Abdominal motor unit activity during respiratory and nonrespiratory tasks

Neurogenic mechanisms for locomotor-respiratory coordination in mammals

Central motor rhythm-generating networks controlling different functions are generally considered to operate mostly independently from one another, each controlling the specific behavioral task to which it is assigned. However, under certain physiological circumstances, central pattern generators (CPGs) can exhibit strong uni- or bidirectional interactions that render them closely inter-dependent. One of the best illustrations of such an inter-CPG interaction is the functional relationship that may occur between rhythmic locomotor and respiratory functions. It is well known that in vertebrates, lung ventilatory rates accelerate at the onset of physical exercise in order to satisfy the accompanying rapid increase in metabolism. Part of this acceleration is sustained by a coupling between locomotion and ventilation, which most often results in a periodic drive of the respiratory cycle by the locomotor rhythm. In terrestrial vertebrates, the likely physiological significance of this coordination is that it serves to reduce the mechanical interference between the two motor systems, thereby producing an energetic benefit and ultimately, enabling sustained aerobic activity. Several decades of studies have shown that locomotor-respiratory coupling is present in most species, independent of the mode of locomotion employed. The present article aims to review and discuss mechanisms engaged in shaping locomotor-respiratory coupling (LRC), with an emphasis on the role of sensory feedback inputs, the direct influences between CPG networks themselves, and finally on spinal cellular candidates that are potentially involved in the coupling of these two vital motor functions.

Clinimetric properties of the pressure biofeedback unit method for estimating respiratory pressures

OBJECTIVE

The Pressure Biofeedback Unit (PBU) is used to assess the transversus abdominis muscle activity in order to determine the effectiveness of segmental stabilization, but not to verify its accuracy for measuring the pressure values of breathing from transversus abdominis activation. The objective of this study was to cross-validate the PBU pressure evaluated in transversus abdominis muscle activation with the respiratory pressure assessed through manovacuometry in order to verify the extent to which the PBU can be used to indirectly evaluate the strength of the respiratory muscle in both men and women and verify the reliability of the methods.

PARTICIPANTS

A total of 39 healthy subjects.

METHODS

Manovacuometry and Pressure Biofeedback Unit tests were performed in three days each with three replications: 1) Maximal Inspiratory Pressure; 2) Maximal Expiratory Pressure; and 3) Pressure Biofeedback Unit.

RESULTS

Both tests showed good reliability and low correlation between the Pressure Biofeedback Unit and Maximal Inspiratory Pressure (r = 0.40; p = 0.01) and Maximal Expiratory Pressure (r = 0.33; p = 0.04). High differences were observed between pressures and wide limits of agreement in Bland-Altman analysis.

CONCLUSION

It seems that the Pressure Biofeedback Unit is not able to effectively predict the respiratory muscles' strength as routinely evaluated through the use of the manovacuometry presenting a low cross-validation and good reliability.

Bimodal Respiratory-Locomotor Neurons in the Neonatal Rat Spinal Cord

Neural networks that can generate rhythmic motor output in the absence of sensory feedback, commonly called central pattern generators (CPGs), are involved in many vital functions such as locomotion or respiration. In certain circumstances, these neural networks must interact to produce coordinated motor behavior adapted to environmental constraints and to satisfy the basic needs of an organism. In this context, we recently reported the existence of an ascending excitatory influence from lumbar locomotor CPG circuitry to the medullary respiratory networks that is able to depolarize neurons of the parafacial respiratory group during fictive locomotion and to subsequently induce an increased respiratory rhythmicity (Le Gal et al., 2014b). Here, using an isolated in vitro brainstem-spinal cord preparation from neonatal rat in which the respiratory and the locomotor networks remain intact, we show that during fictive locomotion induced either pharmacologically or by sacrocaudal afferent stimulation, the activity of both thoracolumbar expiratory motoneurons and interneurons is rhythmically modulated with the locomotor activity. Completely absent in spinal inspiratory cells, this rhythmic pattern is highly correlated with the hindlimb ipsilateral flexor activities. Furthermore, silencing brainstem neural circuits by pharmacological manipulation revealed that this locomotor-related drive to expiratory motoneurons is solely dependent on propriospinal pathways. Together these data provide the first evidence in the newborn rat spinal cord for the existence of bimodal respiratory-locomotor motoneurons and interneurons onto which both central efferent expiratory and locomotor drives converge, presumably facilitating the coordination between the rhythmogenic networks responsible for two different motor functions. Significance statement: In freely moving animals, distant regions of the brain and spinal cord controlling distinct motor acts must interact to produce the best adapted behavioral response to environmental constraints. In this context, it is well established that locomotion and respiration must to be tightly coordinated to reduce muscular interferences and facilitate breathing rate acceleration during exercise. Here, using electrophysiological recordings in an isolated in vitro brainstem-spinal cord preparation from neonatal rat, we report that the locomotor-related signal produced by the lumbar central pattern generator for locomotion selectively modulates the intracellular activity of spinal respiratory neurons engaged in expiration. Our results thus contribute to our understanding of the cellular bases for coordinating the rhythmic neural circuitry responsible for different behaviors.

Autologous dermal grafts for rectus sheath reconstruction and application in closure of ventral myofascial defects

Ventral abdominal hernias pose a reconstructive challenge, with recurrence rates after primary closure exceeding 50 % and synthetic options at high risk for infection. We describe our experience with using autologous dermis, sourced from the redundant overlying abdominal skin, for reconstruction of ventral abdominal wall defects. We describe the surgical technique, applied anatomy and an analysis of short- and long-term outcomes. Twelve consecutive patients undergoing repair of medium-large size, reducible abdominal wall defects were recruited. The dermal graft technique was used in each case, utilizing an autologous running strip of abdominal skin for reconstruction. Both short- and long-term outcomes were assessed prospectively. Scores were given on a scale of 1-10, with 1 = least/worst and 10 = most/best. The described technique was successfully undertaken in all patients. Long-term follow-up demonstrated a 100 % resumption of normal activities, with an improvement in quality of life and physical activity scores postoperatively, and no recurrences. Short-term complications were notable, with five patients requiring postoperative intensive care unit admission, and seven patients requiring respiratory support. In conclusion, the use of autologous rectus sheath reinforcement may achieve good surgical outcomes and high patient satisfaction. While early respiratory complications should be noted, the potential utility of this technique is worthy of future investigation.

Control of the lateral abdominal muscles during walking

Transversus abdominis (TA), obliquus internus (OI), and obliquus externus (OE) are involved in multiple functions: breathing, control of trunk orientation, and stabilization of the pelvis and spine. How these functions are coordinated has received limited attention. We studied electromyographic (EMG) activity of right-sided muscles and 3-dimensional moments during treadmill walking at six different speeds (1.4-5.4 km/h) in sixteen healthy young women. PCA revealed time series of trunk moments to be consistent across speeds and subjects though somewhat less in the sagittal plane. All three muscles were active during ≥75% of the stride cycle, indicative of a stabilizing function. Clear phasic modulations were observed, with TA more active during ipsilateral, and OE during contralateral swing, while OI activity was largely symmetrical. Fourier analysis revealed four main frequencies in muscle activity: respiration, stride frequency, step frequency, and a triphasic pattern. With increasing speed, the absolute power of all frequencies remained constant or increased; the relative power of respiration and stride-related activities decreased, while that of step-related activity and the triphasic pattern increased. Effects of speed were gradual, and EMG linear envelopes had considerable common variance (>70%) across speeds within subjects, suggesting that the same functions were performed at all speeds. Maximum cross-correlations between moments and muscle activity were 0.2-0.6, and further analyses in the time domain revealed both simultaneous and consecutive task execution. To deal with conflicting constraints, the activity of the three muscles was clearly coordinated, with co-contraction of antagonists to offset unwanted mechanical side-effects of each individual muscle.

Activities of human genioglossus motor units

Upper airway muscles play an important role in regulating airway lumen and in increasing the ability of the pharynx to remain patent in the face of subatmospheric intraluminal pressures produced during inspiration. Due to the considerable technical challenges associated with recording from muscles of the upper airway, much of the experimental work conducted in human subjects has centered on recording respiratory-related activities of the extrinsic tongue protudor muscle, the genioglossus (GG). The GG is one of eight muscles that invest the human tongue (Abd-El-Malek, 1939). All eight muscles are innervated by the hypoglossal nerve (cranial nerve XII) the cell bodies of which are located in the hypoglossal motor nucleus (HMN) of the caudal medulla. Much of the earlier work on the respiratory-related activity of XII motoneurons was based on recordings obtained from single motor axons dissected from the whole XII nerve or from whole muscle GG EMG recordings. Detailed information regarding respiratory-related GG motor unit activities was lacking until as recently as 2006. This paper examines key findings that have emerged from the last decade of work conducted in human subjects. Wherever appropriate, these results are compared with results obtained from in vitro and in vivo studies conducted in non-human mammals. The review is written with the objective of facilitating some discussion and some new thoughts regarding future research directions. The material is framed around four topics: (a) motor unit type, (b) rate coding and recruitment, (c) motor unit activity patterns, and (d) a compartment based view of pharyngeal airway control.

The effect of resisted inspiration during an active straight leg raise in pain-free subjects

Alterations of respiratory patterns have been observed in pelvic girdle pain subjects during the active straight leg raise (ASLR). This study investigated how pain-free subjects coordinate motor control during an ASLR when this task is complicated by the addition of a respiratory challenge. Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR, breathing with inspiratory resistance (IR) and ASLR+IR. Subjects responded to ASLR+IR with an increase in the motor activation in the abdominal wall and chest wall compared to when ASLR and IR were performed in isolation. Activation of obliquus internus abdominis was greater on the side of the leg lift during the ASLR+IR, in comparison to symmetrical activation observed in the other abdominal wall muscles. The incremental increase of motor activity was associated with greater intra-abdominal pressure baseline shift when lifting the leg during ASLR+IR compared to ASLR. Individual variation was apparent in the form of the motor control patterns, mostly reflected in variable respiratory activation of the abdominal wall. The findings highlight the flexibility of the neuromuscular system in adapting to simultaneous respiratory and stability demands.

Drive to the human respiratory muscles

The motor control of the respiratory muscles differs in some ways from that of the limb muscles. Effectively, the respiratory muscles are controlled by at least two descending pathways: from the medulla during normal quiet breathing and from the motor cortex during behavioural or voluntary breathing. Neurophysiological studies of single motor unit activity in human subjects during normal and voluntary breathing indicate that the neural drive is not uniform to all muscles. The distribution of neural drive depends on a principle of neuromechanical matching. Those motoneurones that innervate intercostal muscles with greater mechanical advantage are active earlier in the breath and to a greater extent. Inspiratory drive is also distributed differently across different inspiratory muscles, possibly also according to their mechanical effectiveness in developing airway negative pressure. Genioglossus, a muscle of the upper airway, receives various types of neural drive (inspiratory, expiratory and tonic) distributed differentially across the hypoglossal motoneurone pool. The integration of the different inputs results in the overall activity in the muscle to keep the upper airway patent throughout respiration. Integration of respiratory and non-respiratory postural drive can be demonstrated in respiratory muscles, and respiratory drive can even be observed in limb muscles under certain circumstances. Recordings of motor unit activity from the human diaphragm during voluntary respiratory tasks have shown that depending on the task there can be large changes in recruitment threshold and recruitment order of motor units. This suggests that descending drive across the phrenic motoneurone pool is not necessarily consistent. Understanding the integration and distribution of drive to respiratory muscles in automatic breathing and voluntary tasks may have implications for limb motor control.

Structural and Functional Anatomy of the Abdominal Wall

Multiple options exist for managing complex abdominal wall defects. These options range from the use of autologous tissue with rearrangement procedures to the use of prosthetic or bioprosthetic materials. All options rely on a thorough understanding of the structural and functional anatomy of the abdominal wall and the relationship of varying anatomical structures to provide the optimal reconstructive procedure. A successful reconstruction is achieved when the structural anatomy is integrated with understanding the dynamic function of the abdominal wall.

Cutaneous stimulation from patella tape causes a differential increase in vasti muscle activity in people with patellofemoral pain

Patella taping reduces pain in individuals with patellofemoral pain (PFP), although the mechanism remains unclear. One possibility is that patella taping modifies vasti muscle activity via stimulation of cutaneous afferents. The aim of this study was to investigate the effect of stretching the skin over the patella on vasti muscle activity in people with PFP. Electromyographic activity (EMG) of individual motor units in vastus medialis obliquus (VMO) was recorded via a needle electrode and from surface electrodes placed over VMO and vastus lateralis (VL). A tape was applied to the skin directly over the patella and stretch was applied via the tape in three directions, while subjects maintained a gentle isometric knee extension effort at constant force. Recordings were made from five separate motor units in each direction. Stretch applied to the skin over the patella increased VMO surface EMG and was greatest with lateral stretch. There was no change in VL surface EMG activity. While there was no net increase in motor unit firing rate, it was increased in the majority of motor units during lateral stretch. Application of stretch to the skin over VMO via the tape can increase VMO activity, suggesting that cutaneous stimulation may be one mechanism by which patella taping produces a clinical effect.

Hypaxial muscle activity during running and breathing in dogs

The axial muscles of terrestrial vertebrates serve two potentially conflicting functions, locomotion and lung ventilation. To differentiate the locomotor and ventilatory functions of the hypaxial muscles in mammals, we examined the locomotor and ventilatory activity of the trunk muscles of trotting dogs under two conditions: when the ventilatory cycle and the locomotor cycle were coupled and when they were uncoupled. Patterns of muscle-activity entrainment with locomotor and ventilatory events revealed (i)that the internal and external abdominal oblique muscles performed primarily locomotor functions during running yet their activity was entrained to expiration when the dogs were standing, (ii) that the internal and external intercostal, external oblique thoracic and transversus abdominis muscles performed both locomotor and respiratory functions simultaneously, (iii) that the parasternal internal intercostal muscle performed a primarily respiratory function (inspiration) and (iv) that the deep pectoralis and longissimus dorsi muscles performed only locomotor functions and were not active while the dogs were standing still. We conclude that the dual function of many hypaxial muscles may produce functional conflicts during running. The redundancy and complexity of the respiratory musculature as well as the particular pattern of respiratory—locomotor coupling in quadrupedal mammals may circumvent these conflicts or minimize their impact on respiration.

Transneuronal tracing of neural pathways controlling abdominal musculature in the ferret

Abdominal musculature participates in generating a large number of behaviors and protective reflexes, although each abdominal muscle is frequently activated differentially during particular motor responses. For example, rectus abdominis has been reported to play less of a role in respiration than other abdominal muscles, such as transversus abdominis. In the present study, the inputs to transversus abdominis and rectus abdominis motoneurons were determined and compared using the transneuronal transport of two recombinant isogenic strains of pseudorabies virus. After a 5-day post-inoculation period, infected presumed motoneurons were observed principally in cord levels T10-T15 ipsilateral to the injections. The injection of a monosynaptic tracer, beta-cholera toxin, into transversus abdominis confirmed the distribution of motoneurons innervating this muscle. In the brainstem, neurons transneuronally infected following injection of pseudorabies virus into rectus abdominis or transversus abdominis were located in the same regions, which included the medial medullary reticular formation, the medullary raphe nuclei, and nucleus retroambiguus (the expiration region of the caudal ventral respiratory group). Double-labeled cells providing inputs to both rectus and transversus motoneurons were present in both the medial medullary reticular formation and nucleus retroambiguus. These data show that the medial medullary reticular formation contains neurons influencing the activity of multiple abdominal muscles, and support our hypothesis that this region globally affects the excitability of motoneurons involved in respiration.

Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm

In humans, when the stability of the trunk is challenged in a controlled manner by repetitive movement of a limb, activity of the diaphragm becomes tonic but is also modulated at the frequency of limb movement. In addition, the tonic activity is modulated by respiration. This study investigated the mechanical output of these components of diaphragm activity. Recordings were made of costal diaphragm, abdominal, and erector spinae muscle electromyographic activity; intra-abdominal, intrathoracic, and transdiaphragmatic pressures; and motion of the rib cage, abdomen, and arm. During limb movement the diaphragm and transversus abdominis were tonically active with added phasic modulation at the frequencies of both respiration and limb movement. Activity of the other trunk muscles was not modulated by respiration. Intra-abdominal pressure was increased during the period of limb movement in proportion to the reactive forces from the movement. These results show that coactivation of the diaphragm and abdominal muscles causes a sustained increase in intra-abdominal pressure, whereas inspiration and expiration are controlled by opposing activity of the diaphragm and abdominal muscles to vary the shape of the pressurized abdominal cavity.

Discharge properties and recruitment of human diaphragmatic motor units during voluntary inspiratory tasks

1. The behaviour of inspiratory motoneurones is poorly understood in humans and even for limb muscles there are few studies of motoneurone behaviour under concentric conditions. The current study assessed the discharge properties of the human phrenic motoneurones during a range of non-isometric voluntary contractions. 2. We recorded activity from 60 motor units in the costal diaphragm of four subjects using an intramuscular electrode while subjects performed a set of voluntary inspiratory contractions. These included a range of inspiratory efforts above and below the usual tidal range: breaths of different sizes (5-40 % vital capacity, VC) at a constant inspiratory flow (5 % VC s-1) and breaths of a constant size (20 % VC) at different inspiratory flows (2.5-20 % VC s-1). 3. For all the voluntary tasks, motor units were recruited throughout inspiration. For the various tasks, half-way through inspiration, 61-87 % of the sampled motor units had been recruited. 4. When the inspiratory task was deliberately altered, most single motor units began their discharge at a particular volume even when the rate of contraction had altered. 5. The initial firing frequency (median, 6.5 Hz) was consistent for tasks with a constant flow regardless of the size of the breath. However, for breaths of a constant size the initial firing frequencies increased as the inspiratory flow increased (range across tasks, 4.8-9.3 Hz). The 'final' firing frequency at the end of inspiration increased significantly above the initial frequency for each task (by 0.8-5.2 Hz) and was higher for those tasks with higher final lung volumes and higher inspiratory flows (range across tasks, 7.8-11.0 Hz). 6. There was no correlation within a task between the time of recruitment and the initial or final firing frequency for each motor unit. However, for each inspiratory task, initial and final firing frequencies were positively correlated. 7. Because the discharge of three to four units could be recorded simultaneously in a range of tasks, a quantitative 'shuffle' index was developed to describe changes in their recruitment order. Recruitment order was invariant in the task with the slowest inspiratory flow, but varied slightly, but significantly, in tasks with higher inspiratory flows. 8. The discharge rates of single motor units were compared for targeted voluntary breaths and non-targeted involuntary breaths which were matched for size. There were no significant differences in the initial or final firing frequencies, but recruitment order was not always the same in the two types of breath.

Is there a role for transversus abdominis in lumbo-pelvic stability?

There has been considerable interest in the literature regarding the function of transversus abdominis, the deepest of the abdominal muscles, and the clinical approach to training this muscle. With the development of techniques for the investigation of this muscle involving the insertion of fine-wire electromyographic electrodes under the guidance of ultrasound imaging it has been possible to test the hypotheses related to its normal function and function in people with low back pain. The purpose of this review is to provide an appraisal of the current evidence for the role of transversus abdominis in spinal stability, to develop a model of how the contribution of this muscle differs from the other abdominal muscles and to interpret these findings in terms of the consequences of changes in this function.