinal serotonin facilitating the motoneuron PIC. Participants in the young development and SSRI groups also had higher firing rates and a steeper acceleration in initial firing rates (secondary ranges), consistent with the PIC producing a steeper acceleration in membrane depolarization at the onset of motoneuron firing. In summary, both the young development and SSRI groups exhibited increased intrinsic motoneuron excitability compared to the adults, which, in the young development group, was also associated with a larger unsteadiness in the dorsiflexion torque profiles. We propose several intrinsic and extrinsic factors that affect both motoneuron PICs and cell discharge which vary during development, with a time course similar to the changes in motoneuron firing behaviour observed in the present study. KEY POINTS: Neurons in the spinal cord that activate muscles in the limbs (motoneurons) undergo increases in excitability shortly after birth to help animals stand and walk. We examined whether the excitability of human ankle flexor motoneurons also continues to change from child to adulthood by recording the activity of the muscle fibres they innervate. Motoneurons in children and adolescents aged 7-17 years (young development group) had higher signatures of excitability that included faster firing rates and more self-sustained activity compared to adults aged ≥18 years. Participants aged 11-28 years of age taking serotonin reuptake inhibitors had the highest measures of motoneuron excitability compared to their age-matched controls. The young development group also had more unstable contractions, which might partly be related to the high excitability of the motoneurons.

Reduced corticospinal drive to antagonist muscles of upper and lower limbs during hands-and-knees crawling in infants with cerebral palsy: Evidence from intermuscular EMG-EMG coherence

BACKGROUND

There is growing interest in understanding the central control of hands-and-knees crawling, especially as a significant motor developmental milestone for early assessment of motor dysfunction in infants with cerebral palsy (CP) who have not yet acquired walking ability. In particular, CP is known to be associated with walking dysfunctions caused by early damage and incomplete maturation of the corticospinal tract. However, the extent of damage to the corticospinal connections during crawling in infants with CP has not been fully clarified. Therefore, this study aimed to investigate the disparities in intermuscular EMG-EMG coherence, which serve as indicators of corticospinal drives to antagonist muscles in the upper and lower limbs during crawling, between infants with and without CP.

METHODS

This study involved 15 infants diagnosed with CP and 20 typically developing (TD) infants. Surface EMG recordings were obtained from two pairs of antagonist muscles in the upper limbs (triceps brachii (TB) and biceps brachii (BB)) and lower limbs (quadriceps femoris (QF) and hamstrings (HS)), while the infants performed hands-and-knees crawling at their self-selected velocity. Intermuscular EMG-EMG coherence was computed in two frequency bands, the beta band (15-30 Hz) and gamma band (30-60 Hz), which indicate corticospinal drive. Additionally, spatiotemporal parameters, including crawling velocity, cadence, duration, and the percentage of stance phase time, were calculated for comparison. Spearman rank correlations were conducted to assess the relationship between EMG-EMG coherence and crawling spatiotemporal parameters.

RESULTS

Infants with CP exhibited significantly reduced crawling velocity, decreased cadence, longer cycle duration, and a higher percentage of stance phase time compared to TD infants. Furthermore, CP infants demonstrated decreased coherence in the beta and gamma frequency bands (indicators of corticospinal drive) in both upper and lower limb muscles. Regarding limb-related differences in the beta and gamma coherence, significant disparities were found between upper and lower limb muscles in TD infants (p < 0.05), but not in infants with CP (p > 0.05). Additionally, significant correlations between coherence metrics and crawling spatiotemporal parameters were identified in the TD group (p < 0.05), while such correlations were not evident in the CP group.

CONCLUSIONS

Our findings suggest that the corticospinal drive may functionally influence the central control of antagonist muscles in the limbs during typical infant crawling. This functional role could be impaired by neurological conditions such as cerebral palsy. The neurophysiological markers of corticospinal drive, specifically intermuscular EMG-EMG coherence during crawling in infants with cerebral palsy, could potentially serve as a tool to assess developmental response to therapy.

Intramuscular and intermuscular coherence analysis while obstacle crossing during treadmill gait

PURPOSE

This study aimed to identify the contribution of the common synaptic drives to motor units during obstacle avoidance, using coherence analysis between a-pair electromyography (EMG) signals (EMG-EMG coherence).

MATERIALS AND METHODS

Fourteen healthy volunteers walked on a treadmill with and without obstacle avoidance. During obstacle gait, subjects were instructed to step over an obstacle with their right leg while walking that would randomly and unpredictably appear. Surface EMG signals were recorded from the following muscles of the right leg: the proximal and distal ends of tibialis anterior (TAp and TAd), biceps femoris (BF), semitendinosus (ST), lateral gastrocnemius (LG), and medial gastrocnemius (MG). Beta-band (13-30 Hz) EMG-EMG coherence was analysed.

RESULTS

Beta-band EMG-EMG coherence of TAp-TAd during swing phase and BF-ST during pre and initial swing phase when stepping over an obstacle were significantly higher compared to normal gait (both p < 0.05). Beta-band EMG-EMG coherence of TAp-TAd, BF-ST, and LG-MG during stance phase were not significantly different between the two gait conditions (all p > 0.05).

CONCLUSIONS

The present findings suggest increased common synaptic drives to motor units in ankle dorsiflexor and knee flexor muscles during obstacle avoidance. It also may reflect an increased cortical contribution to modify the gait patterns to avoid an obstacle.

Motor control differs for increasing and decreasing force production during ankle Isometric exercises in children

BACKGROUND

Performance of the central nervous system (CNS) in increased and decreasing muscle force around the ankle joint is essential for upright tasks of daily living. Previous studies have shown altered CNS control when they decrease force compared with when they increase force in young and older adults. But whether such alteration exists during childhood with incomplete maturation of CNS systems remain unclear. Therefore, this study aimed to evaluate the disparities in intramuscular EMG-EMG coherence, which serve as indicators of corticospinal drive to muscles during ankle isometric increasing and decreasing force generation in children.

METHODS

We measured intramuscular EMG-EMG coherence activity of the tibialis anterior (TA) and the associated ability to perform isometric efforts at the ankle in 12 typically developing children (mean ± SD age = 5.91±1.37 years) and 12 healthy young adults (mean ± SD age = 23.16±1.52 years). The participants maintained isometric contractions at 20% of their maximal voluntary contractions (MVC) during ankle dorsiflexion to match a triangle trajectory for 7 s, including ramping up in 3.5 s (increasing force phase) and then linearly ramping down to rest in 3.5 s (decreasing force phase). The variability of force control was characterized by the coefficient of variance (CoV) of force output. Intramuscular EMG-EMG coherence from TA in two frequency bands, the beta band (15-30 Hz) and gamma band (30-45) that could reflect the corticospinal drive, were calculated for the comparison. A repeated measures ANOVA with the within-subjects factor of force generation phase (increasing force vs. decreasing force)x between-subjects factor of the group (children and young adults) was used for statistical analysis.

RESULTS

Regarding the within-subjects difference, our results exhibited significantly higher CoV of force (p < 0.01) and lower EMG-EMG coherence of TA when they decrease force compared with when they increase force in both children and young adult groups. Regarding the between-subjects difference, the CoV of force was significantly higher (p < 0.01) in children compared to young adults, while the EMG-EMG coherence in children showed a significantly lower (p < 0.01) coherence compared with young adults. Furthermore, the EMG-EMG coherence measures were negatively correlated with the CoV of force.

CONCLUSIONS

The findings suggest that the age-related development would increase the corticospinal drive to TA muscle to deal with ankle isometric dorsiflexion during childhood, which could be also modulated with the force production phases, including increasing and decreasing force.

Effects of dynamic and isometric motor practice on position control, force control and corticomuscular coherence in preadolescent children

In this study, we investigated the effects of motor practice with an emphasis on either position or force control on motor performance, motor accuracy and variability in preadolescent children. Furthermore, we investigated corticomuscular coherence and potential changes following motor practice. We designed a setup allowing discrete wrist flexions of the non-dominant hand and tested motor accuracy and variability when the task was to generate specific movement endpoints (15-75 deg) or force levels (5-25% MVC). All participants were tested in both tasks at baseline and post motor practice without augmented feedback on performance. Following baseline assessment, participants (44 children aged 9-11 years) were randomly assigned to either position (PC) or force control (FC) motor practice or a resting control group (CON). The PC and FC groups performed four blocks of 40 trials motor practice with augmented feedback on performance. Following practice, improvements in movement accuracy were significantly greater in the PC group compared to the FC and CON groups (p < 0.001). None of the groups displayed changes in force task performance indicating no benefits of force control motor practice and low transfer between tasks (p-values:0.08-0.45). Corticomuscular coherence (C4-FCR) was demonstrated during the hold phase in both tasks with no difference between tasks. Corticomuscular coherence did not change from baseline to post practice in any group. Our findings demonstrate that preadolescent children improve position control following dynamic accuracy motor practice. Contrary to previous findings in adults, preadolescent children displayed smaller or no improvements in force control following isometric motor practice, low transfer between tasks and no changes in corticomuscular coherence.

Isometric force complexity may not fully originate from the nervous system

In humans and animals, spatial and temporal information from the nervous system are translated into muscle force enabling movements of body segments. To gain deeper understanding of this translation of information into movements, we investigated the motor control dynamics of isometric contractions in children, adolescents, young adults and older adults. Twelve children, thirteen adolescents, fourteen young adults, and fifteen older adults completed two minutes of submaximal isometric plantar- and dorsiflexion. Simultaneously, sensorimotor cortex EEG, tibialis anterior and soleus EMG and plantar- and dorsiflexion force was recorded. Surrogate analysis suggested that all signals were from a deterministic origin. Multiscale entropy analysis revealed an inverted U-shape relationship between age and complexity for the force but not for the EEG and EMG signals. This suggests that temporal information in from the nervous system is modulated by the musculoskeletal system during the transmission into force. The entropic half-life analyses indicated that this modulation increases the time scale of the temporal dependency in the force signal compared to the neural signals. Together this indicates that the information embedded in produced force does not exclusively reflect the information embedded in the underlying neural signal.

Age-related differences in gait symmetry obtained from kinematic synergies and muscle synergies of lower limbs during childhood

The age-related changes of gait symmetry in healthy children concerning individual joint and muscle activation data have previously been widely studied. Extending beyond individual joints or muscles, identifying age-related changes in the coordination of multiple joints or muscles (i.e., muscle synergies and kinematic synergies) could capture more closely the underlying mechanisms responsible for gait symmetry development. To evaluate the effect of age on the symmetry of the coordination of multiple joints or muscles during childhood, we measured gait symmetry by kinematic and EMG data in 39 healthy children from 2 years old to 14 years old, divided into three equal age groups: preschool children (G1; 2.0-5.9 years), children (G2; 6.0-9.9 years), pubertal children (G3; 10.0-13.9 years). Participants walked barefoot at a self-selected walking speed during three-dimensional gait analysis (3DGA). Kinematic synergies and muscle synergies were extracted with principal component analysis (PCA) and non-negative matrix factorization (NNMF), respectively. The synergies extracted from the left and right sides were compared with each other to obtain a symmetry value. Statistical analysis was performed to examine intergroup differences. The results showed that the effect of age was significant on the symmetry values extracted by kinematic synergies, while older children exhibited higher kinematic synergy symmetry values compared to the younger group. However, no significant age-related changes in symmetry values of muscle synergy were observed. It is suggested that kinematic synergy of lower joints can be asymmetric at the onset of independent walking and showed improving symmetry with increasing age, whereas the age-related effect on the symmetry of muscle synergies was not demonstrated. These data provide an age-related framework and normative dataset to distinguish age-related differences from pathology in children with neuromotor disorders.

Execution of natural manipulation in the air enhances the beta-rhythm intermuscular coherences of the human arm depending on muscle pairs

Natural manipulation tasks in air consist of two kinematic components: a grasping component, with activation of the hand muscles, and a lifting component, with activation of the proximal muscles. However, it remains unclear whether the synchronized motor commands to the hand/proximal arm muscles are divergently controlled during the task. Therefore, we examined how intermuscular coherence was modulated depending on the muscle combinations during grip and lift (G&L) tasks. Electromyograms (EMGs) were recorded from the biceps brachii (BB), triceps brachii (TB), flexor digitorum superficialis (FDS), and extensor digitorum communis (EDC) muscles. The participants were required to maintain G&L tasks involving a small cubical box with the thumb and index and middle fingers. Consequently, we found that the beta-rhythm coherence (15-35 Hz) in BB-TB, BB-FDS, and TB-EDC pairs during G&L was significantly larger than that during the isolated task with cocontraction of the two target muscles but not BB-EDC, TB-FDS, and FDS-EDC (task and muscle pair specificities). These increases in beta-rhythm coherence were also observed in intramuscular EMG recordings. Furthermore, the results from the execution of several mimic G&L tasks revealed that the separated task-related motor signals and combinations between the motor signals/sensations of the fingertips or object load had minor contributions to the increase in the coherence. These results suggest that during G&L the central nervous system regulates synchronous drive onto motoneurons depending on the muscle pairs and that the multiple combination effect of the sensations of touch/object load and motor signals in the task promotes the synchrony of these pairs.NEW & NOTEWORTHY Natural manipulation in air consists of two kinematic components: grasping, with activation of hand muscles, and lifting, with activation of proximal muscles. We show that during the maintenance of object manipulation in air the central nervous system regulates the synchronous drive onto human motoneuron pools depending on the hand/proximal muscle pairs and that the multiple combination effect of the sensations of touch/object load and motor signals in the task promotes the synchrony of these pairs.

Reorganization of functional and directed corticomuscular connectivity during precision grip from childhood to adulthood

How does the neural control of fine movements develop from childhood to adulthood? Here, we investigated developmental differences in functional corticomuscular connectivity using coherence analyses in 111 individuals from four different age groups covering the age range 8-30 y. EEG and EMG were recorded while participants performed a uni-manual force-tracing task requiring fine control of force in a precision grip with both the dominant and non-dominant hand. Using beamforming methods, we located and reconstructed source activity from EEG data displaying peak coherence with the EMG activity of an intrinsic hand muscle during the task. Coherent cortical sources were found anterior and posterior to the central sulcus in the contralateral hemisphere. Undirected and directed corticomuscular coherence was quantified and compared between age groups. Our results revealed that coherence was greater in adults (20-30 yo) than in children (8-10 yo) and that this difference was driven by greater magnitudes of descending (cortex-to-muscle), rather than ascending (muscle-to-cortex), coherence. We speculate that the age-related differences reflect maturation of corticomuscular networks leading to increased functional connectivity with age. We interpret the greater magnitude of descending oscillatory coupling as reflecting a greater degree of feedforward control in adults compared to children. The findings provide a detailed characterization of differences in functional sensorimotor connectivity for individuals at different stages of typical ontogenetic development that may be related to the maturational refinement of dexterous motor control.

Intramuscular Coherence of the Lower Flexor Muscles during Robotic Ankle-Assisted Gait

A close-fitting assisted walking device (RE-Gait) designed to assist ankle movements might be a novel approach for acquiring the forefoot rocker function in the gait cycle. The purpose of the present study was to investigate the effects of using RE-Gait by evaluating the intramuscular coherence (IMC) of the two parts of the tibialis anterior muscles (TA), which could indicate whether a common synaptic drive is present. Seventeen healthy volunteers walked on a treadmill at a comfortable speed before, during, and immediately after 15-minute RE-Gait intervention. After RE-Gait intervention, IMC of the two parts of the TA muscles in the beta frequency band in the initial swing phase was significantly enhanced during RE-Gait intervention. In addition, IMCs in the beta and low-gamma frequency bands were significantly correlated with the enhancement ratio of the step length. These results suggest that robotic ankle plantar flexion and dorsiflexion assistance in the initial swing phase may be effective for improving gait function with enhancement of the functioning of the sensorimotor loop.

Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation

Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents that participate in running-related sports. Associations between running biomechanics and overuse injuries have been widely studied in adults, however, relatively little research has comparatively targeted running biomechanics in adolescents. Moreover, available literature on injury prevention and rehabilitation for adolescent runners is limited, and there is a tendency to generalize adult literature to adolescent populations despite pertinent considerations regarding growth-related changes unique to these athletes. This perspective article provides commentary and expert opinion surrounding the state of knowledge and future directions for research in adolescent running biomechanics, injury prevention and supplemental training.

Could Gait Biomechanics Become a Marker of Atypical Neuronal Circuitry in Human Development?-The Example of Autism Spectrum Disorder

This perspective paper presents converging recent knowledge in neurosciences (motor neurophysiology, neuroimaging and neuro cognition) and biomechanics to outline the relationships between maturing neuronal network, behavior, and gait in human development. Autism Spectrum Disorder (ASD) represents a particularly relevant neurodevelopmental disorder (NDD) to study these convergences, as an early life condition presenting with sensorimotor and social behavioral alterations. ASD diagnosis relies solely on behavioral criteria. The absence of biological marker in ASD is a main challenge, and hampers correlations between behavioral development and standardized data such as brain structure alterations, brain connectivity, or genetic profile. Gait, as a way to study motor system development, represents a well-studied, early life ability that can be characterized through standardized biomechanical analysis. Therefore, developmental gait biomechanics might appear as a possible motor phenotype and biomarker, solid enough to be correlated to neuronal network maturation, in normal and atypical developmental trajectories—like in ASD.

Gait-combined transcranial alternating current stimulation modulates cortical control of muscle activities during gait

Non-invasive brain stimulation has been of interest as a therapeutic tool to modulate cortical excitability. However, there is little evidence that oscillatory brain stimulation can modulate the cortical control of muscle activities during gait, which can be assessed using coherence analysis of paired surface electromyographic (EMG) recordings. This study aimed to investigate the effects of gait-combined transcranial alternating current stimulation (tACS) at the gait cycle frequency on the cortical control of muscle activities during gait using EMG-EMG coherence analysis. Fourteen healthy young adults participated in this study. All participants underwent 2 test conditions (real tACS and sham stimulation over the leg area of the primary motor cortex during 10-min treadmill walking). The average peak-to-peak amplitudes of the motor evoked potentials (MEPs) from the tibialis anterior (TA) and lateral gastrocnemius muscles in the sitting position and EMG-EMG coherences in the TA muscle, triceps surae muscles, quadriceps muscles, and hamstring muscles during gait were measured before and after stimulation. Entrainment effect was significantly higher during real tACS than during sham stimulation. After real tACS, the MEP amplitude and beta band (13-33 Hz) coherence area increased in the TA muscle. The change in MEP amplitude from the TA muscle was positively correlated with the change in beta band coherence area in the TA muscle. Gait-combined tACS can modulate the strength of descending neural drive to TA motoneurons during gait. This suggests that oscillatory brain stimulation is a useful therapeutic tool to modulate the cortical control of muscle activities during gait.

Smaller muscle mass is associated with increase in EMG-EMG coherence of the leg muscle during unipedal stance in elderly adults

Age-induced decline in the ability to perform daily activities is associated with a deterioration of physical parameters. Changes occur in neuromuscular system with age; however, the relationship between these changes and physical parameters has not been fully elucidated. Therefore, in this study, we aimed to determine the relationship between neuromuscular system evaluated using a coherence analysis of the leg muscles and physical parameters in community-dwelling healthy elderly adults. The participants were required to stand still in bipedal and unipedal stances on a force plate. Then, electromyography (EMG) was recorded from the tibialis anterior (TA) and medial and lateral gastrocnemius (MG/LG) muscles, and intermuscular coherence was calculated between the following pairs: TA and MG (TA-MG), TA and LG (TA-LG), and MG and LG (MG-LG). Furthermore, gait speed, unipedal stance time, and muscle mass were measured. EMG-EMG coherence for the MG-LG pair was significantly greater in the unipedal stance task than in the bipedal one (p = .001). Multiple linear regression analysis revealed that the muscle mass of the leg was negatively correlated with the change in the β-band coherence for the MG-LG pair from bipedal to unipedal stance (R² = 0.067, standard β = -0.345, p = .044). As the β-band coherence could reflect the corticospinal activity, the increased β-band coherence may be a compensation for the smaller muscle mass, or alternatively may be a sign of changes in the nervous system resulting in the loss of muscle mass.

Characterizing cognitive-motor impairments in patients with myotonic dystrophy type 1

Myotonic Dystrophy Type 1 (DM1) is the most frequent hereditary, adult-onset muscular dystrophy. Nevertheless, DM1-associated cognitive-motor impairments have not been fully characterized so far. This study aimed at profiling cognitive and locomotor dysfunctions in these patients. In addition, cognitive-motor interactions were assessed using a dual-task paradigm. Comprehensive cognitive-motor impairment profiles were generated for 19 patients with DM1 and 19 healthy subjects by thorough clinical, biomechanical and neuropsychological examinations. Detailed gait analysis was performed using a 3D motion capture system, whereas cognitive function was assessed using a standardized neuropsychological test battery. Patients with DM1 showed impaired functional mobility, gait velocity and endurance. DM1-related gait pathology was mainly characterized by enhanced dynamic instability, gait variability, and restricted ankle dorsiflexion. Patients' cognitive impairments particularly concerned attentional functions. Dual-task conditions induced gait deviations that slightly differed between patients and controls. DM1-associated cognitive impairments correlated with reduced functional mobility and impaired ankle dorsiflexion. Patients with DM1 revealed significant impairments of walking function, balance and cognitive performance. Differential cognitive-motor interference and significant interactions between cognitive and motor dysfunctions point towards a prominent role of cognition in gait performance of patients with DM1.

Emergence of Different Gaits in Infancy: Relationship Between Developing Neural Circuitries and Changing Biomechanics

How does gait-specific pattern generation evolve in early infancy? The idea that neural and biomechanical mechanisms underlying mature walking and running differ to some extent and involve distinct spinal and supraspinal neural circuits is supported by various studies. Here we consider the issue of human gaits from the developmental point of view, from neonate stepping to adult mature gaits. While differentiating features of the walk and run are clearly distinct in adults, the gradual and progressive developmental bifurcation between the different gaits suggests considerable sharing of circuitry. Gaits development and their biomechanical determinants also depend on maturation of the musculoskeletal system. This review outlines the possible overlap in the neural and biomechanical control of walking and running in infancy, supporting the idea that gaits may be built starting from common, likely phylogenetically conserved elements. Bridging connections between movement mechanics and neural control of locomotion could have profound clinical implications for technological solutions to understand better locomotor development and to diagnose early motor deficits. We also consider the neuromuscular maturation time frame of gaits resulting from active practice of locomotion, underlying plasticity of development.

Maturation of feedforward toe walking motor program is impaired in children with cerebral palsy

Voluntary toe walking in adults is characterized by feedforward control of ankle muscles in order to ensure optimal stability of the ankle joint at ground impact. Toe walking is frequently observed in children with cerebral palsy, but the mechanisms involved have not been clarified. Here, we investigated maturation of voluntary toe walking in typically-developing children and typically-developed adults and compared it to involuntary toe walking in children with cerebral palsy. Twenty-eight children with cerebral palsy (age 3-14 years), 24 typically-developing children (age 2-14 years) and 15 adults (mean age 30.7 years) participated in the study. EMG activity was measured from the tibialis anterior and soleus muscles together with knee and ankle joint position during treadmill walking. In typically-developed adults, low step-to-step variability of the drop of the heel after ground impact was correlated with low tibialis anterior and high soleus EMG with no significant coupling between the antagonist muscle EMGs. Typically-developing children showed a significant age-related decline in EMG amplitude reaching an adult level at 10-12 years of age. The youngest typically-developing children showed a broad peak EMG-EMG synchronization (>100 ms) associated with large 5-15 Hz coherence between antagonist muscle activities. EMG coherence declined with age and at the age of 10-12 years no correlation was observed similar to adults. This reduction in coherence was closely related to improved step-to-step stability of the ankle joint position. Children with cerebral palsy generally showed lower EMG levels than typically-developing children and larger step-to-step variability in ankle joint position. In contrast to typically-developing children, children with cerebral palsy showed no age-related decline in tibialis anterior EMG amplitude. Motor unit synchronization and 5-15 Hz coherence between antagonist EMGs was observed more frequently in children with cerebral palsy when compared to typically-developing children and in contrast to typically-developing participants there was no age-related decline. We conclude that typically-developing children develop mature feedforward control of ankle muscle activity as they age, such that at age 10-12 years there is little agonist-antagonist muscle co-contraction around the time of foot-ground contact during toe walking. Children with cerebral palsy, in contrast, continue to co-contract agonist and antagonist ankle muscles when toe walking. We speculate that children with cerebral palsy maintain a co-contraction activation pattern when toe walking due to weak muscles and insufficient motor and sensory signalling necessary for optimization of feedforward motor programs. These findings are important for understanding of the pathophysiology and treatment of toe walking.

The development of functional and directed corticomuscular connectivity during tonic ankle muscle contraction across childhood and adolescence

In adults, oscillatory activity in the sensorimotor cortex is coherent with contralateral muscle activity at beta frequencies (15-35 Hz) during tonic contraction. This functional coupling reflects the involvement of the sensorimotor cortex, the corticospinal pathway, and likely also ascending sensory feedback in the task at hand. However, little is known about the developmental trajectory of task-related corticomuscular connectivity relating to the voluntary control of the ankle muscles. To address this, we recorded electroencephalography (EEG) from the vertex (Cz) and electromyography (EMG) from ankle muscles (proximal and distal anterior tibial, TA; soleus, SOL; gastrocnemius medialis, GM) in 33 participants aged 7-23 yr during tonic dorsi- and plantar flexion requiring precise maintenance of a submaximal torque level. Coherence was calculated for Cz-TA, Cz-SOL, TA-TA, and SOL-GM signal pairs. We found strong, positive associations between age and beta band coherence for Cz-TA, Cz-SOL, and TA-TA, suggesting that oscillatory corticomuscular connectivity is strengthened during childhood development and adolescence. Directionality analysis indicated that the primary interaction underlying this age-related increase was in the descending direction. In addition, performance during dorsi- and plantar flexion tasks was positively associated with age, indicating more precise control of the ankle joint in older participants. Performance was also positively associated with beta band coherence, suggesting that participants with greater coherence also exhibited greater precision. We propose that these results indicate an age-related increase in oscillatory corticospinal input to the ankle muscle motoneuron pools during childhood development and adolescence, with possible implications for maturation of precision force control. Within the theoretical framework of predictive coding, we suggest that our results may reflect an age-related increase in reliance on feedforward control as the developing nervous system becomes better at predicting the sensory consequences of movement. These findings may contribute to the development of novel intervention strategies targeting improved sensorimotor control in children and adolescents with central motor disorders.

Probing Corticospinal Control During Different Locomotor Tasks Using Detailed Time-Frequency Analysis of Electromyograms

Locomotion relies on the fine-tuned coordination of different muscles which are controlled by particular neural circuits. Depending on the attendant conditions, walking patterns must be modified to optimally meet the demands of the task. Assessing neuromuscular control during dynamic conditions is methodologically highly challenging and prone to artifacts. Here we aim at assessing corticospinal involvement during different locomotor tasks using non-invasive surface electromyography. Activity in tibialis anterior (TA) and gastrocnemius medialis (GM) muscles was monitored by electromyograms (EMGs) in 27 healthy volunteers (11 female) during regular walking, walking while engaged in simultaneous cognitive dual tasks, walking with partial visual restriction, and skilled, targeted locomotion. Whereas EMG intensity of the TA and GM was considerably altered while walking with partial visual restriction and during targeted locomotion, dual-task walking induced only minor changes in total EMG intensity compared to regular walking. Targeted walking resulted in enhanced EMG intensity of GM in the frequency range associated with Piper rhythm synchronies. Likewise, targeted walking induced enhanced EMG intensity of TA at the Piper rhythm frequency around heelstrike, but not during the swing phase. Our findings indicate task- and phase-dependent modulations of neuromuscular control in distal leg muscles during various locomotor conditions in healthy subjects. Enhanced EMG intensity in the Piper rhythm frequency during targeted walking points toward enforced corticospinal drive during challenging locomotor tasks. These findings indicate that comprehensive time-frequency EMG analysis is able to gauge cortical involvement during different movement programs in a non-invasive manner and might be used as complementary diagnostic tool to assess baseline integrity of the corticospinal tract and to monitor changes in corticospinal drive as induced by neurorehabilitation interventions or during disease progression.

Operant conditioning of the motor-evoked potential and locomotion in people with and without chronic incomplete spinal cord injury

Foot drop is very common among people with chronic incomplete spinal cord injury (SCI) and likely stems from SCI that disturbs the corticospinal activation of the ankle dorsiflexor tibialis anterior (TA). Thus, if one can recover or increase the corticospinal excitability reduced by SCI, motor function recovery may be facilitated. Here, we hypothesized that in people suffering from weak dorsiflexion due to chronic incomplete SCI, increasing the TA motor-evoked potential (MEP) through operant up-conditioning can improve dorsiflexion during locomotion, while in people without any injuries, it would have little impact on already normal locomotion. Before and after 24 MEP conditioning or control sessions, locomotor electromyography (EMG) and kinematics were measured. This study reports the results of these locomotor assessments. In participants without SCI, locomotor EMG activity, soleus Hoffmann reflex modulation, and joint kinematics did not change, indicating that MEP up-conditioning or repeated single-pulse transcranial magnetic stimulation (i.e., control protocol) does not influence normal locomotion. In participants with SCI, MEP up-conditioning increased TA activity during the swing-to-swing stance transition phases and ankle joint motion during locomotion in the conditioned leg and increased walking speed consistently. In addition, the swing-phase TA activity and ankle joint motion also improved in the contralateral leg. The results are consistent with our hypothesis. Together with the previous operant conditioning studies in humans and rats, the present study suggests that operant conditioning can be a useful therapeutic tool for enhancing motor function recovery in people with SCI and other central nervous system disorders. NEW & NOTEWORTHY This study examined the functional impact of operant conditioning of motor-evoked potential (MEP) to transcranial magnetic stimulation that aimed to increase corticospinal excitability for the ankle dorsiflexor tibialis anterior (TA). In people with chronic incomplete spinal cord injury (SCI), MEP up-conditioning increased TA activity and improved dorsiflexion during locomotion, while in people without injuries, it had little impact on already normal locomotion. MEP conditioning may potentially be used to enhance motor function recovery after SCI.

Changes in lower limb muscle synchronisation during walking on high-heeled shoes

The goal of this research was to investigate the effect of wearing high-heeled shoes (HHS) on lower limb muscle synchronisation during walking, using beta band (15-30 Hz) coherence analysis. Fifteen females with no previous neuromuscular disorders volunteered in this study. Surface electromyography in frequency domain was studied from rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM) and semitendinosus (ST) muscles during walking by subjects wearing HHS of three different heel heights (low - 4 cm, medium - 6 cm and high - 10 cm). Average coherence values were calculated for RF-VL, RF-VM and RF-ST muscles in beta band to analyse muscle pair synchronisation. In this study, significant increase in beta band coherence was found in all three muscle pairs during walking on HHS of different heel heights (p<0.05). Increased beta band coherence obtained from this study suggested that walking on HHS demands higher muscle pair synchronisation, to maintain stability around the knee joint.

Motor Overflow and Spasticity in Chronic Stroke Share a Common Pathophysiological Process: Analysis of Within-Limb and Between-Limb EMG-EMG Coherence

The phenomenon of exaggerated motor overflow is well documented in stroke survivors with spasticity. However, the mechanism underlying the abnormal motor overflow remains unclear. In this study, we aimed to investigate the possible mechanisms behind abnormal motor overflow and its possible relations with post-stroke spasticity. 11 stroke patients (63.6 ± 6.4 yrs; 4 women) and 11 healthy subjects (31.18 ± 6.18 yrs; 2 women) were recruited. All of them were asked to perform unilateral isometric elbow flexion at submaximal levels (10, 30, and 60% of maximum voluntary contraction). Electromyogram (EMG) was measured from the contracting biceps (iBiceps) muscle and resting contralateral biceps (cBiceps), ipsilateral flexor digitorum superficialis (iFDS), and contralateral FDS (cFDS) muscles. Motor overflow was quantified as the normalized EMG of the resting muscles. The severity of motor impairment was quantified through reflex torque (spasticity) and weakness. EMG-EMG coherence was calculated between the contracting muscle and each of the resting muscles. During elbow flexion on the impaired side, stroke subjects exhibited significant higher motor overflow to the iFDS muscle compared with healthy subjects (ipsilateral or intralimb motor overflow). Stroke subjects exhibited significantly higher motor overflow to the contralateral spastic muscles (cBiceps and cFDS) during elbow flexion on the non-impaired side (contralateral or interlimb motor overflow), compared with healthy subjects. Moreover, there was significantly high EMG-EMG coherence in the alpha band (6–12 Hz) between the contracting muscle and all other resting muscles during elbow flexion on the non-impaired side. Our results of diffuse ipsilateral and contralateral motor overflow with EMG-EMG coherence in the alpha band suggest subcortical origins of motor overflow. Furthermore, correlation between contralateral motor overflow to contralateral spastic elbow and finger flexors and their spasticity was consistently at moderate to high levels. A high correlation suggests that diffuse motor overflow to the impaired side and spasticity likely share a common pathophysiological process. Possible mechanisms are discussed.

Impaired Ability to Suppress Excitability of Antagonist Motoneurons at Onset of Dorsiflexion in Adults with Cerebral Palsy

We recently showed that impaired gait function in adults with cerebral palsy (CP) is associated with reduced rate of force development in ankle dorsiflexors. Here, we explore potential mechanisms. We investigated the suppression of antagonist excitability, calculated as the amount of soleus H-reflex depression at the onset of ankle dorsiflexion compared to rest, in 24 adults with CP (34.3 years, range 18–57; GMFCS 1.95, range 1–3) and 15 healthy, age-matched controls. Furthermore, the central common drive to dorsiflexor motoneurons during a static contraction in the two groups was examined by coherence analyses. The H-reflex was significantly reduced by 37% at the onset of dorsiflexion compared to rest in healthy adults (P < 0.001) but unchanged in adults with CP (P = 0.91). Also, the adults with CP had significantly less coherence. These findings suggest that the ability to suppress antagonist motoneuronal excitability at movement onset is impaired and that the central common drive during static contractions is reduced in adults with CP.

Decrease in force steadiness with aging is associated with increased power of the common but not independent input to motor neurons

Declines in motor function with advancing age have been attributed to changes occurring at all levels of the neuromuscular system. However, the impact of aging on the control of muscle force by spinal motor neurons is not yet understood. In this study on 20 individuals aged between 24 and 75 yr (13 men, 7 women), we investigated the common synaptic input to motor neurons of the tibialis anterior muscle and its impact on force control. Motor unit discharge times were identified from high-density surface EMG recordings during isometric contractions at forces of 20% of maximal voluntary effort. Coherence analysis between motor unit spike trains was used to characterize the input to motor neurons. The decrease in force steadiness with age ( R² = 0.6, P < 0.01) was associated with an increase in the amplitude of low-frequency oscillations of functional common synaptic input to motor neurons ( R² = 0.59; P < 0.01). The relative proportion of common input to independent noise at low frequencies increased with variability (power) in common synaptic input. Moreover, variability in interspike interval did not change and strength of the common input in the gamma band decreased with age ( R² = 0.22; P < 0.01). The findings indicate that age-related reduction in the accuracy of force control is associated with increased common fluctuations to motor neurons at low frequencies and not with an increase in independent synaptic input. NEW & NOTEWORTHY The influence of aging on the role of spinal motor neurons in accurate force control is not yet understood. We demonstrate that aging is associated with increased oscillations in common input to motor neurons at low frequencies and with a decrease in the relative strength of gamma oscillations. These results demonstrate that the synaptic inputs to motor neurons change across the life span and contribute to a decline in force control.

Age-Related Declines in the Ability to Modulate Common Input to Bilateral and Unilateral Plantar Flexors During Forward Postural Lean

Aging can impair an ability to lean the body forward to the edge of the base of support. Here, we investigated, using a coherence analysis, common inputs to bilateral and unilateral plantar flexor muscles to test a hypothesis that the age-related impairment would be related to strong synchronous bilateral activation and reduced cortical control of these muscles. Healthy young (n = 14) and elderly adults (n = 19), who were all right-foot dominant, performed quiet standing task and tasks that required the subjects to lean their body forward to 35 and 75% of the maximum lean distance. The electromyogram was recorded from the bilateral medial gastrocnemius (MG) and soleus (SL) muscles. We analyzed delta-band coherence, that reflects comodulation of muscle activity, between the bilateral homologous muscles (MG-MG and SL-SL pairs). The origin of this bilateral comodulation is suggested to be the subcortical system. Also, we examined beta-band coherence, that is related to the corticospinal drive, between the unilateral muscles (MG-SL pair) in the right leg. Results indicated that the bilateral delta-band coherence for the MG-MG pair was significantly smaller in the 75% forward lean than quiet standing and 35% forward lean tasks for the young adults (quiet: p = 0.036; 35%: p = 0.0011). The bilateral delta-band coherence for the SL-SL pair was significantly smaller in the 75% forward lean than 35% forward lean task for the young adults (p = 0.027). Furthermore, the unilateral beta-band coherence was larger in the forward lean than quiet standing task for the young adults (35%: p < 0.001; 75%: p = 0.029). Contrarily, the elderly adults did not demonstrate such changes. These findings suggest the importance of decreasing the synchronous bilateral activation and increasing the unilateral cortical control of the plantar flexor muscles for the successful forward postural lean performance, and that aging impairs this modulatory ability.

Modulation of EMG-EMG Coherence in a Choice Stepping Task

The voluntary step execution task is a popular measure for identifying fall risks among elderly individuals in the community setting because most falls have been reported to occur during movement. However, the neurophysiological functions during this movement are not entirely understood. Here, we used electromyography (EMG) to explore the relationship between EMG-EMG coherence, which reflects common oscillatory drive to motoneurons, and motor performance associated with stepping tasks: simple reaction time (SRT) and choice reaction time (CRT) tasks. Ten healthy elderly adults participated in the study. Participants took a single step forward in response to a visual imperative stimulus. EMG-EMG coherence was analyzed for 1000 ms before the presentation of the stimulus (stationary standing position) from proximal and distal tibialis anterior (TA) and soleus (SOL) muscles. The main result showed that all paired EMG-EMG coherences in the alpha and beta frequency bands were greater in the SRT than the CRT task. This finding suggests that the common oscillatory drive to the motoneurons during the SRT task occurred prior to taking a step, whereas the lower value of corticospinal activity during the CRT task prior to taking a step may indicate an involvement of inhibitory activity, which is consistent with observations from our previous study (Watanabe et al., 2016). Furthermore, the beta band coherence in intramuscular TA tended to positively correlate with the number of performance errors that are associated with fall risks in the CRT task, suggesting that a reduction in the inhibitory activity may result in a decrease of stepping performance. These findings could advance the understanding of the neurophysiological features of postural adjustments in elderly individuals.

Increased central common drive to ankle plantar flexor and dorsiflexor muscles during visually guided gait

When we walk in a challenging environment, we use visual information to modify our gait and place our feet carefully on the ground. Here, we explored how central common drive to ankle muscles changes in relation to visually guided foot placement. Sixteen healthy adults aged 23 ± 5 years participated in the study. Electromyography (EMG) from the Soleus (Sol), medial Gastrocnemius (MG), and the distal and proximal ends of the Tibialis anterior (TA) muscles and electroencephalography (EEG) from Cz were recorded while subjects walked on a motorized treadmill. A visually guided walking task, where subjects received visual feedback of their foot placement on a screen in real-time and were required to place their feet within narrow preset target areas, was compared to normal walking. There was a significant increase in the central common drive estimated by TA-TA and Sol-MG EMG-EMG coherence in beta and gamma frequencies during the visually guided walking compared to normal walking. EEG-TA EMG coherence also increased, but the group average did not reach statistical significance. The results indicate that the corticospinal tract is involved in modifying gait when visually guided placement of the foot is required. These findings are important for our basic understanding of the central control of human bipedal gait and for the design of rehabilitation interventions for gait function following central motor lesions.

Contribution of sensory feedback to plantar flexor muscle activation during push-off in adults with cerebral palsy

Exaggerated sensory activity has been assumed to contribute to functional impairment following lesion of the central motor pathway. However, recent studies have suggested that sensory contribution to muscle activity during gait is reduced in stroke patients and children with cerebral palsy (CP). We investigated whether this also occurs in CP adults and whether daily treadmill training is accompanied by alterations in sensory contribution to muscle activity. Seventeen adults with CP and 12 uninjured individuals participated. The participants walked on a treadmill while a robotized ankle-foot orthosis applied unload perturbations at the ankle, thereby removing sensory feedback naturally activated during push-off. Reduction of electromyographic (EMG) activity in the soleus muscle caused by unloads was compared and related to kinematics and ankle joint stiffness measurements. Similar measures were obtained after 6 wk of gait training. We found that sensory contribution to soleus EMG activation was reduced in CP adults compared with uninjured adults. The lowest contribution of sensory feedback was found in participants with lowest maximal gait speed. This was related to increased ankle plantar flexor stiffness. Six weeks of gait training did not alter the contribution of sensory feedback. We conclude that exaggerated sensory activity is unlikely to contribute to impaired gait in CP adults, because sensory contribution to muscle activity during gait was reduced compared with in uninjured individuals. Increased passive stiffness around the ankle joint is likely to diminish sensory feedback during gait so that a larger part of plantar flexor muscle activity must be generated by descending motor commands.NEW & NOTEWORTHY Findings suggest that adults with cerebral palsy have less contribution of sensory feedback to ongoing soleus muscle activation during push-off than uninjured individuals. Increased passive stiffness around the ankle joint is likely to diminish sensory feedback during gait, and/or sensory feedback is less integrated with central motor commands in the activation of spinal motor neurons. Consequently, muscle activation must to a larger extent rely on descending drive, which is already decreased because of the cerebral lesion.

EMG synchrony to assess impaired corticomotor control of locomotion after stroke

Adapting one's gait pattern requires a contribution from cortical motor commands. Evidence suggests that frequency-based analysis of electromyography (EMG) can be used to detect this cortical contribution. Specifically, increased EMG synchrony between synergistic muscles in the Piper frequency band has been linked to heightened corticomotor contribution to EMG. Stroke-related damage to cerebral motor pathways would be expected to diminish EMG Piper synchrony. The objective of this study is therefore to test the hypothesis that EMG Piper synchrony is diminished in the paretic leg relative to nonparetic and control legs, particularly during a long-step task of walking adaptability. Twenty adults with post-stroke hemiparesis and seventeen healthy controls participated in this study. EMG Piper synchrony increased more for the control legs compare to the paretic legs when taking a non-paretic long step (5.02±3.22% versus 0.86±2.62%), p<0.01) and when taking a paretic long step (2.04±1.98% versus 0.70±2.34%, p<0.05). A similar but non-significant trend was evident when comparing non-paretic and paretic legs. No statistically significant differences in EMG Piper synchrony were found between legs for typical walking. EMG Piper synchrony was positively associated with walking speed and step length within the stroke group. These findings support the assertion that EMG Piper synchrony indicates corticomotor contribution to walking.

Development and aging of human spinal cord circuitries

The neural motor circuitries in the spinal cord receive information from our senses and the rest of the nervous system and translate it into purposeful movements, which allow us to interact with the rest of the world. In this review, we discuss how these circuitries are established during early development and the extent to which they are shaped according to the demands of the body that they control and the environment with which the body has to interact. We also discuss how aging processes and physiological changes in our body are reflected in adaptations of activity in the spinal cord motor circuitries. The complex, multifaceted connectivity of the spinal cord motor circuitries allows them to generate vastly different movements and to adapt their activity to meet new challenges imposed by bodily changes or a changing environment. There are thus plenty of possibilities for adaptive changes in the spinal motor circuitries both early and late in life.

A critical period of corticomuscular and EMG-EMG coherence detection in healthy infants aged 9-25 weeks

KEY POINTS

The early postnatal development of functional corticospinal connections in human infants is not fully clarified. Corticospinal drive to upper and lower limb muscle shows developmental changes with an increased functional coupling in infants between 9 and 25 weeks in the beta frequency band. The changes in functional coupling coincide with the developmental period where fidgety movements are present in healthy infants. Data support a possible sensitive period where functional connections between corticospinal tract fibres and spinal motoneurones undergo activity-dependent reorganization.

ABSTRACT

The early postnatal development of functional corticospinal connections in human infants is not fully clarified. We used EEG and EMG to investigate the development of corticomuscular and intramuscular coherence as indicators of functional corticospinal connectivity in healthy infants aged 1-66 weeks. EEG was recorded over leg and hand area of motor cortex. EMG recordings were made from right ankle dorsiflexor and right wrist extensor muscles. Quantification of the amount of corticomuscular coherence in the 20-40 Hz frequency band showed a significantly larger coherence for infants aged 9-25 weeks compared to younger and older infants. Coherence between paired EMG recordings from tibialis anterior muscle in the 20-40 Hz frequency band was also significantly larger for the 9-25 week age group. A low-amplitude, broad-duration (40-50 ms) central peak of EMG-EMG synchronization was observed for infants younger than 9 weeks, whereas a short-lasting (10-20 ms) central peak was observed for EMG-EMG synchronization in older infants. This peak was largest for infants aged 9-25 weeks. These data suggest that the corticospinal drive to lower and upper limb muscles shows significant developmental changes with an increase in functional coupling in infants aged 9-25 weeks, a period which coincides partly with the developmental period of normal fidgety movements. We propose that these neurophysiological findings may reflect the existence of a sensitive period where the functional connections between corticospinal tract fibres and spinal motoneurones undergo activity-dependent reorganization. This may be relevant for the timing of early therapy interventions in infants with pre- and perinatal brain injury.

Is child walking conditioned by gender? Surface EMG patterns in female and male children

EMG-based differences between females and males during walking are generally acknowledged in adults. Aim of the study was the quantification of possible gender differences in myoelectric activity of gastrocnemius lateralis (GL) and tibialis anterior (TA) during walking in school-age children. Gender-related comparison with adults was also provided to get possible novel insight in maturation of gait. To this aim, Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatial-temporal and surface-EMG-based parameters over hundreds of strides, was performed in100 healthy school-age children (C-group) and in 33 healthy young adults (YA-group). On average, 301±110 consecutive strides were analyzed for each subject. In C-group, no significant differences (p>0.05) were observed between females and males in GL and TA, considering mean onset/offset instants of activation and occurrence frequency. Stratifying the C-group for age, small differences between females and males in occurrence frequency of GL arose in oldest children. In YA-group, females showed a significant propensity for a more complex recruitment of TA and GL (higher number of activations during gait cycle, quantified by occurrence frequency) compared to males. These outcomes suggest that gender-related differences in sEMG parameters do not characterize the recruitment of GL and TA during child walking in early years (6-8 years), start occurring when adolescence is approaching (10-12 years), and are acknowledged in both ankle muscles only in adults. Present findings seem to support previous studies on maturation of gait which indicate adolescence as the time-range where gait is completing its maturation path.

The developmental dynamics of gait maturation with a focus on spatiotemporal measures

Gait analysis is recognised as a powerful clinical tool for studying relationships between motor control and brain function. By drawing on the literature investigating gait in individuals with neurological disorders, this review provides insight into the neural processes that contribute to and regulate specific spatiotemporal sub-components of gait and how they may mature across early to late childhood. This review also discusses the roles of changing anthropomorphic characteristics, and maturing sensory and higher-order cognitive processes in differentiating the developmental trajectories of the sub-components of gait. Importantly, although studies have shown that cognitive-gait interference is larger in children compared to adults, the contributing neurocognitive mechanisms may vary across age groups who have different types of attentional or cognitive vulnerabilities. These findings have implications for current models of gait maturation by highlighting the need for a dynamic model that focuses on the integration of various factors that contribute to gait though experience and practice. This is essential to elucidating why gait and other motor deficits are often contiguous with cognitive neurodevelopmental disorders.

Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: A pilot, double blind, randomized controlled trial

PURPOSE

Preliminary evidence has shown no additional effects of transcranial direct current stimulation (tDCS) on robotic gait training in chronic stroke, probably due to the neural organization of locomotion involving cortical and spinal control. Our aim was to compare the combined effects of tDCS and transcutaneous spinal direct current stimulation (tsDCS) on robotic gait training in chronic stroke.

METHODS

Thirty chronic stroke patients received ten 20-minute robot-assisted gait training sessions, five days a week, for 2 consecutive weeks combined with anodal tDCS + sham tsDCS (group 1; n = 10) or sham tDCS + cathodal tsDCS (group 2; n = 10) or tDCS + cathodal tsDCS (group 3; n = 10). The primary outcome was the 6-minute walk test (6MWT) performed before, after, 2 weeks and 4 weeks post-treatment.

RESULTS

Significant differences in the 6MWT distance were noted between group 3 and group 1 at the post-treatment and 2-week follow-up evaluations (post-treatment P = 0.015; 2-week follow-up P = 0.001) and between group 3 and group 2 (post-treatment P = 0.010; 2-week follow-up P =  .015). No difference was found between group 2 and group 1.

CONCLUSIONS

Our preliminary findings support the hypothesis that anodal tDCS combined with cathodal tsDCS may be useful to improve the effects of robotic gait training in chronic stroke.

Locomotor sequence learning in visually guided walking

Voluntary limb modifications must be integrated with basic walking patterns during visually guided walking. In this study we tested whether voluntary gait modifications can become more automatic with practice. We challenged walking control by presenting visual stepping targets that instructed subjects to modify step length from one trial to the next. Our sequence learning paradigm is derived from the serial reaction-time (SRT) task that has been used in upper limb studies. Both random and ordered sequences of step lengths were used to measure sequence-specific and sequence-nonspecific learning during walking. In addition, we determined how age (i.e., healthy young adults vs. children) and biomechanical factors (i.e., walking speed) affected the rate and magnitude of locomotor sequence learning. The results showed that healthy young adults (age 24 ± 5 yr,n= 20) could learn a specific sequence of step lengths over 300 training steps. Younger children (age 6-10 yr,n= 8) had lower baseline performance, but their magnitude and rate of sequence learning were the same compared with those of older children (11-16 yr,n= 10) and healthy adults. In addition, learning capacity may be more limited at faster walking speeds. To our knowledge, this is the first study to demonstrate that spatial sequence learning can be integrated with a highly automatic task such as walking. These findings suggest that adults and children use implicit knowledge about the sequence to plan and execute leg movement during visually guided walking.

Descending neural drives to ankle muscles during gait and their relationships with clinical functions in patients after stroke

OBJECTIVE

The objective of this study was to investigate the descending neural drive to ankle muscles during gait in stroke patients using a coherence analysis of surface electromyographic (EMG) recordings and the relationships of the drive with clinical functions.

METHODS

EMG recordings of the paired tibialis anterior (TA), medial and lateral gastrocnemius (MG and LG), and TA-LG muscles were used to calculate intramuscular, synergistic, and agonist-antagonist muscle coherence, respectively, in 11 stroke patients and 9 healthy controls. Paretic motor function, sensory function, spasticity, ankle muscle strength, and gait performance were evaluated.

RESULTS

Paretic TA-TA and MG-LG beta band (15-30 Hz) coherences were significantly lower compared with the non-paretic side and controls. TA-LG beta band coherence was significantly higher on both sides compared with controls. Paretic TA-TA beta band coherence positively correlated with gait speed, and paretic TA-LG beta band coherence negatively correlated with paretic ankle plantar flexor muscle strength.

CONCLUSIONS

The intramuscular and synergistic muscle neural drives were reduced during gait on the paretic side in stroke patients. The agonist-antagonist muscle neural drive was increased to compensate for paretic ankle muscle weakness.

SIGNIFICANCE

Descending neural drive reorganization to agonist-antagonist muscles is important for patients with paretic ankle muscle weakness.

EMG of the tibialis anterior demonstrates a training effect after utilization of a foot drop stimulator

BACKGROUND

Functional Electrical Stimulation (FES) applied through a foot drop stimulator (FDS) is a rehabilitation intervention that can stimulate the common peroneal nerve to provide dorsiflexion at the correct timing during gait.

OBJECTIVE

To determine if FES applied to the peroneal nerve during walking through a FDS would effectively retrain the electromyographic temporal activation of the tibialis anterior in individuals with stroke.

METHODS

Surface electromyography (EMG) were collected bilaterally from the tibialis anterior (TA) while participants (n = 4) walked with and without the FDS at baseline and 4 weeks. Comparisons were made between stimulation timing and EMG activation timing to produce a burst duration similarity index (BDSI).

RESULTS

At baseline, participants displayed variable temporal activation of the TA. At 4 weeks, TA activation during walking without the FDS more closely resembled the pre-programmed FDS timing demonstrated by an increase in BDSI scores in all participants (P = 0.05).

CONCLUSIONS

Continuous use of FDS during a task specific movement can re-train the neuromuscular system. After 4 weeks of utilization the FDS trained the TA to replicate the programmed temporal activation patterns. These findings begin to establish the FDS as a rehabilitation intervention that may facilitate recovery rather than just compensate for stroke related gait impairments due to foot drop.

Gait training facilitates central drive to ankle dorsiflexors in children with cerebral palsy

Foot drop and toe walking are frequent concerns in children with cerebral palsy. The main underlying cause of these problems is early damage and lack of maturation of the corticospinal tract. In the present study we investigated whether 4 weeks of daily treadmill training with an incline may facilitate corticospinal transmission and improve the control of the ankle joint in children with cerebral palsy. Sixteen children with cerebral palsy (Gross Motor Classification System I:6, II:6, III:4) aged 5-14 years old, were recruited for the study. Evaluation of gait ability and intramuscular coherence was made twice before and twice after training with an interval of 1 month. Gait kinematics were recorded by 3D video analysis during treadmill walking with a velocity chosen by the child at the first evaluation. Foot pressure was measured by force sensitive foot soles during treadmill and over ground walking. EMG-EMG coherence was calculated from two separate electrode recordings placed over the tibialis anterior muscle. Training involved 30 min of walking daily on a treadmill with an incline for 30 days. Gait training was accompanied by significant increases in gait speed, incline on the treadmill, the maximal voluntary dorsiflexion torque, the number and amplitude of toe lifts late in the swing phase during gait and the weight exerted on the heel during the early stance phase of the gait cycle. EMG-EMG coherence in the beta and gamma frequency bands recorded from tibialis anterior muscle increased significantly when compared to coherence before training. The largest changes in coherence with training were observed for children <10 years of age. Importantly, in contrast to training-induced EMG increases, the increase in coherence was maintained at the follow-up measurement 1 month after training. Changes in the strength of coherence in the beta and gamma band were positively correlated with improvements in the subjects' ability to lift the toes in the swing phase. These data show that daily intensive gait training increases beta and gamma oscillatory drive to ankle dorsiflexor motor neurons and that it improves toe lift and heel strike in children with cerebral palsy. We propose that intensive gait training may produce plastic changes in the corticospinal tract, which are responsible for improvements in gait function.

Early identification and intervention in cerebral palsy

Infants with possible cerebral palsy (CP) are commonly assumed to benefit from early diagnosis and early intervention, but substantial evidence for this is lacking. There is no consensus in the literature on a definition of 'early', but this review focuses on interventions initiated within the first 6 months after term age. We cover basic neuroscience, arguing for a beneficial effect of early intervention, and discuss why clinical research to support this convincingly is lacking. We argue that infants offered early intervention in future clinical studies must be identified carefully, and that the intervention should be focused on infants showing early signs of CP to determine an effect of treatment. Such signs may be efficiently detected by a combination of neuroimaging and the General Movements Assessment. We propose a research agenda directed at large-scale identification of infants showing early signs of CP and testing of high-intensity, early interventions.

Agonist and antagonist muscle activation in elite athletes: influence of age

PURPOSE

Age-related neuromuscular control adaptations have been investigated mainly in untrained populations, where higher antagonist activation in adults was observed with respect to children. In elite athletes age-related differences in neuromuscular control have scarcely been investigated. Therefore, this study aims at investigating differences in co-activation about the knee joint in two groups of karate athletes belonging to the Junior (JK) and Senior (SK) age categories, performing the roundhouse kick (RK).

METHODS

Six SK and six JK performed the RK impacting on a punching bag. Each participant performed three attempts during which kicking limb kinematics and sEMG from the vastus lateralis (VL) and from the biceps femoris (BF) were recorded. Co-activation index during knee flexion and extension (CIF; CIE) and agonist and antagonist activation areas of VL and BF (I AGO-VL; I AGO-BF; I ANT-VL; I ANT-BF) were computed. Hip and knee range of motion, peak angular velocity and minima and maxima of lower limb angular momentum were computed.

RESULTS

During knee extension, the SK demonstrated higher CIE, higher IANT-BF and higher total angular momentum with respect to the JK. Significant relationships were observed between I ANT-BF and total angular momentum maxima, and between I ANT-BF and age.

CONCLUSIONS

IANT-BF is partially related to the age of the group and to joint protection upon impact. Moreover, given the very brief duration of the task, a feed-forward mechanism modulating antagonist activation partly based on the stress imposed on the knee joint could be hypothesized. This mechanism potentially involves skill dependent re-modelling of the peripheral and central nervous system.

Cortical muscle control of spontaneous movements in human neonates

Anatomical studies show the existence of corticomotor neuronal projections to the spinal cord before birth, but whether the primary motor cortex drives muscle activity in neonatal 'spontaneous' movements is unclear. To investigate this issue, we calculated corticomuscular coherence (CMC) and Granger causality in human neonates. CMC is widely used as an index of functional connectivity between the primary motor cortex and limb muscles, and Granger causality is used across many fields of science to detect the direction of coherence. To calculate CMC and Granger causality, we used electroencephalography (EEG) to measure activity over the cortical region that governs leg muscles, and surface electromyography (EMG) over the right and left tibialis anterior muscles, in 15 healthy term and preterm neonates, during spontaneous movements without any external stimulation. We found that 17 leg muscles (10 right, seven left) in 12 neonates showed significant CMC, whose magnitude significantly correlated with postnatal age only in the beta frequency band. Further analysis revealed Granger causal drive from EEG to EMG in 14 leg muscles. Our findings suggest that the primary motor cortex drives muscle activity when neonates move their limbs. Moreover, the positive correlation between CMC magnitude and postnatal age suggests that corticomuscular communication begins to develop during the neonatal stage. This process may facilitate sensory-motor integration and activity-dependent development.

Reliability and agreement of intramuscular coherence in tibialis anterior muscle

Background

Neuroplasticity drives recovery of walking after a lesion of the descending tract. Intramuscular coherence analysis provides a way to quantify corticomotor drive during a functional task, like walking and changes in coherence serve as a marker for neuroplasticity. Although intramuscular coherence analysis is already applied and rapidly growing in interest, the reproducibility of variables derived from coherence is largely unknown. The purpose of this study was to determine the test-retest reliability and agreement of intramuscular coherence variables obtained during walking in healthy subjects.

Methodology/Principal Findings

Ten healthy participants walked on a treadmill at a slow and normal speed in three sessions. Area of coherence and peak coherence were derived from the intramuscular coherence spectra calculated using rectified and non-rectified M. tibialis anterior Electromyography (EMG). Reliability, defined as the ability of a measurement to differentiate between subjects and established by the intra-class correlation coefficient, was on the limit of good for area of coherence and peak coherence when derived from rectified EMG during slow walking. Yet, the agreement, defined as the degree to which repeated measures are identical, was low as the measurement error was relatively large. The smallest change to exceed the measurement error between two repeated measures was 66% of the average value. For normal walking and/or other EMG-processing settings, not rectifying the EMG and/or high-pass filtering with a high cutoff frequency (100 Hz) the reliability was only moderate to poor and the agreement was considerably lower.

Conclusions/significance

Only for specific conditions and EMG-processing settings, the derived coherence variables can be considered to be reliable measures. However, large changes (>66%) are needed to indicate a real difference. So, although intramuscular coherence is an easy to use and a sufficiently reliable tool to quantify intervention-induced neuroplasticity, the large effects needed to reveal a real change limit its practical use.

Sensory feedback to ankle plantar flexors is not exaggerated during gait in spastic hemiplegic children with cerebral palsy

It is still widely believed that exaggerated stretch reflexes and increased muscle tone in ankle plantar flexors contribute to reduced ankle joint movement during gait in children with cerebral palsy (CP). However, no study has directly measured stretch reflex activity during gait in these children. We investigated sensory feedback mechanisms during walking in 20 CP children and 41 control children. Stretch responses in plantar flexor muscles evoked in stance showed an age-related decline in control but not CP children. In swing the responses were abolished in control children, but significant responses were observed in 14 CP children. This was related to reduced activation of dorsiflexors in swing. Removal of sensory feedback in stance produced a drop in soleus activity of a similar size in control and CP children. Soleus activity was observed in swing to the same extent in control and CP children. Removal of sensory feedback in swing caused a larger drop in soleus activity in control children than in CP children. The lack of age-related decline in stretch reflexes and the inability to suppress reflexes in swing is likely related to lack of maturation of corticospinal control in CP children. Since soleus activity was not seen more frequently than in control children in swing and since sensory feedback did not contribute more to their soleus activity, spasticity is unlikely to contribute to foot drop and toe walking. We propose that altered central drive to the ankle muscles and increased passive muscle stiffness are the main causes of foot drop and toe walking.