Neural mechanisms of intermuscular coherence: implications for the rectification of surface electromyography

Corticomuscular and intermuscular coherence as a function of age and walking balance difficulty

We determined beta-band intermuscular (IMC) and corticomuscular coherence (CMC) as a function of age and walking balance difficulty. Younger (n=14, 23y) and older individuals (n=19, 71y) walked 13 m overground, on a 6-cm-wide ribbon overground, and on a 6-cm-wide (5-cm-high) beam. Walking distance as a proxy for walking balance and speed were computed. CMC was estimated between electroencephalographic signal at Cz electrode and surface electromyographic signals of seven leg muscles, while IMC was calculated in four pairs of leg muscles, during stance and swing gait phases. With increasing difficulty, walking balance decreased in old individuals and speed decreased gradually independent of age. Beam walking increased IMC, while age increased IMC in proximal muscle pairs, and decreased IMC in distal muscle pairs. Age and difficulty increased CMC independent of gait phases. Concluding, CMC and IMC increased with walking balance difficulty and age, except for distal muscle pairs, which had lower IMC with age. These findings suggest an age-related increase in corticospinal involvement in the neural control of walking balance. DATA AVAILABILITY: The datasets used in this study are available from the corresponding author upon reasonable request.

EMG coherence of foot and ankle muscles increases with a postural challenge in men

BACKGROUND

The functional role of intrinsic foot muscles in the control of standing balance is often overlooked in rehabilitation, partly because the interactions with ankle muscles are poorly understood.

RESEARCH QUESTION

How does coactivation of Flexor Digitorum Brevis (FDB) and soleus (SOL) vary across standing tasks of increasing difficulty.

METHODS

Postural sway (Centre of Pressure, CoP) and the electromyographic (EMG) activity of FDB, SOL, Medial Gastrocnemius (MG) and Tibialis Anterior (TA) were measured during bipedal standing, tandem stance, one-legged balance, and standing on toes. Coherence of the rectified EMG signals for SOL and FDB in two bandwidths (0-5 and 10-20 Hz) was calculated as a coactivation index.

RESULTS AND SIGNIFICANCE

The CoP sway and the EMG activity of all muscles was greater (P<0.05) for the three difficult tasks. Significant coherence between the SOL and FDB EMG activity was found in both frequency regions: 0-5 and 10-20 Hz. The coherence integral increased with the difficulty of the postural task, especially in the 10-20 Hz band. The findings underscore the important role of FDB in the control of standing balance across tasks and its coactivation with SOL. Clinical recommendations to improve balance control need to consider the interaction between the plantar flexor and intrinsic-foot muscles.

Added load increases the peak frequency of intermuscular coherence

Cortical motor neuron activity appears to drive lower motor neurons through two distinct frequency bands: the β range (15-30 Hz) during weak muscle contractions and γ range (30-50 Hz) during strong contractions. It is unknown whether the frequency of cortical drive shifts continuously or abruptly between the β and γ frequency bands as contraction strength changes. Intermuscular coherence (IMC) between synergistic arm muscles was used to assess how the frequency of common neuronal drive shifts with increasing contraction strength. Muscle activity was recorded by surface electromyography (EMG) from the biceps and brachioradialis in nine healthy adults performing 30-second isometric holds with added loads. IMC was calculated across the two muscle groups during the isometric contraction. Significant IMC was present in the 20 to 50 Hz range with all loads. Repeated measures ANOVA show the peak frequency of IMC increased significantly when load was added, from a peak of 32.7 Hz with no added load, to 35.3 Hz, 35.7 Hz, and 36.3 Hz with three-, five-, and ten-pound loads respectively. An increase in IMC frequency occurs in response to added load, suggesting that cortical drive functions over a range of frequencies as a function of an isometric contraction against load.

Techniques for Registration of Myoelectric Activity of Women's Pelvic Floor Muscles: A Scoping Review

INTRODUCTION AND HYPOTHESIS

Surface electromyography is commonly applied to measure the electrophysiological activity of the neuromuscular system. However, there is no consensus regarding the best protocol to assess pelvic floor muscles.

METHODS

A scoping literature review was carried out in six databases, using MeSH descriptors. It included studies with electromyographic assessment in adult women presenting or not with pelvic floor dysfunction. The results were presented in categories to contribute to the development of a protocol considering the most used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.

RESULTS

A total of 1,074 articles were identified, and 146 studies were selected for analysis. The intravaginal probe was used in 80.8% of the studies, the bipolar sensor with metallic plates placed on both sides of the vagina was the most frequent (71.3%), with a reference electrode positioned on the anterior superior iliac spine (33.5%). The supine position with hip and knee flexed (45.2%) was the most frequent position used. Of the studies, 44.5% normalized the data by maximum voluntary contraction (MVC) whereas 44.5% performed an average of 3 MVCs.

CONCLUSIONS

The most frequently used protocol for the pelvic floor is the bipolar intracavitary probe with metal plates positioned at 3-9 o'clock and introduced distally to the vaginal introitus with the volunteer in the supine position and the hip and knee flexed with the reference placed on the anterior-superior iliac spine.

Dopamine improves defective cortical and muscular connectivity during bilateral control of gait in Parkinson's disease

Parkinson's Disease (PD)-typical declines in gait coordination are possibly explained by weakness in bilateral cortical and muscular connectivity. Here, we seek to determine whether this weakness and consequent decline in gait coordination is affected by dopamine levels. To this end, we compare cortico-cortical, cortico-muscular, and intermuscular connectivity and gait outcomes between body sides in people with PD under ON and OFF medication states, and in older adults. In our study, participants walked back and forth along a 12 m corridor. Gait events (heel strikes and toe-offs) and electrical cortical and muscular activities were measured and used to compute cortico-cortical, cortico-muscular, and intermuscular connectivity (i.e., coherences in the alpha, beta, and gamma bands), as well as features characterizing gait performance (e.g., the step-timing coordination, length, and speed). We observe that people with PD, mainly during the OFF medication, walk with reduced step-timing coordination. Additionally, our results suggest that dopamine intake in PD increases the overall cortico-muscular connectivity during the stance and swing phases of gait. We thus conclude that dopamine corrects defective feedback caused by impaired sensory-information processing and sensory-motor integration, thus increasing cortico-muscular coherences in the alpha bands and improving gait.

Muscle Recruitment Strategies in a Redundant Task: Age Differences Through Network Analyses

There are numerous studies comparing young and old adults in terms of muscle coordination in standard tasks (e.g., walking, reaching) and small variations of them. These tasks might hide differences: individuals would converge to similar behavior as they practice these throughout life. Also, we are unaware of studies that considered the muscle recruitment nested dynamics. For this reason, our study evaluated how young and old women coordinate and control the movement system while performing an unusual redundant motor control task through the network physiology approach. We acquired electromyographic signals from nine leg muscles of the dominant and non-dominant limbs during maximum voluntary isometric contractions (knee extension and flexion) and co-contraction bouts. Our results showed that young participants presented higher peak torque output, with similar EMG variability, compared to older participants. Considering firing rate frequencies, old and young women demonstrated different traits for network clustering and efficiency for the task. Age seems to affect muscle coordination at higher frequencies, even with a similar number of muscle synergies, indicating that younger women might have more integrated synergies than older women. The findings also point to differential muscle coordination adaptability.

Intermuscular Coherence in Spinocerebellar Ataxias 3 and 6: a Preliminary Study

Spinocerebellar ataxias (SCAs) are familial neurodegenerative diseases involving the cerebellum and spinocerebellar tracts. While there is variable involvement of corticospinal tracts (CST), dorsal root ganglia, and motor neurons in SCA3, SCA6 is characterized by a pure, late-onset ataxia. Abnormal intermuscular coherence in the beta-gamma frequency range (IMCβγ) implies a lack of integrity of CST or the afferent input from the acting muscles. We test the hypothesis that IMCβγ has the potential to be a biomarker of disease activity in SCA3 but not SCA6. Intermuscular coherence between biceps brachii and brachioradialis muscles was measured from surface EMG waveforms in SCA3 (N = 16) and SCA6 (N = 20) patients and in neurotypical subjects (N = 23). IMC peak frequencies were present in the β range in SCA patients and in the γ range in neurotypical subjects. The difference between IMC amplitudes in the γ and β ranges was significant when comparing neurotypical control subjects to SCA3 (p < 0.01) and SCA6 (p = 0.01) patients. IMCβγ amplitude was smaller in SCA3 patients compared to neurotypical subjects (p < 0.05), but not different between SCA3 and SCA6 patients or between SCA6 and neurotypical subjects. IMC metrics can differentiate SCA patients from normal controls.

Dynamics of brain-muscle networks reveal effects of age and somatosensory function on gait

Walking is a complex motor activity that requires coordinated interactions between the sensory and motor systems. We used mobile EEG and EMG to investigate the brain-muscle networks involved in gait control during overground walking in young people, older people, and individuals with Parkinson's disease. Dynamic interactions between the sensorimotor cortices and eight leg muscles within a gait cycle were assessed using multivariate analysis. We identified three distinct brain-muscle networks during a gait cycle. These networks include a bilateral network, a left-lateralized network activated during the left swing phase, and a right-lateralized network active during the right swing. The trajectories of these networks are contracted in older adults, indicating a reduction in neuromuscular connectivity with age. Individuals with the impaired tactile sensitivity of the foot showed a selective enhancement of the bilateral network, possibly reflecting a compensation strategy to maintain gait stability. These findings provide a parsimonious description of interindividual differences in neuromuscular connectivity during gait.

Control of motor output during steady submaximal contractions is modulated by contraction history

The purpose of the study was to investigate the influence of contraction history on force steadiness and the associated EMG activity during submaximal isometric contractions performed with the dorsiflexor muscles. The key feature of the protocol was a triangular ramp contraction performed in the middle of a steady contraction at a lower target force. The target force during the ramp contraction was 20% MVC greater than that during the steady contraction. Thirty-seven healthy individuals (21 men and 16 women) performed the submaximal tasks with the ankle dorsiflexors. Electromyography (EMG) signals were recorded from tibialis anterior with a pair of surface electrodes. The coefficient of variation for force was significantly greater during the second steady contraction compared with the first one at each of the seven target forces (p < 0.015; d = 0.38-0.92). Although the average applied force during the steady contractions before and after the triangular contraction was the same (p = 0.563), the mean EMG amplitude for the steady contractions performed after the triangular contraction was significantly greater at each of the seven target forces (p < 0.0001; d = 0.44-0.68). Also, there were significant differences in mean EMG frequency between the steady contractions performed before and after the triangular contraction (p < 0.01; d = 0.13-0.82), except at 10 and 20% MVC force. The greater force fluctuations during a steady submaximal contraction after an intervening triangular contraction indicate a change in the discharge characteristics of the involved motor units.

Hand and distal joint tremor are most coherent with the activity of elbow flexors and wrist extensors in persons with essential tremor

Essential tremor (ET) affects millions of people. Although frontline treatment options (medication, deep brain stimulation, and focused ultrasound ablation) have provided significant relief, many patients are unsatisfied with the outcomes. Peripheral suppression techniques, such as injections of botulinum toxin or sensory electrical stimulation of muscles, are gaining popularity, but could be optimized if the muscles most responsible for a patient's tremor were identified. The purpose of this study was to quantify the relationship between the activity in various upper limb muscles and the resulting tremor in patients with ET. Surface electromyogram (sEMG) from the 15 major superficial muscles of the upper limb and displacement of the hand and upper limb joints were recorded from 22 persons with ET while they performed kinetic and postural tasks representative of activities of daily living. We calculated the peak coherence (frequency-dependent correlation) in the tremor band (4-8 Hz) between the sEMG of each muscle and the displacement in each major degree of freedom (DOF). Averaged across subjects with ET, the highest coherence was found between elbow flexors (particularly biceps brachii and brachioradialis) and the distal DOF (forearm, wrist, and hand motion), and between wrist extensors (extensor carpi radialis and ulnaris) and the same distal DOF. These coherence values represent the upper bound on the proportion of the tremor caused by each muscle. We conclude that, without further information, elbow flexors and wrist extensors should be among the first muscles considered for peripheral suppression techniques in persons with ET.NEW & NOTEWORTHY We characterized the relationships between activity in upper limb muscles and tremor in persons with essential tremor using coherence, which provides an upper bound on the proportion of the tremor due to each muscle. Averaged across subjects and various tasks, tremor in the hand and distal joints was most coherent with elbow flexors and wrist extensors. We conclude that, without further information, these muscle groups should be among the first considered for peripheral suppression techniques.

Muscle synergies are associated with intermuscular coherence and cortico-synergy coherence in an isometric upper limb task

To elucidate the underlying physiological mechanisms of muscle synergies, we investigated long-range functional connectivity by cortico-muscular (CMC), intermuscular (IMC) and cortico-synergy (CSC) coherence. Fourteen healthy participants executed an isometric upper limb task in synergy-tuned directions. Cortical activity was recorded using 32-channel electroencephalography (EEG) and muscle activity using 16-channel electromyography (EMG). Using non-negative matrix factorisation (NMF), we calculated muscle synergies from two different tasks. A preliminary multidirectional task was used to identify synergy-preferred directions (PDs). A subsequent coherence task, consisting of generating forces isometrically in the synergy PDs, was used to assess the functional connectivity properties of synergies. Overall, we were able to identify four different synergies from the multidirectional task. A significant alpha band IMC was consistently present in all extracted synergies. Moreover, IMC alpha band was higher between muscles with higher weights within a synergy. Interestingly, CSC alpha band was also significantly higher across muscles with higher weights within a synergy. In contrast, no significant CMC was found between the motor cortex area and synergy muscles. The presence of a shared input onto synergistic muscles within a synergy supports the idea of neurally derived muscle synergies that build human movement. Our findings suggest cortical modulation of some of the synergies and the consequential existence of shared input between muscles within cortically modulated synergies.

Intermuscular Coherence during Quiet Standing in Sub-Acute Patients after Stroke: An Exploratory Study

Asymmetrically impaired standing control is a prevalent disability among stroke patients; however, most of the neuromuscular characteristics are unclear. Therefore, the main purpose of this study was to investigate between-limb differences in intermuscular coherence during quiet standing. Consequently, 15 patients who had sub-acute stroke performed a quiet standing task without assistive devices, and electromyography was measured on the bilateral tibialis anterior (TA), soleus (SL), and medial gastrocnemius (MG). The intermuscular coherence of the unilateral synergistic (SL-MG) pair and unilateral antagonist (TA-SL and TA-MG) pairs in the delta (0-5 Hz) and beta (15-35 Hz) bands were calculated and compared between the paretic and non-paretic limbs. The unilateral synergistic SL-MG coherence in the beta band was significantly greater in the non-paretic limb than in the paretic limb (p = 0.017), while unilateral antagonist TA-MG coherence in the delta band was significantly greater in the paretic limb than in the non-paretic limb (p < 0.01). During quiet standing, stroke patients showed asymmetry in the cortical control of the plantar flexor muscles, and synchronous control between the antagonistic muscles was characteristic of the paretic limb. This study identified abnormal muscle activity patterns and asymmetrical cortical control underlying impaired standing balance in patients with sub-acute stroke using an intermuscular coherence analysis.

3D muscle networks based on vibrational mechanomyography

Objective. Muscle network modeling maps synergistic control during complex motor tasks. Intermuscular coherence (IMC) is key to isolate synchronization underlying coupling in such neuromuscular control. Model inputs, however, rely on electromyography, which can limit the depth of muscle and spatial information acquisition across muscle fibers.Approach. We introduce three-dimensional (3D) muscle networks based on vibrational mechanomyography (vMMG) and IMC analysis to evaluate the functional co-modulation of muscles across frequency bands in concert with the longitudinal, lateral, and transverse directions of muscle fibers. vMMG is collected from twenty subjects using a bespoke armband of accelerometers while participants perform four hand gestures. IMC from four superficial muscles (flexor carpi radialis, brachioradialis, extensor digitorum communis, and flexor carpi ulnaris) is decomposed using matrix factorization into three frequency bands. We further evaluate the practical utility of the proposed technique by analyzing the network responses to various sensor-skin contact force levels, studying changes in quality, and discriminative power of vMMG.Main results. Results show distinct topological differences, with coherent coupling as high as 57% between specific muscle pairs, depending on the frequency band, gesture, and direction. No statistical decrease in signal strength was observed with higher contact force.Significance. Results support the usability vMMG as a tool for muscle connectivity analyses and demonstrate the use of IMC as a new feature space for hand gesture classification. Comparison of spectrotemporal and muscle network properties between levels of force support the robustness of vMMG-based network models to variations in tissue compression. We argue 3D models of vMMG-based muscle networks provide a new foundation for studying synergistic muscle activation, particularly in out-of-clinic scenarios where electrical recording is impractical.

Increased EMG-EMG coherence in the theta and alpha bands during bimanual force modulation

During the execution of movements, error correction processes have been inferred by EEG activation at oscillation frequencies in the theta (4-8 Hz) and alpha (8-12 Hz) bands. The current study examined whether evidence for error detection and correction could be found at the muscular level through the use of EMG-EMG coherence, which quantifies the amount of synchronous EMG activity between limbs in the frequency domain. Participants (n = 13) performed a bimanual force production task involving either wrist flexors or extensors under conditions in which the force was to be held constant or continuously modulated. As predicted, the modulation of changing force output resulted in significantly greater force variability and increased EMG-EMG coherence throughout the theta and alpha band for both flexor and extensor responses. These results are consistent with EEG activation frequencies associated with error correction, motor reprogramming and sustained attention and indicate that evidence for these cortical processes can also be observed at the muscular level in the form of correlated EMG frequency content between limbs.

Pattern Matching for Real-Time Extraction of Fast and Slow Spectral Components From sEMG Signals

Previous studies have demonstrated the potential of surface electromyography (sEMG) spectral decomposition in evaluating muscle performance, motor learning, and early diagnosis of muscle conditions. However, decomposition techniques require large data sets and are computationally demanding, making their implementation in real-life scenarios challenging. Based on the hypothesis that spectral components will present low inter-subject variability, the present paper proposes the foundational principles for developing a real-time system for their extraction by utilizing a pre-defined library of components derived from an extensive data set to match new measurements. The model library was tailored to fulfill specific requirements for real-time system application and the challenges encountered during implementation are discussed in the paper. For system validation, four distinct data sets comprising isotonic and isometric muscle activations were utilized. The extracted during validation showed low inter-subject variability, suggesting that a wide range of physiological variations can be described with them. The adoption of the proposed system for muscle analysis could provide a deeper understanding of the underlying mechanisms governing different motor conditions and neuromuscular disorders, as it allows for the measurement of these components in various daily-life scenarios.

EMG-EMG coherence during voluntary control of human standing tasks: a systematic scoping review

Background

Intra- or inter-muscular (EMG-EMG) coherence is a simple and non-invasive method for estimating central nervous system control during human standing tasks. Although this research area has developed, no systematic literature review has been conducted.

Objectives

We aimed to map the current literature on EMG-EMG coherence during various standing tasks to identify the research gaps and summarize previous studies comparing EMG-EMG coherence between healthy young and elderly adults.

Methods

Electronic databases (PubMed, Cochrane Library, and CINAHL) were searched for articles published from inception to December 2021. We incorporated studies that analyzed EMG-EMG coherence of the postural muscles in various standing tasks.

Results

Finally, 25 articles fulfilled the inclusion criteria and involved 509 participants. Most participants were healthy young adults, while only one study included participants with medical conditions. There was some evidence that EMG-EMG coherence could identify differences in standing control between healthy young and elderly adults, although the methodology was highly heterogeneous.

Conclusion

The present review indicates that EMG-EMG coherence may help elucidate changes in standing control with age. In future studies, this method should be used in participants with central nervous system disorders to understand better the characteristics of standing balance disabilities.

Intermuscular coherence in spinocerebellar ataxias 3 and 6: a preliminary study

Objective : Spinocerebellar ataxias (SCAs) are familial neurodegenerative diseases involving the cerebellum and spinocerebellar tracts. While there is variable involvement of corticospinal tracts (CST), dorsal root ganglia, and motor neurons in SCA3, SCA6 is characterized by a pure, late-onset ataxia. Abnormal intermuscular coherence in the beta-gamma frequency range (IMCbg) implies lack of integrity of CST or the afferent input from the acting muscles. We test the hypothesis that IMCbg has the potential to be a biomarker of disease activity in SCA3 but not SCA6. Methods: Intermuscular coherence between biceps and brachioradialis muscles was measured from surface EMG waveforms in SCA3 (N=16) and SCA6 (N=20) patients, and in neurotypical subjects (N=23). Results: IMC peak frequencies were present in the b range in SCA patients and in the g range in neurotypical subjects. The difference between IMC amplitudes in the g and b ranges was significant when comparing neurotypical control subjects to SCA3 (p < 0.01) and SCA6 (p = 0.01) patients. IMCbg amplitude was smaller in SCA3 patients compared to neurotypical subjects (p<0.05), but not different between SCA3 and SCA6 patients or between SCA6 and neurotypical subjects. Conclusion/significance: IMC metrics can differentiate SCA patients from normal controls.

Functional electrical stimulation therapy for upper extremity rehabilitation following spinal cord injury: a pilot study

STUDY DESIGN

Pilot study.

OBJECTIVES

To examine if functional electrical stimulation therapy (FEST) improves neuromuscular factors underlying upper limb function in individuals with SCI.

SETTING

A tertiary spinal cord rehabilitation center specialized in spinal cord injury care in Canada.

METHODS

We examined 29 muscles from 4 individuals living with chronic, cervical, and incomplete SCI. The analysis was focused on the changes in muscle activation, as well as on how the treatment could change the ability to control a given muscle or on how multiple muscles would be coordinated during volitional efforts.

RESULTS

There was evidence of gains in muscle strength, activation, and median frequency after the FEST. Gains in muscle activation indicated the activation of a greater number of motor units and gains in muscle median frequency the involvement of higher threshold, faster motor units. In some individuals, these changes were smaller but accompanied by increased control over muscle contraction, evident in a greater ability to sustain a volitional contraction, reduce the co-contraction of antagonist muscles, and provide cortical drive.

CONCLUSIONS

FEST increases muscle strength and activation. Enhanced control of muscle contraction, reduced co-contraction of antagonist muscles, and a greater presence of cortical drive were some of the findings supporting the effects of FEST at the sensory-motor integration level.

Post-contraction potentiation can react inversely to post-activation potentiation depending on the test contraction force

The surface electromyographic (EMG) activity of the biceps brachii during weak elbow flexion reportedly increases immediately after strong elbow flexion, even during the exertion of a given force. This phenomenon is called post-contraction potentiation (EMG-PCP). However, the effects of test contraction intensity (TCI) on EMG-PCP remain unclear. This study evaluated PCP levels at various TCI values. Sixteen healthy participants were asked to perform a force matching task (2%, 10%, or 20% of the maximum voluntary contraction [MVC]) before (Test 1) and after (Test 2) a conditioning contraction (50% of MVC). With a 2% TCI, the EMG amplitude was higher in Test 2 than in Test 1. With a 20% TCI, the EMG amplitude was lower in Test 2 than in Test 1. Furthermore, EMG spectral analyses showed that the α- and β-band power ratios in Test 2 were enhanced by 2% TCI compared with Test 1. These findings suggest that TCI is crucial in determining the EMG-force relationship immediately after a brief intensive contraction.

Essential Tremor accentuates the pattern of tremor-band coherence between upper-limb muscles

Although Essential Tremor is one of the most common movement disorders, current treatment options are relatively limited. Peripheral tremor suppression methods have shown potential, but we do not currently know which muscles are most responsible for patients' tremor, making it difficult to optimize suppression methods. The purpose of this study was to quantify the relationships between the tremorogenic activity in muscles throughout the upper limb. Muscle activity was recorded from the 15 major superficial upper-limb muscles in 24 subjects with Essential Tremor while they held various postures or made upper-limb movements. We calculated the coherence in the tremor band (4-12 Hz) between the activity of all muscle pairs and the time-varying phase difference between sufficiently coherent muscle pairs. Overall, the observed pattern somewhat mirrored functional relationships: agonistic muscle pairs were most coherent and in phase, whereas antagonist and unrelated muscle pairs exhibited less coherence and were either consistently in phase, consistently antiphase, consistently out of phase (unrelated pairs only), or else inconsistent. Patients exhibited significantly more coherence than control subjects (p<0.001) in the vast majority of muscle pairs (95 out of 105). Furthermore, differences between patients and controls were most pronounced among agonists; thus, the coherence pattern existing in control subjects was accentuated in patients with ET. We conclude that tremor-band activity is broadly distributed among the muscles of the upper limb, challenging efforts to determine which muscles are most responsible for a patient's tremor.

The Effects of Conscious Movement Processing on the Neuromuscular Control of Posture

Maintaining balance is thought to primarily occur sub-consciously. Occasionally, however, individuals will direct conscious attention towards balance, e.g., in response to a threat to balance. Such conscious movement processing (CMP) increases the reliance on attentional resources and may disrupt balance performance. However, the underlying changes in neuromuscular control remain poorly understood. We investigated the effects of CMP (manipulated using verbal instructions) on neural control of posture in twenty-five adults (11 females, mean age = 23.9, range = 18-33). Participants performed 90-s, bipedal stance balance trials in high- and low-CMP conditions, during both stable (solid surface) and unstable (foam) task conditions. Postural sway amplitude, frequency and complexity were used to assess postural control. Surface EMG was recorded bilaterally from lower leg muscles (Soleus, Tibialis Anterior, Gastrocnemius Medialis, Peroneus Longus) and intermuscular coherence (IMC) was assessed for 12 muscle pairs across four frequency bands. We observed significantly increased sway amplitude, and decreased sway frequency and complexity in the high- compared to the low-CMP conditions. All sway variables increased in the unstable compared to the stable conditions. We observed reduced beta band IMC between several muscle pairs during high- compared to low-CMP, but these findings did not remain significant after controlling for multiple comparisons. Finally, IMC significantly increased in the unstable conditions for most muscle combinations and frequency bands. In all, results tentatively suggest that CMP-induced changes in sway outcomes may be facilitated by reduced beta-band IMC, but these findings need to be replicated before they can be interpreted more conclusively.

Sensorimotor recalibration of postural control strategies occurs after whole body vibration

Efficient postural control results from an effective interplay between sensory feedbacks integration and muscle modulation and can be affected by ageing and neuromuscular injuries. With this study, we investigated the effect of whole-body vibratory stimulation on postural control strategies employed to maintain an upright posture. We explored both physiological and posturography metrics, through corticomuscular and intramuscular coherence, and muscle networks analyses. The stimulation disrupts balance in the short term, but leads to a greater contribution of cortical activity, necessary to modulate muscle activation via the formation of (new) synergies. We also observed a reconfiguration of muscle recruitment patterns that returned to pre-stimulation levels after few minutes, accompanied by a slight improvement of balance in the anterior-posterior direction. Our results suggest that, in the context of postural control, appropriate mechanical stimulation is capable of triggering a recalibration of the sensorimotor set and might offer new perspectives for motor re-education.

Safety and effects of a therapeutic 15 Hz rTMS protocol administered at different suprathreshold intensities in able-bodied individuals

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) remains a promising strategy for neurorehabilitation. The stimulation intensity (SI) influences the aftereffects observed. Here, we examined whether single sessions of a 15 Hz rTMS protocol, administered at suprathreshold SI, can be safely administered to able-bodied (AB) individuals. Six right-handed men were included in this pilot study. HF-rTMS was delivered over the right M1, in 10 trains of 75 biphasic stimuli at 15 Hz, at 105-120% of the individual resting motor threshold (RMT). To assess safety, electromyography (EMG) was monitored to control for signs of spread of excitation and brief EMG burst (BEB) after stimulation. Additionally, TMS side effects questionnaires and the numeric rating scale (NRS) were administered during each session. We assessed corticospinal excitability (CSE) and motor performance changes with measures of resting (rMEP) and active (aMEP) motor evoked potential and grip strength and box and blocks test (BBT) scores, respectively. Overall, the sessions were tolerated and feasible without any pain development. However, EMG analysis during 15 Hz rTMS administration revealed increased BEB frequency with SI. Statistical models revealed an increase of CSE at rest (rMEP) but not during active muscle contraction (aMEP). No linear relationship was observed between 15 Hz rTMS SI and rMEP increase. No significant changes were highlighted for motor performance measures. Although feasible and tolerable by the AB individuals tested, the results demonstrate that when administered at suprathreshold intensities (≥ 105% RMT) the 15 Hz rTMS protocol reveals signs of persistent excitation, suggesting that safety precautions and close monitoring of participants should be performed when testing such combinations of high-intensity and high-frequency stimulation protocols. The results also give insight into the nonlinear existent relationship between the SI and HF-rTMS effects on CSE.NEW & NOTEWORTHY The results of this pilot study show the effects of a therapeutically promising 15 Hz repetitive transcranial magnetic stimulation (rTMS) protocol, administered at different suprathreshold intensities in able-bodied individuals. Although tolerable and feasible with a neuromodulatory potential, 15 Hz rTMS might result in persistent excitability that needs to be closely monitored if administered at suprathreshold stimulation intensity. These results reaffirm the importance of feasibility studies, especially in translational animal-to-human research.

Functional and neuromuscular changes induced via a low-cost, muscle-computer interface for telerehabilitation: A feasibility study in chronic stroke

Stroke is a leading cause of adult disability in the United States. High doses of repeated task-specific practice have shown promising results in restoring upper limb function in chronic stroke. However, it is currently challenging to provide such doses in clinical practice. At-home telerehabilitation supervised by a clinician is a potential solution to provide higher-dose interventions. However, telerehabilitation systems developed for repeated task-specific practice typically require a minimum level of active movement. Therefore, severely impaired people necessitate alternative therapeutic approaches. Measurement and feedback of electrical muscle activity via electromyography (EMG) have been previously implemented in the presence of minimal or no volitional movement to improve motor performance in people with stroke. Specifically, muscle neurofeedback training to reduce unintended co-contractions of the impaired hand may be a targeted intervention to improve motor control in severely impaired populations. Here, we present the preliminary results of a low-cost, portable EMG biofeedback system (Tele-REINVENT) for supervised and unsupervised upper limb telerehabilitation after stroke. We aimed to explore the feasibility of providing higher doses of repeated task-specific practice during at-home training. Therefore, we recruited 5 participants (age = 44-73 years) with chronic, severe impairment due to stroke (Fugl-Meyer = 19-40/66). They completed a 6-week home-based training program that reinforced activity of the wrist extensor muscles while avoiding coactivation of flexor muscles via computer games. We used EMG signals to quantify the contribution of two antagonistic muscles and provide biofeedback of individuated activity, defined as a ratio of extensor and flexor activity during movement attempt. Our data suggest that 30 1-h sessions over 6 weeks of at-home training with our Tele-REINVENT system is feasible and may improve individuated muscle activity as well as scores on standard clinical assessments (e.g., Fugl-Meyer Assessment, Action Research Arm Test, active wrist range of motion) for some individuals. Furthermore, tests of neuromuscular control suggest modest changes in the synchronization of electroencephalography (EEG) and EMG signals within the beta band (12-30 Hz). Finally, all participants showed high adherence to the training protocol and reported enjoying using the system. These preliminary results suggest that using low-cost technology for home-based telerehabilitation after severe chronic stroke is feasible and may be effective in improving motor control via feedback of individuated muscle activity.

Motor control strategies differ between monoarticular and biarticular quadriceps muscles during bipedal squats

The interplay between biarticular and monoarticular muscles of the knee and hip joints during bipedal squats (SQ_BP ) requires adequate central-nervous control mechanisms to enable smooth and dynamic movements. Here, we investigated motor control between M. vastus medialis (VM), M. vastus lateralis (VL), and M. rectus femoris (RF) in 12 healthy male recreational athletes during SQ_BP with three load levels (50%, 62.5% & 75% of 3-repetition maximum) following a standardized strength training protocol (3 sets of 10 repetitions). To quantify differences in motor control mechanisms in both time and frequency domains, we analyzed (1) muscle covariation via correlation analyses, as well as (2) common neural input via intermuscular coherence (IMC) between RF, VM, and VL. Our results revealed significantly higher gamma IMC between VM-VL compared to RF-VL and RF-VM for both legs. Correlation analyses demonstrated significantly higher correlation coefficients during ascent periods compared to descent periods across all analyzed muscle pairs. However, no load-dependent modulation of motor control could be observed. Our study provides novel evidence that motor control during SQ_BP is characterized by differences in common input between biarticular and monoarticular muscles. Additionally, muscle activation patterns show higher similarity during ascent compared to descent periods. Future research should aim to validate and extend our observations as insights into the underlying control mechanisms offer the possibility for practical implications to optimize training concepts in elite sports and rehabilitation.

Quantification of high and low sEMG spectral components during sustained isometric contraction

Superficial Electromyography (sEMG) spectrum contains aggregated information from several underlying physiological processes. Due to technological limitations, the isolation of these processes is challenging, and therefore, the interpretation of changes in muscle activity frequency is still controversial. Recent studies showed that the spectrum of sEMG signals recorded from isotonic and short-term isometric contractions can be decomposed into independent components whose spectral features recall those of motor unit action potentials. In this paper sEMG spectral decomposition is tested during muscle fatigue induced by long-term isometric contraction where sEMG spectral changes have been widely studied. The main goals of this work are to validate spectral component extraction during long-term isometric muscle activation and the quantification of energy exchange between the low- and high-frequency bands of sEMG signals during muscle fatigue.

Synergistic Upper-limb Functional Muscle Connectivity using Acoustic Mechanomyography

Functional connectivity is a critical concept in describing synergistic muscle synchronization for the execution of complex motor tasks. Muscle synchronization is typically derived from the decomposition of intermuscular coherence (IMC) at different frequency bands through electromyography (EMG) signal analysis with limited out-of-clinic applications. In this investigation, we introduce muscle network analysis to assess the coordination and functional connectivity of muscles based on mechanomyography (MMG), focused on a targeted group of muscles that are typically active in the conduction of activities of daily living using the upper limb. In this regard, functional muscle networks are evaluated in this paper for ten able-bodied participants and three amputees. MMG activity was acquired from a custom-made wearable MMG armband placed over four superficial muscles around the forearm (i.e., flexor carpi radialis (FCR), brachioradialis (BR), extensor digitorum communis (EDC), and flexor carpi ulnaris (FCU)) while participants performed four different hand gestures. The results of connectivity analysis at multiple frequency bands showed significant topographical differences across gestures for low (< 5Hz) and high (> 12 Hz) frequencies and observable differences between able-bodied and amputee subjects. These findings show evidence that MMG can be used for the analysis of functional muscle connectivity and mapping of synergistic synchronization of upper-limb muscles in complex upper-limb tasks. The new physiological modality further provides key insights into the neural circuitry of motor coordination and offers the concomitant outcomes of demonstrating the feasibility of MMG to map muscle coherence from a neurophysiological perspective as well as providing the mechanistic basis for its translation into human-robot interfaces.

Body Weight Control Is a Key Element of Motor Control for Toddlers' Walking

New-borns can step when supported for about 70-80% of their own body weight. Gravity-related sensorimotor information might be an important factor in developing the ability to walk independently. We explored how body weight support alters motor control in toddlers during the first independent steps and in toddlers with about half a year of walking experience. Sixteen different typically developing children were assessed during (un)supported walking on a running treadmill. Electromyography of 18-24 bilateral leg and back muscles and vertical ground reaction forces were recorded. Strides were grouped into four levels of body weight support ranging from no (<10%), low (10-35%), medium (35-55%), and high (55-95%) support. We constructed muscle synergies and muscle networks and assessed differences between levels of support and between groups. In both groups, muscle activities could be described by four synergies. As expected, the mean activity decreased with body weight support around foot strikes. The younger first-steps group showed changes in the temporal pattern of the synergies when supported for more than 35% of their body weight. In this group, the muscle network was dense with several interlimb connections. Apparently, the ability to process gravity-related information is not fully developed at the onset of independent walking causing motor control to be fairly disperse. Synergy-specific sensitivity for unloading implies distinct neural mechanisms underlying (the emergence of) these synergies.

Disrupted cortico-peripheral interactions in motor disorders

Motor disorders may arise from neurological damage or diseases at different levels of the hierarchical motor control system and side-loops. Altered cortico-peripheral interactions might be essential characteristics indicating motor dysfunctions. By integrating cortical and peripheral responses, top-down and bottom-up cortico-peripheral coupling measures could provide new insights into the motor control and recovery process. This review first discusses the neural bases of cortico-peripheral interactions, and corticomuscular coupling and corticokinematic coupling measures are addressed. Subsequently, methodological efforts are summarized to enhance the modeling reliability of neural coupling measures, both linear and nonlinear approaches are introduced. The latest progress, limitations, and future directions are discussed. Finally, we emphasize clinical applications of cortico-peripheral interactions in different motor disorders, including stroke, neurodegenerative diseases, tremor, and other motor-related disorders. The modified interaction patterns and potential changes following rehabilitation interventions are illustrated. Altered coupling strength, modified coupling directionality, and reorganized cortico-peripheral activation patterns are pivotal attributes after motor dysfunction. More robust coupling estimation methodologies and combination with other neurophysiological modalities might more efficiently shed light on motor control and recovery mechanisms. Future studies with large sample sizes might be necessary to determine the reliabilities of cortico-peripheral interaction measures in clinical practice.

Cortico-muscular interaction to monitor the effects of neuromuscular electrical stimulation pedaling training in chronic stroke

Neuromuscular electrical stimulation (NMES) has been widely utilized in post-stroke motor restoration. However, its impact on the closed-loop sensorimotor control process remains largely unclear. This is the first study to investigate the directional changes in cortico-muscular interactions after repetitive rehabilitation training by measuring the noninvasive electroencephalogram (EEG) and electromyography (EMG) signals. In this study, 10 subjects with chronic stroke received 20 sessions of NMES-pedaling interventions, and each training session included three 10-min NMES-driven pedaling trials. In addition, pre- and post-intervention assessments of lower limb isometric contraction were conducted before and after the whole NMES-pedaling interventions. The EEG (128 channels) and EMG (3 bilateral lower limb sensors) signals were collected during the isometric contraction tasks for the paretic and non-paretic lower limbs. Both the cortico-muscular coherence (CMC) and generalized partial directed coherence (GPDC) values were analyzed between eight selected EEG channels in the central primary motor cortex and EMG channels. The results revealed significant clinical improvements. Additionally, rehabilitation training facilitated cortico-muscular interaction of the ipsilesional brain and paretic lower limbs (p = 0.004). Moreover, both the descending and ascending cortico-muscular pathways were altered after NMES-training (p = 0.001, p < 0.001). Therefore, the results implied potential applications of EEG-EMG in understanding neuromuscular changes during the post-stroke motor rehabilitation process.

Dynamic Modulation of Beta Band Cortico-Muscular Coupling Induced by Audio-Visual Rhythms

Human movements often spontaneously fall into synchrony with auditory and visual environmental rhythms. Related behavioral studies have shown that motor responses are automatically and unintentionally coupled with external rhythmic stimuli. However, the neurophysiological processes underlying such motor entrainment remain largely unknown. Here, we investigated with electroencephalography (EEG) and electromyography (EMG) the modulation of neural and muscular activity induced by periodic audio and/or visual sequences. The sequences were presented at either 1 or 2 Hz, while participants maintained constant finger pressure on a force sensor. The results revealed that although there was no change of amplitude in participants' EMG in response to the sequences, the synchronization between EMG and EEG recorded over motor areas in the beta (12-40 Hz) frequency band was dynamically modulated, with maximal coherence occurring about 100 ms before each stimulus. These modulations in beta EEG-EMG motor coherence were found for the 2-Hz audio-visual sequences, confirming at a neurophysiological level the enhancement of motor entrainment with multimodal rhythms that fall within preferred perceptual and movement frequency ranges. Our findings identify beta band cortico-muscular coupling as a potential underlying mechanism of motor entrainment, further elucidating the nature of the link between sensory and motor systems in humans.

Temporal control of muscle synergies is linked with alpha-band neural drive

KEY POINTS

It is theorized that the nervous system controls groups of muscles together as functional units, or 'synergies', resulting in correlated electromyographic (EMG) signals among muscles. However, such correlation does not necessarily imply group-level neural control. Oscillatory synchronization (coherence) among EMG signals implies neural coupling, but it is not clear how this relates to control of muscle synergies. EMG was recorded from seven arm muscles of 10 adult participants rotating an upper limb ergometer, and EMG-EMG coherence, EMG amplitude correlations and their relationship with each other were characterized. A novel method to derive multi-muscle synergies from EMG-EMG coherence is presented and these are compared with classically defined synergies. Coherent alpha-band (8-16 Hz) drive was strongest among muscles whose gross activity levels are well correlated within a given task. The cross-muscle distribution and temporal modulation of coherent alpha-band drive suggests a possible role in the neural coordination/monitoring of synergies.

ABSTRACT

During movement, groups of muscles may be controlled together by the nervous system as an adaptable functional entity, or 'synergy'. The rules governing when (or if) this occurs during voluntary behaviour in humans are not well understood, at least in part because synergies are usually defined by correlated patterns of muscle activity without regard for the underlying structure of their neural control. In this study, we investigated the extent to which comodulation of muscle output (i.e. correlation of electromyographic (EMG) amplitudes) implies that muscles share intermuscular neural input (assessed via EMG-EMG coherence analysis). We first examined this relationship among pairs of upper limb muscles engaged in an arm cycling task. We then applied a novel multidimensional EMG-EMG coherence analysis allowing synergies to be characterized on the basis of shared neural drive. We found that alpha-band coherence (8-16 Hz) is related to the degree to which overall muscle activity levels correlate over time. The extension of this coherence analysis to describe the cross-muscle distribution and temporal modulation of alpha-band drive revealed a close match to the temporal and structural features of traditionally defined muscle synergies. Interestingly, the coherence-derived neural drive was inversely associated with, and preceded, changes in EMG amplitudes by ∼200 ms. Our novel characterization of how alpha-band neural drive is dynamically distributed among muscles is a fundamental step forward in understanding the neural origins and correlates of muscle synergies.

Dynamic modulation of cortico-muscular coupling during real and imagined sensorimotor synchronisation

People have a natural and intrinsic ability to coordinate body movements with rhythms surrounding them, known as sensorimotor synchronisation. This can be observed in daily environments, when dancing or singing along with music, or spontaneously walking, talking or applauding in synchrony with one another. However, the neurophysiological mechanisms underlying accurately synchronised movement with selected rhythms in the environment remain unclear. Here we studied real and imagined sensorimotor synchronisation with interleaved auditory and visual rhythms using cortico-muscular coherence (CMC) to better understand the processes underlying the preparation and execution of synchronised movement. Electroencephalography (EEG), electromyography (EMG) from the finger flexors, and continuous force signals were recorded in 20 participants during tapping and imagined tapping with discrete stimulus sequences consisting of alternating auditory beeps and visual flashes. The results show that the synchronisation between cortical and muscular activity in the beta (14-38 Hz) frequency band becomes time-locked to the taps executed in synchrony with the visual and auditory stimuli. Dynamic modulation in CMC also occurred when participants imagined tapping with the visual stimuli, but with lower amplitude and a different temporal profile compared to real tapping. These results suggest that CMC does not only reflect changes related to the production of the synchronised movement, but also to its preparation, which appears heightened under higher attentional demands imposed when synchronising with the visual stimuli. These findings highlight a critical role of beta band neural oscillations in the cortical-muscular coupling underlying sensorimotor synchronisation.

Alterations in Muscle Networks in the Upper Extremity of Chronic Stroke Survivors

Muscle networks describe the functional connectivity between muscles quantified through the decomposition of intermuscular coherence (IMC) to identify shared frequencies at which certain muscles are co-modulated by common neural input. Efforts have been devoted to characterizing muscle networks in healthy subjects but stroke-linked alterations to muscle networks remain unexplored. Muscle networks were assessed for eight key upper extremity muscles during isometric force generation in stroke survivors with mild, moderate, and severe impairment and compared against healthy controls to identify stroke-specificalterations in muscle connectivity. Coherence matrices were decomposed using non-negative matrix factorization. The variance accounted for thresholding was then assessed to identify the number of muscle networks. Results showed that the number of muscle networks decreased in stroke survivors compared to age-matched healthy controls (four networks in the healthy control group) as the severity of post-stroke motor impairment increased (three in the mild- and two in the moderate- and severe-strokegroups). Statistically significant reductions of IMC in the synergistic deltoid muscles in the alpha-band in stroke patients versus healthy controls ( p < 0.05) were identified. This study represents the first effort, to the best of our knowledge, to assess stroke-linked alterations in functional intermuscular connectivity using muscle network analysis. The findings revealed a pattern of alterations to muscle networks in stroke survivors compared to healthy controls, as a result of the loss of brain function associated with the stroke. These alterations in muscle networks reflected underlying pathophysiology. These findings can help better understand the motor impairment and motor control in stroke and may advance rehabilitation efforts for stroke by identifying the impaired neuromuscular coordination among multiple muscles in the frequency domain.

Antagonistic muscle prefatigue weakens the functional corticomuscular coupling during isometric elbow extension contraction

OBJECTIVE

During muscle fatigue, acute changes in the interaction between the sensorimotor cortex and peripheral neurons have been widely studied. However, it is still unclear about the effect of antagonist muscle prefatigue on corticomuscular coupling and central modulation. The purpose of this study was to investigate the changes in the magnitude of electroencephalogram-electromyography (EEG-EMG) coherence and phase synchronization index (PSI) induced by antagonistic muscle prefatigue.

METHODS

Twelve young male volunteers conducted a 30-s long, nonfatiguing isometric elbow extension with a target force level of 20% maximum voluntary contraction (MVC) before and after a fatiguing sustained elbow flexion contraction at 20% MVC until task failure. Coherence and PSI between the EEG recorded over the sensorimotor cortex and the surface EMG of the triceps brachii (TB) muscle were quantified for the pre- and post-fatigue elbow extension contractions.

RESULTS

Coherence and PSI in the gamma frequency band (35-60 Hz) were found significantly decreased in the postfatigue elbow extension contraction than the prefatigue contraction. The power of the EEG in the beta and gamma band were significantly increased, while the EMG power showed no significant changes when the antagonistic muscle was prefatigued. PSI in the gamma frequency band between the EMG of the TB muscle and the EEG were found significantly decreased during postfatigue elbow extension contraction compared with prefatigue contraction.

CONCLUSION

Antagonistic muscle prefatigue led to significantly lower gamma band corticomuscular coherence and phase coupling during an isometric elbow extension position task. The lower corticomuscular coupling may indicate a central modulation mechanism of antagonist muscle prefatigue that related to decreased descending common drive or joint instability compensation modulation mechanism.

Intermuscular coherence analysis in older adults reveals that gait-related arm swing drives lower limb muscles via subcortical and cortical pathways

KEY POINTS

Gait-related arm swing in humans supports efficient lower limb muscle activation, indicating a neural coupling between the upper and lower limbs during gait. Intermuscular coherence analyses of gait-related electromyography from upper and lower limbs in 20 healthy participants identified significant coherence in alpha and beta/gamma bands indicating that upper and lower limbs share common subcortical and cortical drivers that coordinate the rhythmic four-limb gait pattern. Additional directed connectivity analyses revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. The results provide a neural underpinning that arm swing may serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

ABSTRACT

Human gait benefits from arm swing, as it enhances efficient lower limb muscle activation in healthy participants as well as patients suffering from neurological impairment. The underlying neuronal mechanisms of such coupling between upper and lower limbs remain poorly understood. The aim of the present study was to examine this coupling by intermuscular coherence analysis during gait. Additionally, directed connectivity analysis of this coupling enabled assessment of whether gait-related arm swing indeed drives lower limb muscles. To that end, electromyography recordings were obtained from four lower limb muscles and two upper limb muscles bilaterally, during gait, of 20 healthy participants (mean (SD) age 67 (6.8) years). Intermuscular coherence analysis revealed functional coupling between upper and lower limb muscles in the alpha and beta/gamma band during muscle specific periods of the gait cycle. These effects in the alpha and beta/gamma bands indicate involvement of subcortical and cortical sources, respectively, that commonly drive the rhythmic four-limb gait pattern in an efficiently coordinated fashion. Directed connectivity analysis revealed that upper limb muscles drive and shape lower limb muscle activity during gait via subcortical and cortical pathways and to a lesser extent vice versa. This indicates that gait-related arm swing reflects the recruitment of neuronal support for optimizing the cyclic movement pattern of the lower limbs. These findings thus provide a neural underpinning for arm swing to potentially serve as an effective rehabilitation therapy concerning impaired gait in neurological diseases.

Changes in Intermuscular Coherence as a Function of Age and Phase of Speech Production During an Overt Reading Task

PURPOSE

The authors evaluated changes in intermuscular coherence (IMC) of orofacial and speech breathing muscles across phase of speech production in healthy younger and older adults.

METHOD

Sixty adults (30 younger = M: 26.97 year; 30 older = M: 66.37 year) read aloud a list of 40 words. IMC was evaluated across phase: preparation (300 ms before speech onset), initiation (300 ms after onset), and total execution (entire word).

RESULTS

Orofacial IMC was lowest in the initiation, higher in preparation, and highest for the total execution phase. Chest wall IMC was lowest for the preparation and initiation and highest for the total execution phase. Despite age-related differences in accuracy, neuromuscular modulation for phase was similar between groups.

CONCLUSION

These results expand our knowledge of speech motor control by demonstrating that IMC is sensitive to phase of speech planning and production.

Development of a Low-Cost, Modular Muscle-Computer Interface for At-Home Telerehabilitation for Chronic Stroke

Stroke is a leading cause of long-term disability in the United States. Recent studies have shown that high doses of repeated task-specific practice can be effective at improving upper-limb function at the chronic stage. Providing at-home telerehabilitation services with therapist supervision may allow higher dose interventions targeted to this population. Additionally, muscle biofeedback to train patients to avoid unwanted simultaneous activation of antagonist muscles (co-contractions) may be incorporated into telerehabilitation technologies to improve motor control. Here, we present the development and feasibility of a low-cost, portable, telerehabilitation biofeedback system called Tele-REINVENT. We describe our modular electromyography acquisition, processing, and feedback algorithms to train differentiated muscle control during at-home therapist-guided sessions. Additionally, we evaluated the performance of low-cost sensors for our training task with two healthy individuals. Finally, we present the results of a case study with a stroke survivor who used the system for 40 sessions over 10 weeks of training. In line with our previous research, our results suggest that using low-cost sensors provides similar results to those using research-grade sensors for low forces during an isometric task. Our preliminary case study data with one patient with stroke also suggest that our system is feasible, safe, and enjoyable to use during 10 weeks of biofeedback training, and that improvements in differentiated muscle activity during volitional movement attempt may be induced during a 10-week period. Our data provide support for using low-cost technology for individuated muscle training to reduce unintended coactivation during supervised and unsupervised home-based telerehabilitation for clinical populations, and suggest this approach is safe and feasible. Future work with larger study populations may expand on the development of meaningful and personalized chronic stroke rehabilitation.

Exercise intervention protocol in children and young adults with cerebral palsy: the effects of strength, flexibility and gait training on physical performance, neuromuscular mechanisms and cardiometabolic risk factors (EXECP)

Background

Individuals with cerebral palsy (CP) have problems in everyday tasks such as walking and climbing stairs due to a combination of neuromuscular impairments such as spasticity, muscle weakness, reduced joint flexibility and poor coordination. Development of evidence-based interventions are in pivotal role in the development of better targeted rehabilitation of CP, and thus in maintaining their motor function and wellbeing. Our aim is to investigate the efficacy of an individually tailored, multifaceted exercise intervention (EXECP) in children and young adults with CP. EXECP is composed of strength, flexibility and gait training. Furthermore, this study aims to verify the short-term retention of the adaptations three months after the end of the EXECP intervention.

Methods

Twenty-four children and young adults with spastic CP will be recruited to participate in a 9-month research project with a 3-month training intervention, consisting of two to three 90-min sessions per week. In each session, strength training for the lower limbs and trunk muscles, flexibility training for the lower limbs and inclined treadmill gait training will be performed. We will evaluate muscle strength, joint flexibility, neuromuscular and cardiometabolic parameters. A nonconcurrent multiple baseline design with two pre-tests and two post-tests all interspaced by three months is used. In addition to the CP participants, 24 typically developing age and sex-matched participants will perform the two pre-tests (i.e. no intervention) to provide normative data.

Discussion

This study has a comprehensive approach examining longitudinal effects of wide variety of variables ranging from physical activity and gross motor function to sensorimotor functions of the brain and neuromuscular and cardiometabolic parameters, providing novel information about the adaptation mechanisms in cerebral palsy. To the best of our knowledge, this is the first intervention study providing supervised combined strength, flexibility and gait training for young individuals with CP.

Trial registration number

ISRCTN69044459, prospectively registered (21/04/2017).

A pilot study assessing reliability and age-related differences in corticomuscular and intramuscular coherence in ankle dorsiflexors during walking

Corticomuscular (CMC) and intramuscular (intraMC) coherence represent measures of corticospinal interaction. Both CMC and intraMC can be assessed during human locomotion tasks, for example, while walking. Corticospinal control of gait can deteriorate during the aging process and CMC and intraMC may represent an important monitoring means. However, it is unclear whether such assessments represent a reliable tool when performed during walking in an ecologically valid scenario and whether age‐related differences may occur. Wireless surface electroencephalography and electromyography were employed in a pilot study with young and old adults during overground walking in two separate sessions. CMC and intraMC analyses were performed in the gathered beta and lower gamma frequencies (i.e., 13–40 Hz). Significant log‐transformed coherence area was tested for intersessions test–retest reliability by determining intraclass correlation coefficient (ICC), yielding to low reliability in CMC in both younger and older adults. intraMC exclusively showed low reliability in the older adults, whereas intraMC in the younger adults revealed similar values as previously reported: test–retest reliability [ICC (95% CI): 0.44 (−0.23, 0.87); SEM: 0.46; MDC: 1.28; MDC%: 103; Hedge's g (95% CI): 0.54 (−0.13, 1.57)]. Significant differences between the age groups were observed in intraMC by either comparing the two groups with the first test [Hedge's g (95% CI): 1.55 (0.85, 2.15); p‐value: .006] or with the retest data [Hedge's g (95% CI): 2.24 (0.73, 3.70); p‐value: .005]. Notwithstanding the small sample size investigated, intraMC seems a moderately reliable assessment in younger adults. The further development and use of this measure in practical settings to infer corticospinal interaction in human locomotion in clinical practice is warranted and should help to refine the analysis. This necessitates involving larger sample sizes as well as including a wider number of lower limb muscles. Moreover, further research seems warranted by the observed differences in modulation mechanisms of corticospinal control of gait as ascertained by intraMC between the age groups.

Techniques for registration of myoelectric activity of women's pelvic floor muscles: a scoping review protocol

OBJECTIVE

The objective of this review is to identify the most frequently used protocols for analyzing the myoelectric activity of the pelvic floor muscles during surface electromyography in women aged 18 years or older.

INTRODUCTION

Surface electromyography is normally used in assessment and treatment for research purposes when it is intended to quantitatively measure the electrophysiological behavior of the neuromuscular system. However, although there are internationally standardized, non-invasive assessment protocols for most muscle groups, there is no consensus for pelvic floor muscles, which makes it difficult to standardize in scientific research and clinical applicability.

INCLUSION CRITERIA

Studies that explore registration protocols and filtering parameters of surface electromyographic signals in women aged over 18 years old with or without pelvic floor dysfunction will be considered. Studies encompassing either electromyographic biofeedback as a treatment resource only or electroneuromyography (needle electrode) will be excluded.

METHODS

Primary studies published in the previous 10 years in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and Cochrane Central databases will be included. The search will encompass descriptors registered in MeSH. The identified articles will be assessed for eligibility by two independent reviewers in three stages: evaluation by title, abstract, and full text. If there is any disagreement, a third reviewer will be consulted. Data will be extracted and organized in standardized spreadsheets. The results will be assigned to categories in order to facilitate the organization of a protocol with the most commonly used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.

Intermuscular coherence between homologous muscles during dynamic and static movement periods of bipedal squatting

Coordination of functionally coupled muscles is a key aspect of movement execution. Demands on coordinative control increase with the number of involved muscles and joints, as well as with differing movement periods within a given motor sequence. While previous research has provided evidence concerning inter- and intramuscular synchrony in isolated movements, compound movements remain largely unexplored. With this study, we aimed to uncover neural mechanisms of bilateral coordination through intermuscular coherence (IMC) analyses between principal homologous muscles during bipedal squatting (BpS) at multiple frequency bands (alpha, beta, and gamma). For this purpose, participants performed bipedal squats without additional load, which were divided into three distinct movement periods (eccentric, isometric, and concentric). Surface electromyography (EMG) was recorded from four homologous muscle pairs representing prime movers during bipedal squatting. We provide novel evidence that IMC magnitudes differ between movement periods in beta and gamma bands, as well as between homologous muscle pairs across all frequency bands. IMC was greater in the muscle pairs involved in postural and bipedal stability compared with those involved in muscular force during BpS. Furthermore, beta and gamma IMC magnitudes were highest during eccentric movement periods, whereas we did not find movement-related modulations for alpha IMC magnitudes. This finding thus indicates increased integration of afferent information during eccentric movement periods. Collectively, our results shed light on intermuscular synchronization during bipedal squatting, as we provide evidence that central nervous processing of bilateral intermuscular functioning is achieved through task-dependent modulations of common neural input to homologous muscles.

NEW & NOTEWORTHY It is largely unexplored how the central nervous system achieves coordination of homologous muscles of the upper and lower body within a compound whole body movement, and to what extent this neural drive is modulated between different movement periods and muscles. Using intermuscular coherence analysis, we show that homologous muscle functions are mediated through common oscillatory input that extends over alpha, beta, and gamma frequencies with different synchronization patterns at different movement periods.

Age-specific modulation of intermuscular beta coherence during gait before and after experimentally induced fatigue

We examined the effects of age on intermuscular beta-band (15-35 Hz) coherence during treadmill walking before and after experimentally induced fatigue. Older (n = 12) and younger (n = 12) adults walked on a treadmill at 1.2 m/s for 3 min before and after repetitive sit-to-stand, rSTS, to induce muscle fatigability. We measured stride outcomes and coherence from 100 steps in the dominant leg for the synergistic (biceps femoris (BF)-semitendinosus, rectus femoris (RF)-vastus lateralis (VL), gastrocnemius lateralis (GL)-Soleus (SL), tibialis anterior (TA)-peroneus longus (PL)) and for the antagonistic (RF-BF and TA-GL) muscle pairs at late swing and early stance. Older vs. younger adults had 43-62% lower GL-SL, RF-VL coherence in swing and TA-PL and RF-VL coherence in stance. After rSTS, RF-BF coherence in late swing decreased by ~ 20% and TA-PL increased by 16% independent of age (p = 0.02). Also, GL-SL coherence decreased by ~ 23% and increased by ~ 23% in younger and older, respectively. Age affects the oscillatory coupling between synergistic muscle pairs, delivered presumably via corticospinal tracts, during treadmill walking. Muscle fatigability elicits age-specific changes in the common fluctuations in muscle activity, which could be interpreted as a compensation for muscle fatigability to maintain gait performance.

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.

Muscle Synergies and Coherence Networks Reflect Different Modes of Coordination During Walking

When walking speed is increased, the frequency ratio between the arm and leg swing switches spontaneously from 2:1 to 1:1. We examined whether these switches are accompanied by changes in functional connectivity between multiple muscles. Subjects walked on a treadmill with their arms swinging along their body while kinematics and surface electromyography (EMG) of 26 bilateral muscles across the body were recorded. Walking speed was varied from very slow to normal. We decomposed EMG envelopes and intermuscular coherence spectra using non-negative matrix factorization (NMF), and the resulting modes were combined into multiplex networks and analyzed for their community structure. We found five relevant muscle synergies that significantly differed in activation patterns between 1:1 and 2:1 arm-leg coordination and the transition period between them. The corresponding multiplex network contained a single module indicating pronounced muscle co-activation patterns across the whole body during a gait cycle. NMF of the coherence spectra distinguished three EMG frequency bands: 4-8, 8-22, and 22-60 Hz. The community structure of the multiplex network revealed four modules, which clustered functional and anatomical linked muscles across modes of coordination. Intermuscular coherence at 4-22 Hz between upper and lower body and within the legs was particularly pronounced for 1:1 arm-leg coordination and was diminished when switching between modes of coordination. These findings suggest that the stability of arm-leg coordination is associated with modulations in long-distant neuromuscular connectivity.

A Virtual Reality Muscle-Computer Interface for Neurorehabilitation in Chronic Stroke: A Pilot Study

Severe impairment of limb movement after stroke can be challenging to address in the chronic stage of stroke (e.g., greater than 6 months post stroke). Recent evidence suggests that physical therapy can still promote meaningful recovery after this stage, but the required high amount of therapy is difficult to deliver within the scope of standard clinical practice. Digital gaming technologies are now being combined with brain–computer interfaces to motivate engaging and frequent exercise and promote neural recovery. However, the complexity and expense of acquiring brain signals has held back widespread utilization of these rehabilitation systems. Furthermore, for people that have residual muscle activity, electromyography (EMG) might be a simpler and equally effective alternative. In this pilot study, we evaluate the feasibility and efficacy of an EMG-based variant of our REINVENT virtual reality (VR) neurofeedback rehabilitation system to increase volitional muscle activity while reducing unintended co-contractions. We recruited four participants in the chronic stage of stroke recovery, all with severely restricted active wrist movement. They completed seven 1-hour training sessions during which our head-mounted VR system reinforced activation of the wrist extensor muscles without flexor activation. Before and after training, participants underwent a battery of clinical and neuromuscular assessments. We found that training improved scores on standardized clinical assessments, equivalent to those previously reported for brain–computer interfaces. Additionally, training may have induced changes in corticospinal communication, as indexed by an increase in 12–30 Hz corticomuscular coherence and by an improved ability to maintain a constant level of wrist muscle activity. Our data support the feasibility of using muscle–computer interfaces in severe chronic stroke, as well as their potential to promote functional recovery and trigger neural plasticity.

Altered Muscle Networks in Post-Stroke Survivors

Muscle networks represent a series of interactions among muscles in the central nervous system's effort to reduce the redundancy of the musculoskeletal system in motor-control. How this occurs has only been investigated recently in healthy subjects with a novel technique exploring the functional connectivity between muscles through intermuscular coherence (IMC), yet the potential value of this method in characterizing the alteration of muscular networks after stroke remains unknown. In this study, muscle networks were assessed in post-stroke survivors and healthy controls to identify possible alterations in the neural oscillatory drive to muscles after stroke. Surface electromyography (sEMG) was collected from eight key upper extremity muscles to non-invasively determine the common neural input to the spinal motor neurons innervating muscle fibers. Coherence was computed between all possible muscle pairs and further decomposed by non-negative matrix factorization (NMF) to identify the common spectral patterns of coherence underlying the muscle networks. Results suggested that the number of identified muscle networks during dynamic force generation decreased after stroke. The findings in this study could provide a new prospective for understanding the motor control recovery during post-stroke rehabilitation.