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Cuadra C, De Boef A, Luong S, Wolf SL, Nichols TR, Lyle MA. Reduced inhibition from quadriceps onto soleus after acute quadriceps fatigue suggests Golgi tendon organ contribution to heteronymous inhibition. Eur J Neurosci 2024; 60:4317-4331. [PMID: 38853295 PMCID: PMC11304518 DOI: 10.1111/ejn.16438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
Heteronymous inhibition between lower limb muscles is primarily attributed to recurrent inhibitory circuits in humans but could also arise from Golgi tendon organs (GTOs). Distinguishing between recurrent inhibition and mechanical activation of GTOs is challenging because their heteronymous effects are both elicited by stimulation of nerves or a muscle above motor threshold. Here, the unique influence of mechanically activated GTOs was examined by comparing the magnitude of heteronymous inhibition from quadriceps (Q) muscle stimulation onto ongoing soleus electromyographic at five Q stimulation intensities (1.5-2.5× motor threshold) before and after an acute bout of stimulation-induced Q fatigue. Fatigue was used to decrease Q stimulation evoked force (i.e., decreased GTO activation) despite using the same pre-fatigue stimulation currents (i.e., same antidromic recurrent inhibition input). Thus, a decrease in heteronymous inhibition after Q fatigue and a linear relation between stimulation-evoked torque and inhibition both before and after fatigue would support mechanical activation of GTOs as a source of inhibition. A reduction in evoked torque but no change in inhibition would support recurrent inhibition. After fatigue, Q stimulation-evoked knee torque, heteronymous inhibition magnitude and inhibition duration were significantly decreased for all stimulation intensities. In addition, heteronymous inhibition magnitude was linearly related to twitch-evoked knee torque before and after fatigue. These findings support mechanical activation of GTOs as a source of heteronymous inhibition along with recurrent inhibition. The unique patterns of heteronymous inhibition before and after fatigue across participants suggest the relative contribution of GTOs, and recurrent inhibition may vary across persons.
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Affiliation(s)
- Cristian Cuadra
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Adam De Boef
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Sarah Luong
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
| | - Steven L Wolf
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - T Richard Nichols
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Mark A Lyle
- Division of Physical Therapy, Emory University, Atlanta, Georgia, USA
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2
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Cuadra C, Wolf SL, Lyle MA. Heteronymous feedback from quadriceps onto soleus in stroke survivors. RESEARCH SQUARE 2024:rs.3.rs-4540327. [PMID: 38978589 PMCID: PMC11230478 DOI: 10.21203/rs.3.rs-4540327/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background Recent findings suggest increased excitatory heteronymous feedback from quadriceps onto soleus may contribute to abnormal coactivation of knee and ankle extensors after stroke. However, there is lack of consensus on whether persons post-stroke exhibit altered heteronymous reflexes and, when present, the origin of increased excitation (i.e. increased excitation alone and/or decreased inhibition). This study examined heteronymous excitation and inhibition from quadriceps onto soleus in paretic, nonparetic, and age-matched control limbs to determine whether increased excitation was due to excitatory and/or reduced inhibitory reflex circuits. A secondary purpose was to examine whether heteronymous reflex magnitudes were related to clinical measures of lower limb recovery, walking-speed, and dynamic balance. Methods Heteronymous excitation and inhibition from quadriceps onto soleus were examined in fourteen persons post-stroke and fourteen age-matched unimpaired participants. Heteronymous feedback was elicited by femoral nerve and quadriceps muscle stimulation in separate trials while participants tonically activated soleus at 20% max. Fugl-Myer assessment of lower extremity, 10-meter walk test, and Mini-BESTest were assessed in stroke survivors. Results Heteronymous excitation and inhibition onsets, durations, and magnitudes were not different between paretic, nonparetic or age-matched unimpaired limbs. Quadriceps stimulation elicited excitation that was half the magnitude of femoral nerve stimulation. Femoral nerve elicited paretic limb heteronymous excitation was positively correlated with walking speed but did not reach significance because only a subset of paretic limbs exhibited excitation (n = 8, Spearman r = 0.69, P = 0.058). Conclusions Heteronymous feedback from quadriceps onto soleus assessed in a seated posture was not impaired in persons post-stroke. Despite being unable to identify whether reduced inhibition contributes to abnormal excitation reported in prior studies, our results indicate quadriceps stimulation may allow a better estimate of heteronymous inhibition in those that exhibit exaggerated excitation. Heteronymous excitation magnitude in the paretic limb was positively correlated with self-selected walking speed suggesting paretic limb excitation at the higher end of a normal range may facilitate walking ability after stroke. Future studies are needed to identify whether heteronymous feedback from Q onto SOL is altered after stroke in upright postures and during motor tasks as a necessary next step to identify mechanisms underlying motor impairment.
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Cleland BT, Giffhorn M, Jayaraman A, Madhavan S. Understanding corticomotor mechanisms for activation of non-target muscles during unilateral isometric contractions of leg muscles after stroke. Int J Neurosci 2023:1-10. [PMID: 37750212 PMCID: PMC10963339 DOI: 10.1080/00207454.2023.2263817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Muscle activation often occurs in muscles ipsilateral to a voluntarily activated muscle and to a greater extent after stroke. In this study, we measured muscle activation in non-target, ipsilateral leg muscles and used transcranial magnetic stimulation (TMS) to provide insight into whether corticomotor pathways contribute to involuntary activation. MATERIALS AND METHODS Individuals with stroke performed unilateral isometric ankle dorsiflexion, ankle plantarflexion, knee extension, and knee flexion. To quantify involuntary muscle activation in non-target muscles, muscle activation was measured during contractions from the ipsilateral tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and biceps femoris (BF) and normalized to resting muscle activity. To provide insight into mechanisms of involuntary non-target muscle activation, TMS was applied to the contralateral hemisphere, and motor evoked potentials (MEPs) were recorded. RESULTS We found significant muscle activation in nearly every non-target muscle during isometric unilateral contractions. MEPs were frequently observed in non-target muscles, but greater non-target MEP amplitude was not associated with greater non-target muscle activation. CONCLUSIONS Our results suggest that non-target muscle activation occurs frequently in individuals with chronic stroke. The lack of association between non-target TMS responses and non-target muscle activation suggests that non-target muscle activation may have a subcortical or spinal origin. Non-target muscle activation has important clinical implications because it may impair torque production, out-of-synergy movement, and muscle activation timing.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
| | - Matt Giffhorn
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Arun Jayaraman
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
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Cuadra C, Wolf SL, Lyle MA. Differential effect of heteronymous feedback from femoral nerve and quadriceps muscle stimulation onto soleus H-reflex. PLoS One 2023; 18:e0290078. [PMID: 37578948 PMCID: PMC10424854 DOI: 10.1371/journal.pone.0290078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
Excitatory feedback from muscle spindles, and inhibitory feedback from Golgi tendon organs and recurrent inhibitory circuits are widely distributed within the spinal cord to modulate activity between human lower limb muscles. Heteronymous feedback is most commonly studied in humans by stimulating peripheral nerves, but the unique effect of non-spindle heteronymous feedback is difficult to determine due to the lower threshold of excitatory spindle axons. A few studies suggest stimulation of the muscle belly preferentially elicits non-spindle heteronymous feedback. However, there remains a lack of consensus on the differential effect of nerve and muscle stimulation onto the H-reflex, and the relation of the heteronymous effects onto H-reflex compared to that onto ongoing EMG has not been determined. In this cross-sectional study, we compared excitatory and inhibitory effects from femoral nerve and quadriceps muscle belly stimulation onto soleus H-reflex size in 15 able-bodied participants and in a subset also compared heteronymous effects onto ongoing soleus EMG at 10% and 20% max. Femoral nerve stimulation elicited greater excitation of the H-reflex compared to quadriceps stimulation. The differential effect was also observed onto ongoing soleus EMG at 20% max but not 10%. Femoral nerve and quadriceps stimulation elicited similar inhibition of the soleus H-reflexes, and these results were better associated with soleus EMG at 20%. The results support surface quadriceps muscles stimulation as a method to preferentially study heteronymous inhibition at least in healthy adults. The primary benefit of using muscle stimulation is expected to be in persons with abnormal, prolonged heteronymous excitation. These data further suggest heteronymous feedback should be evaluated with H-reflex or onto ongoing EMG of at least 20% max to identify group differences or modulation of heteronymous feedback in response to treatment or task.
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Affiliation(s)
- Cristian Cuadra
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Steven L. Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Senior Research Scientist, Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, Georgia, United States of America
| | - Mark A. Lyle
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Merlo A, Galletti M, Zerbinati P, Prati P, Mascioli F, Basini G, Rambelli C, Masiero S, Mazzoli D. Surgical quadriceps lengthening can reduce quadriceps spasticity in chronic stroke patients. A case-control study. Front Neurol 2022; 13:980692. [PMID: 36313503 PMCID: PMC9606420 DOI: 10.3389/fneur.2022.980692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Muscle overactivity is one of the positive signs of upper motor neuron lesions. In these patients, the loss of muscle length and extensibility resulting from soft tissue rearrangement has been suggested as a contributing cause of muscle overactivity in response to stretching. Objective To assess the effects of surgical lengthening of the quadriceps femoris (QF) muscle-tendon unit by aponeurectomy on muscle spasticity. Methods This is a case-control study on chronic stroke patients with hemiparesis that have undergone lower limb functional surgery over a 8-year period. CASEs underwent corrective surgery for both the foot and knee deviations, inclusive of a QF aponeurectomy. Controls (CTRLs) underwent corrective surgery for foot deviations only. QF spasticity was assessed with the Modified Tardieu Scale (MTS) before and 1 month after surgery. The Wilcoxon test was used to assess MTS variations over time and the Mann–Whitney test was used to verify the presence of group differences at the 1 month mark. Results Ninety-three patients were included: 57 cases (30F, 1–34 years from lesion) and 36 controls (12F, 1–35 years from lesion). Before surgery, both CASEs and CTRLs had similar MTS scores (median MTS = 3) and functional characteristics. One month after surgery, QF spasticity was significantly lower in the CASEs compared to CTRLs (p = 0.033) due to a significant reduction of the median MTS score from 3 to 0 in the CASE group (p < 0.001) and no variations in the CTRL group (p = 0.468). About half of the cases attained clinically significant MTS reductions and complete symptom relief even many years from the stroke. Conclusions Functional surgery inclusive of QF aponeurectomy can be effective in reducing or suppressing spasticity in chronic stroke patients. This is possibly a result of the reduction in neuromuscular spindle activation due to a decrease in muscle shortening, passive tension, and stiffness.
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Affiliation(s)
- Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Martina Galletti
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
- *Correspondence: Martina Galletti
| | | | - Paolo Prati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Francesca Mascioli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Giacomo Basini
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Chiara Rambelli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
- Section of Rehabilitation, Department of Neuroscience, University of Padova, Padua, Italy
| | - Stefano Masiero
- Section of Rehabilitation, Department of Neuroscience, University of Padova, Padua, Italy
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
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Lyle MA, Cuadra C, Wolf SL. Quadriceps muscle stimulation evokes heteronymous inhibition onto soleus with limited Ia activation compared to femoral nerve stimulation. Exp Brain Res 2022; 240:2375-2388. [PMID: 35881156 PMCID: PMC10314715 DOI: 10.1007/s00221-022-06422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
Heteronymous excitatory feedback from muscle spindles and inhibitory feedback from Golgi tendon organs and recurrent inhibitory circuits can influence motor coordination. The functional role of inhibitory feedback is difficult to determine, because nerve stimulation, the primary method used in humans, cannot evoke inhibition without first activating the largest diameter muscle spindle axons. Here, we tested the hypothesis that quadriceps muscle stimulation could be used to examine heteronymous inhibition more selectively when compared to femoral nerve stimulation by comparing the effects of nerve and muscle stimulation onto ongoing soleus EMG held at 20% of maximal effort. Motor threshold and two higher femoral nerve and quadriceps stimulus intensities matched by twitch evoked torque magnitudes were examined. We found that significantly fewer participants exhibited excitation during quadriceps muscle stimulation when compared to nerve stimulation (14-29% vs. 64-71% of participants across stimulation intensities) and the magnitude of heteronymous excitation from muscle stimulation, when present, was much reduced compared to nerve stimulation. Muscle and nerve stimulation resulted in heteronymous inhibition that significantly increased with increasing stimulation evoked torque magnitudes. This study provides novel evidence that muscle stimulation may be used to more selectively examine inhibitory heteronymous feedback between muscles in the human lower limb when compared to nerve stimulation.
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Affiliation(s)
- Mark A Lyle
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, N.E. Room 236D, Atlanta, GA, 30322, USA.
| | - Cristian Cuadra
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, N.E. Room 236D, Atlanta, GA, 30322, USA
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538, Santiago, Chile
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, N.E. Room 236D, Atlanta, GA, 30322, USA
- Senior Research Scientist, Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Atlanta, GA, USA
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7
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Takahashi Y, Kawakami M, Mikami R, Nakajima T, Nagumo T, Yamaguchi T, Honaga K, Kondo K, Ishii R, Fujiwara T, Liu M. Relationship between spinal reflexes and leg motor function in sub-acute and chronic stroke patients. Clin Neurophysiol 2022; 138:74-83. [DOI: 10.1016/j.clinph.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/27/2022] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
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Cruz-Montecinos C, Pérez-Alenda S, Cerda M, Maas H. Modular reorganization of gait in chronic but not in artificial knee joint constraint. J Neurophysiol 2021; 126:516-531. [PMID: 34133242 DOI: 10.1152/jn.00418.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. The aims of this study were to investigate 1) the effects of an artificial knee joint constraint on the modular organization of gait in healthy subjects; and 2) the differences in modular organization between healthy subjects with an artificial knee joint constraint and people with a similar but chronic knee joint constraint. Eleven healthy subjects and eight people with a chronic knee joint constraint walked overground at 1 m/s. The healthy subjects also walked with a constraint limiting knee joint movement to 20°. The total variance accounted (tVAF) for one to four synergies and modular organization were assessed using surface electromyography from 11 leg muscles. The distribution of number of synergies were not significantly different between groups. The tVAF and the motor modules were not significantly affected by the artificial knee constraint. A higher tVAF for one and two synergies, as well as merging of motor modules were observed in the chronic knee constraint group. We conclude that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that merging of motor modules may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.NEW & NOTEWORTHY It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. This study showed that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that modular reorganization may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mauricio Cerda
- Integrative Biology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Chow JW, Stokic DS. Relations between knee and ankle muscle coactivation and temporospatial gait measures in patients without hypertonia early after stroke. Exp Brain Res 2020; 238:2909-2919. [PMID: 33063171 DOI: 10.1007/s00221-020-05936-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/24/2020] [Indexed: 12/21/2022]
Abstract
It is unclear whether muscle coactivation during gait is altered early after stroke and among which muscles. We sought to characterize muscle coactivation during gait in subacute stroke subjects without hypertonia and explore the relationship with temporospatial parameters. In 70 stroke (23 ± 12 days post-onset) and 29 age-matched healthy subjects, surface electromyography signals were used to calculate coactivation magnitude and duration between rectus femoris and medial hamstring (knee antagonistic coactivation), tibialis anterior and medial gastrocnemius (ankle antagonistic coactivation), and rectus femoris and medial gastrocnemius (extensor synergistic coactivation) during early double-support (DS1), early single-support (SS1), late single-support (SS2), late double-support (DS2), and swing (SW). Compared to both free and very-slow speeds of controls, stroke subjects had bilaterally decreased ankle coactivation magnitude in SS2 and duration in SS1 and SS2 as well as increased extensor coactivation magnitude in DS2 and SW. Both non-paretic knee and ankle coactivation magnitudes in SS2 moderately correlated with most temporospatial parameters (|r| ≥ 0.40). Antagonistic and synergistic coactivation patterns of the knee and ankle muscles during gait are altered bilaterally in subacute stroke subjects without lower limb hypertonia suggesting impairments in motor control. Greater coactivation magnitudes in the non-paretic knee and both ankles during the terminal stance (SS2) are associated with the overall worse gait performance. Unlike previously reported excessive coactivation or no change in chronic stroke, bilaterally decreased and increased coactivation patterns are present in subacute stroke. These findings warrant longitudinal studies to examine the evolution of changes in muscle coactivation from subacute to chronic stroke.
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Affiliation(s)
- John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA.
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA
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10
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Akbas T, Kim K, Doyle K, Manella K, Lee R, Spicer P, Knikou M, Sulzer J. Rectus femoris hyperreflexia contributes to Stiff-Knee gait after stroke. J Neuroeng Rehabil 2020; 17:117. [PMID: 32843057 PMCID: PMC7448457 DOI: 10.1186/s12984-020-00724-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Stiff-Knee gait (SKG) after stroke is often accompanied by decreased knee flexion angle during the swing phase. The decreased knee flexion has been hypothesized to originate from excessive quadriceps activation. However, it is unclear whether hyperreflexia plays a role in this activation. The goal of this study was to establish the relationship between quadriceps hyperreflexia and knee flexion angle during walking in post-stroke SKG. Methods The rectus femoris (RF) H-reflex was recorded in 10 participants with post-stroke SKG and 10 healthy controls during standing and walking at the pre-swing phase. In order to attribute the pathological neuromodulation to quadriceps muscle hyperreflexia and activation, healthy individuals voluntarily increased quadriceps activity using electromyographic (EMG) feedback during standing and pre-swing upon RF H-reflex elicitation. Results We observed a negative correlation (R = − 0.92, p = 0.001) between knee flexion angle and RF H-reflex amplitude in post-stroke SKG. In contrast, H-reflex amplitude in healthy individuals in presence (R = 0.47, p = 0.23) or absence (R = − 0.17, p = 0.46) of increased RF muscle activity was not correlated with knee flexion angle. We observed a body position-dependent RF H-reflex modulation between standing and walking in healthy individuals with voluntarily increased RF activity (d = 2.86, p = 0.007), but such modulation was absent post-stroke (d = 0.73, p = 0.296). Conclusions RF reflex modulation is impaired in post-stroke SKG. The strong correlation between RF hyperreflexia and knee flexion angle indicates a possible regulatory role of spinal reflex excitability in post-stroke SKG. Interventions targeting quadriceps hyperreflexia could help elucidate the causal role of hyperreflexia on knee joint function in post-stroke SKG.
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Affiliation(s)
- Tunc Akbas
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Kyoungsoon Kim
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Kathleen Doyle
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Kathleen Manella
- University of St. Augustine for Health Sciences, Austin, TX, USA
| | - Robert Lee
- St. David's Medical Center, Austin, TX, USA
| | - Patrick Spicer
- Seton Brain and Spine Institute, Ascension Texas, University of Texas at Austin, Austin, TX, USA
| | - Maria Knikou
- Graduate Center of the City University of New York and Physical Therapy Department, College of Staten Island, New York, NY, USA
| | - James Sulzer
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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11
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Cattagni T, Geiger M, Supiot A, de Mazancourt P, Pradon D, Zory R, Roche N. A single session of anodal transcranial direct current stimulation applied over the affected primary motor cortex does not alter gait parameters in chronic stroke survivors. Neurophysiol Clin 2019; 49:283-293. [DOI: 10.1016/j.neucli.2019.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 01/20/2023] Open
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12
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Brough LG, Kautz SA, Bowden MG, Gregory CM, Neptune RR. Merged plantarflexor muscle activity is predictive of poor walking performance in post-stroke hemiparetic subjects. J Biomech 2018; 82:361-367. [PMID: 30528553 DOI: 10.1016/j.jbiomech.2018.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
Stroke is the leading cause of long-term disability and individuals post-stroke often experience impaired walking ability. The plantarflexor (PF) muscles are critical to walking through their contributions to the ground reaction forces and body segment energetics. Previous studies have shown muscle activity during walking can be grouped into co-excited muscle sets, or modules. Improper co-activation, or merging of modules, is a common impairment in individuals post-stroke. The purpose of this study was to determine the influence of merged PF modules on walking performance in individuals post stroke by examining balance control, body support and propulsion, and walking symmetry. Muscle modules were identified using non-negative matrix factorization to classify subjects as having an independent or merged PF module. The merged group had decreased balance control with a significantly higher frontal plane whole-body angular momentum than both the independent and control groups, while the independent and control groups were not significantly different. The merged group also had higher paretic braking and nonparetic propulsion than both the independent and control groups. These results remained when comparisons were limited to subjects who had the same number of modules, indicating this was not a general effect due to subjects with merged PF having fewer modules. It is likely that a merged PF module is indicative of general PF dysfunction even when some activation occurs at the appropriate time. These results suggest an independent PF module is critical to walking performance, and thus obtaining an independent PF module should be a crucial aim of stroke rehabilitation.
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Affiliation(s)
- Lydia G Brough
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Steven A Kautz
- Ralph H Johnson VA Medical Center, Charleston, SC, USA; Department of Health Sciences & Research and Division of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA
| | - Mark G Bowden
- Ralph H Johnson VA Medical Center, Charleston, SC, USA; Department of Health Sciences & Research and Division of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA
| | - Chris M Gregory
- Ralph H Johnson VA Medical Center, Charleston, SC, USA; Department of Health Sciences & Research and Division of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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13
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Kwan MSM, Hassett LM, Ada L, Canning CG. Relationship between lower limb coordination and walking speed after stroke: an observational study. Braz J Phys Ther 2018; 23:527-531. [PMID: 31708057 DOI: 10.1016/j.bjpt.2018.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Although lower limb muscle strength is associated with walking performance in people after stroke, even when there is good strength, walking speed may remain slower than normal, perhaps due to incoordination. OBJECTIVE The aim of this study was to examine the relationship between walking speed and lower limb coordination in people with good strength after stroke. METHODS An observational study was conducted with 30 people with stroke and 30 age-matched controls. Inclusion criteria for stroke were good lower limb strength (i.e., ≥Grade 4) and walking speed at >0.6m/s without aids in bare feet (with recruitment stratified so that walking speed was evenly represented across the range). Walking performance was measured as speed during the 10-m Walk Test and distance during the 6-min Walk Test. Coordination was measured using the Lower Extremity Motor Coordination Test and reported in taps/s. RESULTS Stroke survivors walked at 1.00 (SD 0.26) m/s during the10-m Walk Test (64% of normal), walked 349 (SD 94) m during the 6-min Walk Test (68% of normal), and performed the Lower Extremity Motor Coordination Test at 1.20 (SD 0.34) taps/s with the affected side (64% of normal). Lower Extremity Motor Coordination Test scores for the affected side were statistically significantly correlated with walking performance in the 10-m Walk Test (r=0.42, p=0.02) and the 6-min Walk Test (r=0.50, p=0.01). CONCLUSION Coordination was related to walking performance, suggesting that loss of coordination may contribute to slow walking in this group of stroke survivors with good strength. TRIAL REGISTRATION ANZCTR12614000856617 (www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366827).
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Affiliation(s)
- May Suk-Man Kwan
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Leanne M Hassett
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Maupas E, Dyer JO, Melo SDA, Forget R. Patellar tendon vibration reduces the increased facilitation from quadriceps to soleus in post-stroke hemiparetic individuals. Ann Phys Rehabil Med 2017; 60:319-328. [PMID: 28528818 DOI: 10.1016/j.rehab.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Stimulation of the femoral nerve in healthy people can facilitate soleus H-reflex and electromyography (EMG) activity. In stroke patients, such facilitation of transmission in spinal pathways linking the quadriceps and soleus muscles is enhanced and related to co-activation of knee and ankle extensors while sitting and walking. Soleus H-reflex facilitation can be depressed by vibration of the quadriceps in healthy people, but the effects of such vibration have never been studied on the abnormal soleus facilitation observed in people after stroke. OBJECTIVES To determine whether vibration of the quadriceps can modify the enhanced heteronymous facilitation of the soleus muscle observed in people with spastic stroke after femoral nerve stimulation and compare post-vibration effects on soleus facilitation in control and stroke individuals. METHODS Modulation of voluntary soleus EMG activity induced by femoral nerve stimulation (2×motor threshold) was assessed before, during and after vibration of the patellar tendon in 10 healthy controls and 17 stroke participants. RESULTS Voluntary soleus EMG activity was facilitated by femoral nerve stimulation in 4/10 (40%) controls and 11/17 (65%) stroke participants. The level of facilitation was greater in the stroke than control group. Vibration significantly reduced early heteronymous facilitation in both groups (50% of pre-vibration values). However, the delay in recovery of soleus facilitation after vibration was shorter for the stroke than control group. The control condition with the vibrator turned off had no effect on the modulation. CONCLUSIONS Patellar tendon vibration can reduce the facilitation between knee and ankle extensors, which suggests effective presynaptic inhibition but decreased post-activation depression in the lower limb of people after chronic hemiparetic stroke. Further studies are warranted to determine whether such vibration could be used to reduce the abnormal extension synergy of knee and ankle extensors in people after hemiparetic stroke.
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Affiliation(s)
- Eric Maupas
- ASEI, centre Paul-Dottin, 31520 Ramonville-Saint-Agne, France; Laboratoire de physiologie de la posture et du mouvement PoM, université Champollion, 81000 Albi, France.
| | - Joseph-Omer Dyer
- Centre de recherche interdisciplinaire en réadaptation, institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS du centre-Sud-de-l'Île-de-Montréal, Québec, Canada; École de réadaptation, faculté de médecine, université de Montréal, Québec, Canada
| | - Sibele de Andrade Melo
- Centre de recherche interdisciplinaire en réadaptation, institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS du centre-Sud-de-l'Île-de-Montréal, Québec, Canada; École de réadaptation, faculté de médecine, université de Montréal, Québec, Canada
| | - Robert Forget
- Centre de recherche interdisciplinaire en réadaptation, institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS du centre-Sud-de-l'Île-de-Montréal, Québec, Canada; École de réadaptation, faculté de médecine, université de Montréal, Québec, Canada
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Intrathecal baclofen bolus reduces exaggerated extensor coactivation during pre-swing and early-swing of gait after acquired brain injury. Clin Neurophysiol 2017; 128:725-733. [DOI: 10.1016/j.clinph.2017.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/30/2017] [Accepted: 02/22/2017] [Indexed: 01/05/2023]
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