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Debenham MIB, Franz CK, Berger MJ. Neuromuscular consequences of spinal cord injury: New mechanistic insights and clinical considerations. Muscle Nerve 2024; 70:12-27. [PMID: 38477416 DOI: 10.1002/mus.28070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024]
Abstract
The spinal cord facilitates communication between the brain and the body, containing intrinsic systems that work with lower motor neurons (LMNs) to manage movement. Spinal cord injuries (SCIs) can lead to partial paralysis and dysfunctions in muscles below the injury. While traditionally this paralysis has been attributed to disruptions in the corticospinal tract, a growing body of work demonstrates LMN damage is a factor. Motor units, comprising the LMN and the muscle fibers with which they connect, are essential for voluntary movement. Our understanding of their changes post-SCI is still emerging, but the health of motor units is vital, especially when considering innovative SCI treatments like nerve transfer surgery. This review seeks to collate current literature on how SCI impact motor units and explore neuromuscular clinical implications and treatment avenues. SCI reduced motor unit number estimates, and surviving motor units had impaired signal transmission at the neuromuscular junction, force-generating capacity, and excitability, which have the potential to recover chronically, yet the underlaying mechanisms are unclear. Furthermore, electrodiagnostic evaluations can aid in assessing the health lower and upper motor neurons, identify suitable targets for nerve transfer surgeries, and detect patients with time sensitive injuries. Lastly, many electrodiagnostic abnormalities occur in both chronic and acute SCI, yet factors contributing to these abnormalities are unknown. Future studies are required to determine how motor units adapt following SCI and the clinical implications of these adaptations.
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Affiliation(s)
- Mathew I B Debenham
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin K Franz
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Piotrkiewicz M. The role of computer simulations in the investigation of mechanisms underlying rhythmic firing of human motoneuron. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Balbinot G, Li G, Wiest MJ, Pakosh M, Furlan JC, Kalsi-Ryan S, Zariffa J. Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review. J Neuroeng Rehabil 2021; 18:105. [PMID: 34187509 PMCID: PMC8244234 DOI: 10.1186/s12984-021-00888-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) disrupts spinal and supraspinal pathways, and this process is reflected in changes in surface electromyography (sEMG). sEMG is an informative complement to current clinical testing and can capture the residual motor command in great detail-including in muscles below the level of injury with seemingly absent motor activities. In this comprehensive review, we sought to describe how the sEMG properties are changed after SCI. We conducted a systematic literature search followed by a narrative review focusing on sEMG analysis techniques and signal properties post-SCI. We found that early reports were mostly focused on the qualitative analysis of sEMG patterns and evolved to semi-quantitative scores and a more detailed amplitude-based quantification. Nonetheless, recent studies are still constrained to an amplitude-based analysis of the sEMG, and there are opportunities to more broadly characterize the time- and frequency-domain properties of the signal as well as to take fuller advantage of high-density EMG techniques. We recommend the incorporation of a broader range of signal properties into the neurophysiological assessment post-SCI and the development of a greater understanding of the relation between these sEMG properties and underlying physiology. Enhanced sEMG analysis could contribute to a more complete description of the effects of SCI on upper and lower motor neuron function and their interactions, and also assist in understanding the mechanisms of change following neuromodulation or exercise therapy.
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Affiliation(s)
- Gustavo Balbinot
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
| | - Guijin Li
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Matheus Joner Wiest
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Julio Cesar Furlan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jose Zariffa
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
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Effect of synchronization of firings of different motor unit types on the force variability in a model of the rat medial gastrocnemius muscle. PLoS Comput Biol 2021; 17:e1008282. [PMID: 33901164 PMCID: PMC8101995 DOI: 10.1371/journal.pcbi.1008282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/06/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022] Open
Abstract
The synchronized firings of active motor units (MUs) increase the oscillations of muscle force, observed as physiological tremor. This study aimed to investigate the effects of synchronizing the firings within three types of MUs (slow—S, fast resistant to fatigue–FR, and fast fatigable–FF) on the muscle force production using a mathematical model of the rat medial gastrocnemius muscle. The model was designed based on the actual proportion and physiological properties of MUs and motoneurons innervating the muscle. The isometric muscle and MU forces were simulated by a model predicting non-synchronized firing of a pool of 57 MUs (including 8 S, 23 FR, and 26 FF) to ascertain a maximum excitatory signal when all MUs were recruited into the contraction. The mean firing frequency of each MU depended upon the twitch contraction time, whereas the recruitment order was determined according to increasing forces (the size principle). The synchronization of firings of individual MUs was simulated using four different modes and inducing the synchronization of firings within three time windows (± 2, ± 4, and ± 6 ms) for four different combinations of MUs. The synchronization was estimated using two parameters, the correlation coefficient and the cross-interval synchronization index. The four scenarios of synchronization increased the values of the root-mean-square, range, and maximum force in correlation with the increase of the time window. Greater synchronization index values resulted in higher root-mean-square, range, and maximum of force outcomes for all MU types as well as for the whole muscle output; however, the mean spectral frequency of the forces decreased, whereas the mean force remained nearly unchanged. The range of variability and the root-mean-square of forces were higher for fast MUs than for slow MUs; meanwhile, the relative values of these parameters were highest for slow MUs, indicating their important contribution to muscle tremor, especially during weak contractions. The synchronization of firings of motor units (MUs), the smallest functional elements of skeletal muscle increases fluctuations in muscle force, known as physiological tremor, which can disturb high-precision movements. In this study, we adopted a recently proposed muscle model consisting of MUs of three different types (fast fatigable, fast resistant to fatigue, and slow) to study four different scenarios of MU synchronization during a steady level of excitatory input to motoneurons. The discharge patterns were synchronized between pairs of MUs by shifting in time individual pulses, which occurred within a short time interval, and a degree of synchronization was then estimated. The increased synchronization index resulted in increased force variability for all MU types as well as for the whole muscle output; however, the mean force levels remained nearly unchanged, whereas the frequencies of the force oscillations were decreased. The absolute range of force variability was higher for fast than for slow MUs, indicating their dominant influence on muscle tremor at strong contractions, but the highest relative increase in force variability was observed for synchronized slow MUs, indicating their significant contribution to tremor during weak contractions, in which only slow MUs are active.
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Modified PRISM and SCI-SET Spasticity Measures for Persons With Traumatic Spinal Cord Injury: Results of a Rasch Analyses. Arch Phys Med Rehabil 2020; 101:1570-1579. [DOI: 10.1016/j.apmr.2020.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/28/2020] [Accepted: 05/09/2020] [Indexed: 11/23/2022]
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Plantier V, Sanchez-Brualla I, Dingu N, Brocard C, Liabeuf S, Gackière F, Brocard F. Calpain fosters the hyperexcitability of motoneurons after spinal cord injury and leads to spasticity. eLife 2019; 8:e51404. [PMID: 31815668 PMCID: PMC6927741 DOI: 10.7554/elife.51404] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022] Open
Abstract
Up-regulation of the persistent sodium current (INaP) and down-regulation of the potassium/chloride extruder KCC2 lead to spasticity after spinal cord injury (SCI). We here identified calpain as the driver of the up- and down-regulation of INaP and KCC2, respectively, in neonatal rat lumbar motoneurons. Few days after SCI, neonatal rats developed behavioral signs of spasticity with the emergence of both hyperreflexia and abnormal involuntary muscle contractions on hindlimbs. At the same time, in vitro isolated lumbar spinal cords became hyperreflexive and displayed numerous spontaneous motor outputs. Calpain-I expression paralleled with a proteolysis of voltage-gated sodium (Nav) channels and KCC2. Acute inhibition of calpains reduced this proteolysis, restored the motoneuronal expression of Nav and KCC2, normalized INaP and KCC2 function, and curtailed spasticity. In sum, by up- and down-regulating INaP and KCC2, the calpain-mediated proteolysis of Nav and KCC2 drives the hyperexcitability of motoneurons which leads to spasticity after SCI.
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Affiliation(s)
- Vanessa Plantier
- Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université and CNRSMarseilleFrance
| | - Irene Sanchez-Brualla
- Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université and CNRSMarseilleFrance
| | - Nejada Dingu
- Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université and CNRSMarseilleFrance
| | - Cécile Brocard
- Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université and CNRSMarseilleFrance
| | - Sylvie Liabeuf
- Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université and CNRSMarseilleFrance
| | - Florian Gackière
- Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université and CNRSMarseilleFrance
| | - Frédéric Brocard
- Institut de Neurosciences de la Timone (UMR7289), Aix-Marseille Université and CNRSMarseilleFrance
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Lu Z, Chen X, Zhang X, Tong KY, Zhou P. Real-Time Control of an Exoskeleton Hand Robot with Myoelectric Pattern Recognition. Int J Neural Syst 2017; 27:1750009. [DOI: 10.1142/s0129065717500095] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Robot-assisted training provides an effective approach to neurological injury rehabilitation. To meet the challenge of hand rehabilitation after neurological injuries, this study presents an advanced myoelectric pattern recognition scheme for real-time intention-driven control of a hand exoskeleton. The developed scheme detects and recognizes user’s intention of six different hand motions using four channels of surface electromyography (EMG) signals acquired from the forearm and hand muscles, and then drives the exoskeleton to assist the user accomplish the intended motion. The system was tested with eight neurologically intact subjects and two individuals with spinal cord injury (SCI). The overall control accuracy was [Formula: see text] for the neurologically intact subjects and [Formula: see text] for the SCI subjects. The total lag of the system was approximately 250[Formula: see text]ms including data acquisition, transmission and processing. One SCI subject also participated in training sessions in his second and third visits. Both the control accuracy and efficiency tended to improve. These results show great potential for applying the advanced myoelectric pattern recognition control of the wearable robotic hand system toward improving hand function after neurological injuries.
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Affiliation(s)
- Zhiyuan Lu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX, USA
- TIRR Memorial Hermann Research Center, 1333B Moursund St., Houston, TX, USA
| | - Xiang Chen
- Biomedical Engineering Program, University of Science and Technology of China, Hefei, P. R. China
| | - Xu Zhang
- Biomedical Engineering Program, University of Science and Technology of China, Hefei, P. R. China
| | - Kay-Yu Tong
- Division of Biomedical Engineering, Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong, P. R. China
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX, USA
- TIRR Memorial Hermann Research Center, 1333B Moursund St., Houston, TX, USA
- Guangdong Work Injury Rehabilitation Center, 68 Qide Rd., Guangzhou, P. R. China
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Thomas CK, Häger CK, Klein CS. Increases in human motoneuron excitability after cervical spinal cord injury depend on the level of injury. J Neurophysiol 2016; 117:684-691. [PMID: 27852734 DOI: 10.1152/jn.00676.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022] Open
Abstract
After human spinal cord injury (SCI), motoneuron recruitment and firing rate during voluntary and involuntary contractions may be altered by changes in motoneuron excitability. Our aim was to compare F waves in single thenar motor units paralyzed by cervical SCI to those in uninjured controls because at the single-unit level F waves primarily reflect the intrinsic properties of the motoneuron and its initial segment. With intraneural motor axon stimulation, F waves were evident in all 4 participants with C4-level SCI, absent in 8 with C5 or C6 injury, and present in 6 of 12 Uninjured participants (P < 0.001). The percentage of units that generated F waves differed across groups (C4: 30%, C5 or C6: 0%, Uninjured: 16%; P < 0.001). Mean (±SD) proximal axon conduction velocity was slower after C4 SCI [64 ± 4 m/s (n = 6 units), Uninjured: 73 ± 8 m/s (n = 7 units); P = 0.037]. Mean distal axon conduction velocity differed by group [C4: 40 ± 8 m/s (n = 20 units), C5 or C6: 49 ± 9 m/s (n = 28), Uninjured: 60 ± 7 m/s (n = 45); P < 0.001]. Motor unit properties (EMG amplitude, twitch force) only differed after SCI (P ≤ 0.004), not by injury level. Motor units with F waves had distal conduction velocities, M-wave amplitudes, and twitch forces that spanned the respective group range, indicating that units with heterogeneous properties produced F waves. Recording unitary F waves has shown that thenar motoneurons closer to the SCI (C5 or C6) have reduced excitability whereas those further away (C4) have increased excitability, which may exacerbate muscle spasms. This difference in motoneuron excitability may be related to the extent of membrane depolarization following SCI. NEW & NOTEWORTHY Unitary F waves were common in paralyzed thenar muscles of people who had a chronic spinal cord injury (SCI) at the C4 level compared with uninjured people, but F waves did not occur in people that had SCI at the C5 or C6 level. These results highlight that intrinsic motoneuron excitability depends, in part, on how close the motoneurons are to the site of the spinal injury, which could alter the generation and strength of voluntary and involuntary muscle contractions.
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Affiliation(s)
- Christine K Thomas
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida;
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; and
| | - Cliff S Klein
- Guangdong Work Injury Rehabilitation Center, Guangzhou, People's Republic of China
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9
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Abstract
The severe muscle weakness and atrophy measured after human spinal cord injury (SCI) may relate to chronic muscle denervation due to motoneuron death and/or altered muscle use. The aim of this study was to estimate motoneuron death after traumatic human SCI. The diameter and number of myelinated axons were measured in ventral roots post-mortem because ventral roots contain large diameter (> 7 μm) myelinated axons that typically arise from motoneurons and innervate skeletal muscle. In four cases (SCI levels C7, C8, T4, and L1) involving contusion (n = 3) or laceration (n = 1), there was a significant reduction in the number of large diameter myelinated axons at the lesion epicenter (mean ± standard error [SE]: 45 ± 11% Uninjured), one level above (51 ± 14%), and one (27 ± 12%), two (45 ± 40%), and three (54 ± 23%) levels below the epicenter. Reductions in motoneuron numbers varied by side and case. These deficits result from motoneuron death because the gray matter was destroyed at and near the lesion epicenter. Muscle denervation must ensue. In seven cases, ventral roots at or below the epicenter had large diameter myelinated axons with unusually thin myelin, a sign of incomplete remyelination. The mean ± SE g ratio (axon diameter/fiber diameter) was 0.60 ± 0.01 for axons of all diameters in five above-lesion ventral roots, but increased significantly for large diameter fibers (≥ 12 μm) in three roots at the lesion epicenter. Motoneuron death after human SCI will coarsen muscle force gradation and control, while extensive muscle denervation will stifle activity-based treatments.
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Affiliation(s)
- Robert M Grumbles
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida
| | - Christine K Thomas
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, University of Miami Miller School of Medicine , Miami, Florida.,3 Department of Physiology and Biophysics, University of Miami Miller School of Medicine , Miami, Florida
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Brocard C, Plantier V, Boulenguez P, Liabeuf S, Bouhadfane M, Viallat-Lieutaud A, Vinay L, Brocard F. Cleavage of Na+ channels by calpain increases persistent Na+ current and promotes spasticity after spinal cord injury. Nat Med 2016; 22:404-11. [DOI: 10.1038/nm.4061] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 02/08/2016] [Indexed: 12/13/2022]
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Li L, Li X, Liu J, Zhou P. Alterations in multidimensional motor unit number index of hand muscles after incomplete cervical spinal cord injury. Front Hum Neurosci 2015; 9:238. [PMID: 26005410 PMCID: PMC4424856 DOI: 10.3389/fnhum.2015.00238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/13/2015] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to apply a novel multidimensional motor unit number index (MD-MUNIX) technique to examine hand muscles in patients with incomplete cervical spinal cord injury (SCI). The MD-MUNIX was estimated from the compound muscle action potential (CMAP) and different levels of surface interference pattern electromyogram (EMG) at multiple directions of voluntary isometric muscle contraction. The MD-MUNIX was applied in the first dorsal interosseous (FDI), thenar and hypothenar muscles of SCI (n = 12) and healthy control (n = 12) subjects. The results showed that the SCI subjects had significantly smaller CMAP and MD-MUNIX in all the three examined muscles, compared to those derived from the healthy control subjects. The multidimensional motor unit size index (MD-MUSIX) demonstrated significantly larger values for the FDI and hypothenar muscles in SCI subjects than those from healthy control subjects, whereas the MD-MUSIX enlargement was marginally significant for the thenar muscles. The findings from the MD-MUNIX analyses provide an evidence of motor unit loss in hand muscles of cervical SCI patients, contributing to hand function deterioration.
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Affiliation(s)
- Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University Guangzhou, China ; Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center Houston, TX, USA
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center Houston, TX, USA
| | - Jie Liu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago Chicago, IL, USA
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center Houston, TX, USA ; Biomedical Engineering Program, University of Science and Technology of China Hefei, China
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12
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Petrie MA, Suneja M, Faidley E, Shields RK. A minimal dose of electrically induced muscle activity regulates distinct gene signaling pathways in humans with spinal cord injury. PLoS One 2014; 9:e115791. [PMID: 25531450 PMCID: PMC4274164 DOI: 10.1371/journal.pone.0115791] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
Paralysis after a spinal cord injury (SCI) induces physiological adaptations that compromise the musculoskeletal and metabolic systems. Unlike non-SCI individuals, people with spinal cord injury experience minimal muscle activity which compromises optimal glucose utilization and metabolic control. Acute or chronic muscle activity, induced through electrical stimulation, may regulate key genes that enhance oxidative metabolism in paralyzed muscle. We investigated the short and long term effects of electrically induced exercise on mRNA expression of human paralyzed muscle. We developed an exercise dose that activated the muscle for only 0.6% of the day. The short term effects were assessed 3 hours after a single dose of exercise, while the long term effects were assessed after training 5 days per week for at least one year (adherence 81%). We found a single dose of exercise regulated 117 biological pathways as compared to 35 pathways after one year of training. A single dose of electrical stimulation increased the mRNA expression of transcriptional, translational, and enzyme regulators of metabolism important to shift muscle toward an oxidative phenotype (PGC-1α, NR4A3, IFRD1, ABRA, PDK4). However, chronic training increased the mRNA expression of specific metabolic pathway genes (BRP44, BRP44L, SDHB, ACADVL), mitochondrial fission and fusion genes (MFF, MFN1, MFN2), and slow muscle fiber genes (MYH6, MYH7, MYL3, MYL2). These findings support that a dose of electrical stimulation (∼10 minutes/day) regulates metabolic gene signaling pathways in human paralyzed muscle. Regulating these pathways early after SCI may contribute to reducing diabetes in people with longstanding paralysis from SCI.
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Affiliation(s)
- Michael A. Petrie
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Elizabeth Faidley
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
- Department of Veterans Affairs, VA Medical Center, Iowa City, Iowa, United States of America
- * E-mail:
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Zijdewind I, Bakels R, Thomas CK. Motor unit firing rates during spasms in thenar muscles of spinal cord injured subjects. Front Hum Neurosci 2014; 8:922. [PMID: 25452723 PMCID: PMC4231945 DOI: 10.3389/fnhum.2014.00922] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/29/2014] [Indexed: 11/13/2022] Open
Abstract
Involuntary contractions of paralyzed muscles (spasms) commonly disrupt daily activities and rehabilitation after human spinal cord injury (SCI). Our aim was to examine the recruitment, firing rate modulation, and derecruitment of motor units that underlie spasms of thenar muscles after cervical SCI. Intramuscular electromyographic activity (EMG), surface EMG, and force were recorded during thenar muscle spasms that occurred spontaneously or that were triggered by movement of a shoulder or leg. Most spasms were submaximal (mean: 39%, SD: 33 of the force evoked by median nerve stimulation at 50 Hz) with strong relationships between EMG and force (R (2) > 0.69). Unit recruitment occurred over a wide force range (0.2-103% of 50 Hz force). Significant unit rate modulation occurred during spasms (frequency at 25% maximal force: 8.8 Hz, 3.3 SD; at maximal force: 16.1 Hz, 4.1 SD). Mean recruitment frequency (7.1 Hz, 3.2 SD) was significantly higher than derecruitment frequency (5.4 Hz, 2.4 SD). Coactive unit pairs that fired for more than 4 s showed high (R (2) > 0.7, n = 4) or low (R (2):0.3-0.7, n = 12) rate-rate correlations, and derecruitment reversals (21 pairs, 29%). Later recruited units had higher or lower maximal firing rates than lower threshold units. These discrepant data show that coactive motoneurons are drive both by common inputs and by synaptic inputs from different sources during muscle spasms. Further, thenar motoneurons can still fire at high rates in response to various peripheral inputs after SCI, supporting the idea that low maximal voluntary firing rates and forces in thenar muscles result from reduced descending drive.
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Affiliation(s)
- Inge Zijdewind
- Department Neuroscience, Medical Physiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Rob Bakels
- Department Neuroscience, Medical Physiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Christine K Thomas
- The Miami Project to Cure Paralysis, Departments of Neurological Surgery, Physiology and Biophysics, University of Miami Miller School of Medicine Miami, FL, USA
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Thomas CK, Dididze M, Martinez A, Morris RW. Identification and classification of involuntary leg muscle contractions in electromyographic records from individuals with spinal cord injury. J Electromyogr Kinesiol 2014; 24:747-54. [PMID: 25023162 DOI: 10.1016/j.jelekin.2014.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/02/2014] [Accepted: 05/30/2014] [Indexed: 11/27/2022] Open
Abstract
Involuntary muscle contractions (spasms) are common after human spinal cord injury (SCI). Our aim was to compare how well two raters independently identified and classified different types of spasms in the same electromyographic records (EMG) using predefined rules. Muscle spasms were identified by the presence, timing and pattern of EMG recorded from paralyzed leg muscles of four subjects with chronic cervical SCI. Spasms were classified as one of five types: unit, tonic, clonus, myoclonus, mixed. In 48h of data, both raters marked the same spasms most of the time. More variability in the total spasm count arose from differences between muscles (84%; within subjects) than differences between subjects (6.5%) or raters (2.6%). Agreement on spasm classification was high (89%). Differences in spasm count, and classification largely occurred when EMG was marked as a single spasm by one rater but split into multiple spasms by the other rater. EMG provides objective measurements of spasm number and type in contrast to the self-reported spasm counts that are often used to make clinical decisions about spasm management. Data on inter-rater agreement and discrepancies on muscle spasm analysis can both drive the design and evaluation of software to automate spasm identification and classification.
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Affiliation(s)
- C K Thomas
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL 33136, USA; Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA.
| | - M Dididze
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL 33136, USA
| | - A Martinez
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL 33136, USA
| | - R W Morris
- Department of Human Genetics, University of Miami, Miami, FL 33136, USA
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15
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Suresh AK, Hu X, Powers RK, Heckman CJ, Suresh NL, Rymer WZ. Changes in motoneuron afterhyperpolarization duration in stroke survivors. J Neurophysiol 2014; 112:1447-56. [PMID: 24920018 DOI: 10.1152/jn.01091.2012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hemispheric brain injury resulting from a stroke is often accompanied by muscle weakness in limbs contralateral to the lesion. In the present study, we investigated whether weakness in contralesional hand muscle in stroke survivors is partially attributable to alterations in motor unit activation, including alterations in firing rate modulation range. The afterhyperpolarization (AHP) potential of a motoneuron is a primary determinant of motoneuron firing rate. We examined differences in AHP duration in motoneurons innervating paretic and less impaired (contralateral) limb muscles of hemiparetic stroke survivors as well as in control subjects. A novel surface EMG (sEMG) electrode was used to record motor units from the first dorsal interosseous muscle. The sEMG data were subsequently decomposed to derive single-motor unit events, which were then utilized to produce interval (ISI) histograms of the motoneuron discharges. A modified version of interval death rate (IDR) analysis was used to estimate AHP duration. Results from data analyses performed on both arms of 11 stroke subjects and in 7 age-matched control subjects suggest that AHP duration is significantly longer for motor units innervating paretic muscle compared with units in contralateral muscles and in units of intact subjects. These results were supported by a coefficient of variation (CV) analysis showing that paretic motor unit discharges have a lower CV than either contralateral or control units. This study suggests that after stroke biophysical changes occur at the motoneuron level, potentially contributing to lower firing rates and potentially leading to less efficient force production in paretic muscles.
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Affiliation(s)
- Aneesha K Suresh
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois;
| | - Xiaogang Hu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois
| | - Randall K Powers
- Department of Physiology and Biophysics, University of Washington, Seattle, Washington
| | - C J Heckman
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois; Department of Physiology, Northwestern University, Chicago, Illinois; and
| | - Nina L Suresh
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois
| | - William Zev Rymer
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
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16
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D'Amico JM, Condliffe EG, Martins KJB, Bennett DJ, Gorassini MA. Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity. Front Integr Neurosci 2014; 8:36. [PMID: 24860447 PMCID: PMC4026713 DOI: 10.3389/fnint.2014.00036] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/17/2014] [Indexed: 01/08/2023] Open
Abstract
The state of areflexia and muscle weakness that immediately follows a spinal cord injury (SCI) is gradually replaced by the recovery of neuronal and network excitability, leading to both improvements in residual motor function and the development of spasticity. In this review we summarize recent animal and human studies that describe how motoneurons and their activation by sensory pathways become hyperexcitable to compensate for the reduction of functional activation of the spinal cord and the eventual impact on the muscle. Specifically, decreases in the inhibitory control of sensory transmission and increases in intrinsic motoneuron excitability are described. We present the idea that replacing lost patterned activation of the spinal cord by activating synaptic inputs via assisted movements, pharmacology or electrical stimulation may help to recover lost spinal inhibition. This may lead to a reduction of uncontrolled activation of the spinal cord and thus, improve its controlled activation by synaptic inputs to ultimately normalize circuit function. Increasing the excitation of the spinal cord with spared descending and/or peripheral inputs by facilitating movement, instead of suppressing it pharmacologically, may provide the best avenue to improve residual motor function and manage spasticity after SCI.
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Affiliation(s)
- Jessica M D'Amico
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada
| | - Elizabeth G Condliffe
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada ; Department of Biomedical Engineering, University of Alberta Edmonton, AB, Canada ; Division of Physical Medicine and Rehabilitation, University of Alberta Edmonton, AB, Canada
| | - Karen J B Martins
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Physical Education and Recreation, University of Alberta Edmonton, AB, Canada
| | - David J Bennett
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Rehabilitation Medicine, University of Alberta Edmonton, AB, Canada
| | - Monica A Gorassini
- Centre for Neuroscience, University of Alberta Edmonton, AB, Canada ; Faculty of Medicine and Dentistry, University of Alberta Edmonton, AB, Canada ; Department of Biomedical Engineering, University of Alberta Edmonton, AB, Canada
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17
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Winslow J, Martinez A, Thomas CK. Automatic identification and classification of muscle spasms in long-term EMG recordings. IEEE J Biomed Health Inform 2014; 19:464-70. [PMID: 24801733 DOI: 10.1109/jbhi.2014.2320633] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spinal cord injured (SCI) individuals may be afflicted by spasticity, a condition in which involuntary muscle spasms are common. EMG recordings can be analyzed to quantify this symptom of spasticity but manual identification and classification of spasms are time consuming. Here, an algorithm was created to find and classify spasm events automatically within 24-h recordings of EMG. The algorithm used expert rules and time-frequency techniques to classify spasm events as tonic, unit, or clonus spasms. A companion graphical user interface (GUI) program was also built to verify and correct the results of the automatic algorithm or manually defined events. Eight channel EMG recordings were made from seven different SCI subjects. The algorithm was able to correctly identify an average (±SD) of 94.5 ± 3.6% spasm events and correctly classify 91.6 ± 1.9% of spasm events, with an accuracy of 61.7 ± 16.2%. The accuracy improved to 85.5 ± 5.9% and the false positive rate decreased to 7.1 ± 7.3%, respectively, if noise events between spasms were removed. On average, the algorithm was more than 11 times faster than manual analysis. Use of both the algorithm and the GUI program provide a powerful tool for characterizing muscle spasms in 24-h EMG recordings, information which is important for clinical management of spasticity.
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18
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Thomas CK, Grumbles RM. Age at spinal cord injury determines muscle strength. Front Integr Neurosci 2014; 8:2. [PMID: 24478643 PMCID: PMC3899581 DOI: 10.3389/fnint.2014.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022] Open
Abstract
As individuals with spinal cord injury (SCI) age they report noticeable deficits in muscle strength, endurance and functional capacity when performing everyday tasks. These changes begin at ~45 years. Here we present a cross-sectional analysis of paralyzed thenar muscle and motor unit contractile properties in two datasets obtained from different subjects who sustained a cervical SCI at different ages (≤46 years) in relation to data from uninjured age-matched individuals. First, completely paralyzed thenar muscles were weaker when C6 SCI occurred at an older age. Muscles were also significantly weaker if the injury was closer to the thenar motor pools (C6 vs. C4). More muscles were strong (>50% uninjured) in those injured at a younger (≤25 years) vs. young age (>25 years), irrespective of SCI level. There was a reduction in motor unit numbers in all muscles tested. In each C6 SCI, only ~30 units survived vs. 144 units in uninjured subjects. Since intact axons only sprout 4-6 fold, the limits for muscle reinnervation have largely been met in these young individuals. Thus, any further reduction in motor unit numbers with time after these injuries will likely result in chronic denervation, and may explain the late-onset muscle weakness routinely described by people with SCI. In a second dataset, paralyzed thenar motor units were more fatigable than uninjured units. This gap widened with age and will reduce functional reserve. Force declines were not due to electromyographic decrements in either group so the site of failure was beyond excitation of the muscle membrane. Together, these results suggest that age at SCI is an important determinant of long-term muscle strength, and fatigability, both of which influence functional capacity.
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Affiliation(s)
- Christine K. Thomas
- The Miami Project to Cure Paralysis, University of Miami Miller School of MedicineMiami, FL, USA
- Department of Neurological Surgery, University of Miami Miller School of MedicineMiami, FL, USA
- Department of Physiology and Biophysics, University of Miami Miller School of MedicineMiami, FL, USA
| | - Robert M. Grumbles
- The Miami Project to Cure Paralysis, University of Miami Miller School of MedicineMiami, FL, USA
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19
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Thomas CK, Bakels R, Klein CS, Zijdewind I. Human spinal cord injury: motor unit properties and behaviour. Acta Physiol (Oxf) 2014; 210:5-19. [PMID: 23901835 DOI: 10.1111/apha.12153] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/31/2013] [Accepted: 07/29/2013] [Indexed: 01/03/2023]
Abstract
Spinal cord injury (SCI) results in widespread variation in muscle function. Review of motor unit data shows that changes in the amount and balance of excitatory and inhibitory inputs after SCI alter management of motoneurons. Not only are units recruited up to higher than usual relative forces when SCI leaves few units under voluntary control, the force contribution from recruitment increases due to elevation of twitch/tetanic force ratios. Force gradation and precision are also coarser with reduced unit numbers. Maximal unit firing rates are low in hand muscles, limiting voluntary strength, but are low, normal or high in limb muscles. Unit firing rates during spasms can exceed voluntary rates, emphasizing that deficits in descending drive limit force production. SCI also changes muscle properties. Motor unit weakness and fatigability seem universal across muscles and species, increasing the muscle weakness that arises from paralysis of units, motoneuron death and sensory impairment. Motor axon conduction velocity decreases after human SCI. Muscle contractile speed is also reduced, which lowers the stimulation frequencies needed to grade force when paralysed muscles are activated with patterned electrical stimulation. This slowing does not necessarily occur in hind limb muscles after cord transection in cats and rats. The nature, duration and level of SCI underlie some of these species differences, as do variations in muscle function, daily usage, tract control and fibre-type composition. Exploring this diversity is important to promote recovery of the hand, bowel, bladder and locomotor function most wanted by people with SCI.
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Affiliation(s)
- C. K. Thomas
- The Miami Project to Cure Paralysis, Departments of Neurological Surgery, and Physiology and Biophysics; University of Miami; Miami FL USA
| | - R. Bakels
- Department of Neuroscience; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - C. S. Klein
- Rehabilitation Institute of Chicago; Chicago IL USA
| | - I. Zijdewind
- Department of Neuroscience; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
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20
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Motoneurone afterhyperpolarisation time-course following stroke. Clin Neurophysiol 2013; 125:544-51. [PMID: 24074627 DOI: 10.1016/j.clinph.2013.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Our aim was to investigate any changes in the estimated time-course of the afterhyperpolarisation (AHP) in motoneurones innervating the tibialis anterior following stroke, with a secondary objective to compare the results from two different AHP estimation techniques. METHODS Motor units from tibialis anterior on the paretic and non-paretic sides of 15 subjects with chronic stroke were recorded using intramuscular electrodes during voluntary isometric contraction. Participants varied the motor unit firing rate from its lowest rate to approximately 10 Hz. The AHP duration was estimated using the interval death rate (IDR) and transition point methods. RESULTS The AHP decay time-constant was significantly different between sides (paretic: 41.7 ± 8.5 ms, non-paretic: 36.2 ± 6.4 ms). Additionally, the paretic AHP time-constant was significantly longer in participants with low motor recovery (45.9 ± 9.1 ms) than with high motor recovery (39.3 ± 10.0 ms) as measured by CMSA score. The AHP estimates from the two techniques were correlated (r=0.78). CONCLUSIONS The AHP time-course prolongation on the paretic side of people with chronic stroke is more pronounced in people with low motor recovery. SIGNIFICANCE Changes in the motoneurone AHP time course post-stroke were related to muscle function and may play a role in the commonly-observed reduction of motor unit discharge rate during voluntary contractions following stroke.
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21
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Torres-Torrelo J, Rodríguez-Rosell D, Nunez-Abades P, Carrascal L, Torres B. Glutamate modulates the firing rate in oculomotor nucleus motoneurons as a function of the recruitment threshold current. J Physiol 2012; 590:3113-27. [PMID: 22570384 DOI: 10.1113/jphysiol.2011.226985] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Studies in alert preparations have demonstrated that ocular motoneurons exhibit a phasic–tonic firing rate related to eye velocity and position, respectively. The slopes of these relationships are higher in motoneurons with higher recruitment threshold and have been proposed to depend upon synaptic input. To investigate this hypothesis, motoneurons of the rat oculomotor nucleus were recorded in a brain slice preparation in control conditions and during glutamate (5 μm) application to the bath. Glutamate did not affect membrane potential or input resistance, but produced a decrease in rheobase and depolarization voltage as a function of the current needed for generating a maintained repetitive discharge (recruitment threshold current). In addition, glutamate compressed the range of recruitment threshold current (0.1–0.4 nA) as compared to the control (0.15–0.7 nA). Glutamate exposed motoneurons showed an increase in the tonic frequency gain and the peak frequency. Such increments depended on the recruitment threshold current and the last recruited motoneurons almost doubled the tonic frequency gain (35.2 vs. 57.9 spikes s(−1) nA(−1)) and the peak frequency (52.4 vs. 102.6 spikes s(−1)). Finally, glutamate increased the spike frequency adaptation due to a significant increase in the phasic firing component as compared to the tonic one. In conclusion, glutamate modulates tonic and phasic discharge properties as a function of the recruitment threshold current and, presumably, motoneuron size. These findings contribute to understand the link between cellular functions and motoneuron discharge during oculomotor behaviour.
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Maria P, Lydia K, Jia-Jin JC, Irena HP. Assessment of Human Motoneuron Afterhyperpolarization Duration in Health and Disease. Biocybern Biomed Eng 2012. [DOI: 10.1016/s0208-5216(12)70041-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Winslow J, Dididze M, Thomas CK. Automatic classification of motor unit potentials in surface EMG recorded from thenar muscles paralyzed by spinal cord injury. J Neurosci Methods 2009; 185:165-77. [PMID: 19761794 PMCID: PMC2904617 DOI: 10.1016/j.jneumeth.2009.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 08/06/2009] [Accepted: 09/08/2009] [Indexed: 10/20/2022]
Abstract
Involuntary electromyographic (EMG) activity has only been analyzed in the paralyzed thenar muscles of spinal cord injured (SCI) subjects for several minutes. It is unknown if this motor unit activity is ongoing. Longer duration EMG recordings can investigate the biological significance of this activity. Since no software is currently capable of classifying 24h of EMG data at a single motor unit level, the goal of this research was to devise an algorithm that would automatically classify motor unit potentials by tracking the firing behavior of motor units over 24h. Two channels of thenar muscle surface EMG were recorded over 24h from seven SCI subjects with a chronic cervical level injury using a custom data logging device with custom software. The automatic motor unit classification algorithm developed here employed multiple passes through these 24-h EMG recordings to segment, cluster, form global templates and classify motor unit potentials, including superimposed potentials. The classification algorithm was able to track an average of 19 global classes in seven 24-h recordings with a mean (+/-SE) accuracy of 89.9% (+/-0.98%) and classify potentials from these individual motor units with a mean accuracy of 90.3% (+/-0.97%). The algorithm could analyze 24h of data in 2-3 weeks with minimal input from a person, while a human operator was estimated to take more than 2 years. This automatic method could be applied clinically to investigate the fasciculation potentials often found in motoneuron disorders such as amyotrophic lateral sclerosis.
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Affiliation(s)
- Jeffrey Winslow
- The Miami Project to Cure Paralysis, University of Miami MILLER School of Medicine, 1095 NW 14 Terrace, R48, Miami, FL, 33136 USA
- Department of Biomedical Engineering, University of Miami, P.O. Box 248294, Coral Gables, FL, 33124 USA
| | - Marina Dididze
- The Miami Project to Cure Paralysis, University of Miami MILLER School of Medicine, 1095 NW 14 Terrace, R48, Miami, FL, 33136 USA
| | - Christine K Thomas
- The Miami Project to Cure Paralysis, University of Miami MILLER School of Medicine, 1095 NW 14 Terrace, R48, Miami, FL, 33136 USA
- Department of Neurological Surgery and Department of Physiology and Biophysics, University of Miami MILLER School of Medicine, Miami, FL, 33136 USA, Phone: (305)-243-7109, Fax: (305)-243-3913
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