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Veerkamp K, Carty CP, Waterval NFJ, Geijtenbeek T, Buizer AI, Lloyd DG, Harlaar J, van der Krogt MM. Predicting Gait Patterns of Children With Spasticity by Simulating Hyperreflexia. J Appl Biomech 2023; 39:334-346. [PMID: 37532263 DOI: 10.1123/jab.2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 08/04/2023]
Abstract
Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was performed to extract distinct gait patterns from experimental gait data of 17 children with spasticity to be used as comparative validation data. A forward dynamic simulation framework was employed to predict gait with either velocity- or force-based hyperreflexia. This framework entailed a generic musculoskeletal model controlled by reflexes and supraspinal drive, governed by a multiobjective cost function. Hyperreflexia values were optimized to enable the simulated gait to best match experimental gait patterns. Three experimental gait patterns were extracted: (1) increased knee flexion, (2) increased ankle plantar flexion, and (3) increased knee flexion and ankle plantar flexion when compared with typical gait. Overall, velocity-based hyperreflexia outperformed force-based hyperreflexia. The first gait pattern could mostly be explained by rectus femoris and hamstrings velocity-based hyperreflexia, the second by gastrocnemius velocity-based hyperreflexia, and the third by gastrocnemius, soleus, and hamstrings velocity-based hyperreflexia. This study shows how velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, which may help in providing targeted treatment.
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Affiliation(s)
- Kirsten Veerkamp
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD,Australia
- Griffith Centre of Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD,Australia
- Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD,Australia
| | - Christopher P Carty
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD,Australia
- Griffith Centre of Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD,Australia
- Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD,Australia
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, QLD,Australia
| | - Niels F J Waterval
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam,The Netherlands
| | - Thomas Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft,The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam,The Netherlands
| | - David G Lloyd
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD,Australia
- Griffith Centre of Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD,Australia
- Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD,Australia
| | - Jaap Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft,The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam,The Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam,The Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam,The Netherlands
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Lassmann C, Ilg W, Rattay TW, Schöls L, Giese M, Haeufle DFB. Dysfunctional neuro-muscular mechanisms explain gradual gait changes in prodromal spastic paraplegia. J Neuroeng Rehabil 2023; 20:90. [PMID: 37454121 PMCID: PMC10349428 DOI: 10.1186/s12984-023-01206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND In Hereditary Spastic Paraplegia (HSP) type 4 (SPG4) a length-dependent axonal degeneration in the cortico-spinal tract leads to progressing symptoms of hyperreflexia, muscle weakness, and spasticity of lower extremities. Even before the manifestation of spastic gait, in the prodromal phase, axonal degeneration leads to subtle gait changes. These gait changes - depicted by digital gait recording - are related to disease severity in prodromal and early-to-moderate manifest SPG4 participants. METHODS We hypothesize that dysfunctional neuro-muscular mechanisms such as hyperreflexia and muscle weakness explain these disease severity-related gait changes of prodromal and early-to-moderate manifest SPG4 participants. We test our hypothesis in computer simulation with a neuro-muscular model of human walking. We introduce neuro-muscular dysfunction by gradually increasing sensory-motor reflex sensitivity based on increased velocity feedback and gradually increasing muscle weakness by reducing maximum isometric force. RESULTS By increasing hyperreflexia of plantarflexor and dorsiflexor muscles, we found gradual muscular and kinematic changes in neuro-musculoskeletal simulations that are comparable to subtle gait changes found in prodromal SPG4 participants. CONCLUSIONS Predicting kinematic changes of prodromal and early-to-moderate manifest SPG4 participants by gradual alterations of sensory-motor reflex sensitivity allows us to link gait as a directly accessible performance marker to emerging neuro-muscular changes for early therapeutic interventions.
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Affiliation(s)
- Christian Lassmann
- Multi-level Modeling in Motor Control and Rehabilitation Robotics, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Department of Computer Engineering, Wilhelm-Schickard-Institute for Computer Science, University of Tuebingen, Tuebingen, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Centre for Integrative Neuroscience (CIN), Tuebingen, Germany
| | - Tim W. Rattay
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Center for Rare Diseases (ZSE), University of Tuebingen, Tuebingen, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Center for Rare Diseases (ZSE), University of Tuebingen, Tuebingen, Germany
| | - Martin Giese
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Centre for Integrative Neuroscience (CIN), Tuebingen, Germany
| | - Daniel F. B. Haeufle
- Multi-level Modeling in Motor Control and Rehabilitation Robotics, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Centre for Integrative Neuroscience (CIN), Tuebingen, Germany
- Institute for Modeling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany
- Institute of Computer Engineering (ZITI), Heidelberg University, Heidelberg, Germany
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Mackay S, Walker M, Williams G. Focal muscle spasticity has little impact on muscle power for walking in people with Traumatic Brain Injury. Clin Biomech (Bristol, Avon) 2023; 107:105978. [PMID: 37295342 DOI: 10.1016/j.clinbiomech.2023.105978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Spasticity is prevalent following Traumatic Brain Injury. 'Focal' muscle spasticity has been defined as spasticity affecting a localised muscle group, but it's impact on gait kinetics remains unclear. The aim of this study was to investigate the relationship between focal muscle spasticity and gait kinetics following Traumatic Brain Injury. METHODS Ninety-three participants attending physiotherapy for mobility limitations following Traumatic Brain Injury were invited to participate in the study. Participants underwent clinical gait analysis and were grouped depending on the presence or absence of focal muscle spasticity. Kinetic data was obtained for each sub-group, and participants were compared to healthy controls. FINDINGS Hip extensor power generation at initial contact, hip flexor power generation at terminal stance, and knee extensor power absorption at terminal stance were all significantly increased, and ankle power generation was significantly reduced at push-off when comparing Traumatic Brain Injury to healthy control populations. There were only two significant differences between participants with and without focal muscle spasticity, hip extensor power generation at initial contact was increased (1.53 vs 1.03 W/kg, P < .05) for those with focal hamstring spasticity, and knee extensor power absorption in early stance was reduced (-0.28 vs -0.64 W/kg, P < .05) for those with focal rectus femoris spasticity. However, these results should be interpreted with caution as the sub-group of participants with focal hamstring and rectus femoris spasticity was small. INTERPRETATION Focal muscle spasticity had little association with abnormal gait kinetics in this cohort of independently ambulant people with Traumatic Brain Injury.
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Affiliation(s)
- Sarah Mackay
- Physiotherapy Department, Epworth Hospital, Richmond 3121, Melbourne, Australia.
| | - Meg Walker
- Physiotherapy Department, Epworth Hospital, Richmond 3121, Melbourne, Australia
| | - Gavin Williams
- Physiotherapy Department, Epworth Hospital, Richmond 3121, Melbourne, Australia; School of Physiotherapy, University of Melbourne, Victoria 3010, Australia
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Williams G, Banky M. Association of Lower Limb Focal Spasticity With Kinematic Variables During Walking in Traumatic Brain Injury. J Neurol Phys Ther 2022; 46:213-218. [PMID: 35404881 DOI: 10.1097/npt.0000000000000400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Focal muscle spasticity is defined as spasticity that affects a localized group of muscles. It is prevalent in many adult-onset neurological conditions, yet the relationship of focal muscle spasticity with walking remains unclear. Therefore, the aim of this study was to determine the relationship of focal muscle spasticity with the kinematics of walking in traumatic brain injury (TBI). METHODS Ninety-one participants with TBI underwent clinical gait analysis and assessment of focal lower limb muscle spasticity in a prospective cross-sectional study. A matched group of 25 healthy controls (HCs) were recruited to establish a reference dataset. Kinematic data for each person with and without focal muscle spasticity following TBI were compared with the HC cohort at a matched walking speed. RESULTS The TBI and HC cohorts were well matched. Only those with focal hamstring muscle spasticity walked significantly different to those without. They had significantly greater knee flexion (23.4° compared with 10.5°, P < 0.01) at initial contact. There were no other significant differences in kinematic variables between those with and without focal muscle spasticity. There was no significant association between focal muscle spasticity and walking speed. DISCUSSION AND CONCLUSIONS Focal muscle spasticity and abnormal kinematics whilst walking were common in this cohort of people with TBI. However, focal muscle spasticity had little relationship with kinematic variables, and no significant relationship with walking speed. This finding has implications for the treatment of focal muscle spasticity to improve walking following TBI. Focal muscle spasticity had little relationship with kinematic variables and walking speed in this cohort of people with TBI who could walk without assistance.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A381).
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Affiliation(s)
- Gavin Williams
- The University of Melbourne, Melbourne, Australia (G.W.); and Epworth Healthcare, Richmond, Australia (G.W., M.B.)
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Bruel A, Ghorbel SB, Russo AD, Stanev D, Armand S, Courtine G, Ijspeert A. Investigation of neural and biomechanical impairments leading to pathological toe and heel gaits using neuromusculoskeletal modelling. J Physiol 2022; 600:2691-2712. [PMID: 35442531 PMCID: PMC9401908 DOI: 10.1113/jp282609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/11/2022] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Pathological toe and heel gaits are commonly present in various conditions such as spinal cord injury, stroke or cerebral palsy. These conditions present various neural and biomechanical impairments and the cause-effect relationships between these impairments and pathological gaits are hard to establish clinically. Based on neuromechanical simulation, this study focuses on the plantarflexor muscles and builds a new reflex circuit controller to model and evaluate the potential effect of both neural and biomechanical impairments on gait. Our results suggest an important contribution of active reflex mechanisms in pathological toe gait. This "what if" based on neuromechanical modelling is thus deemed of great interest to target potential pathological gait causes. ABSTRACT This study investigates the pathological toe and heel gaits in human locomotion using neuromusculoskeletal modelling and simulation. In particular, it aims at investigating potential cause-effect relationships between biomechanical or neural impairments and pathological gaits. Toe and heel gaits are commonly present in spinal cord injury, stroke or cerebral palsy. Toe walking is mainly attributed to spasticity and contracture at plantarflexor muscles, whereas heel walking can be attributed to muscle weakness from biomechanical or neural origin. To investigate the effect of these impairments on gait, this study focuses on the soleus and gastrocnemius muscles as they contribute to ankle plantarflexion. We built a reflex circuit model on top of Geyer and Herr's work (2010) with additional pathways affecting the plantarflexor muscles. The SCONE software, which provides optimisation tools for 2D neuromechanical simulation of human locomotion, is used to optimise the corresponding reflex parameters and simulate healthy gait. We then modelled various bilateral plantarflexors biomechanical and neural impairments, and individually introduced them in the healthy model. We characterised the resulting simulated gaits as pathological or not by comparing ankle kinematics and ankle moment with the healthy optimised gait based on metrics used in clinical studies. Our simulations suggest that toe walking can be generated by hyperreflexia, whereas muscle and neural weaknesses induce partially heel gait. Thus, this "what if" approach is deemed of great interest as it allows the investigation of the effect of various impairments on gait and suggests an important contribution of active reflex mechanisms in pathological toe gait. Abstract figure legend Various biomechanical and neural impairments are individually modelled at the level of the plantarflexor muscles in a musculoskeletal model and a complex reflex circuit-based gait controller. For instance, as shown on the left, the plantarflexors spindle reflex gain (KS) is increased to mimic hyperreflexia. The gait controller is then optimised for each of the impaired condition and the resulting gaits are characterised as pathological gait based on ankle kinematics and ankle moment metrics used in clinical studies. Thus, this "what if" approach allows the investigation of the effect of various impairments on gait presented in the table on the right. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alice Bruel
- BioRobotics laboratory, EPFL, Lausanne, 1015, Switzerland
| | | | | | - Dimitar Stanev
- BioRobotics laboratory, EPFL, Lausanne, 1015, Switzerland
| | | | | | - Auke Ijspeert
- BioRobotics laboratory, EPFL, Lausanne, 1015, Switzerland
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A Conceptual Blueprint for Making Neuromusculoskeletal Models Clinically Useful. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052037] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on the design of clinical treatments for movement impairments. Such impairments are caused by common conditions such as stroke, osteoarthritis, Parkinson’s disease, spinal cord injury, cerebral palsy, limb amputation, and even cancer. The lack of clinical impact is somewhat surprising given that comparable computational technology has transformed the design of airplanes, automobiles, and other commercial products over the same time period. This paper provides the author’s personal perspective for how neuromusculoskeletal models can become clinically useful. First, the paper motivates the potential value of neuromusculoskeletal models for clinical treatment design. Next, it highlights five challenges to achieving clinical utility and provides suggestions for how to overcome them. After that, it describes clinical, technical, collaboration, and practical needs that must be addressed for neuromusculoskeletal models to fulfill their clinical potential, along with recommendations for meeting them. Finally, it discusses how more complex modeling and experimental methods could enhance neuromusculoskeletal model fidelity, personalization, and utilization. The author hopes that these ideas will provide a conceptual blueprint that will help the neuromusculoskeletal modeling research community work toward clinical utility.
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Akbas T, Sulzer J. Musculoskeletal simulation framework for impairment-based exoskeletal assistance post-stroke. IEEE Int Conf Rehabil Robot 2020; 2019:1185-1190. [PMID: 31374790 DOI: 10.1109/icorr.2019.8779564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Assistive technology for the lower extremities has shown great promise towards improving gait function in people following neuromuscular injuries. However, our previous work assisting knee flexion torque in post-stroke Stiff-Knee gait found that augmenting strength can induce secondary complications such as spasticity due to stretching of the rectus femoris. In this work we explore whether we could have obtained improved knee flexion but avoided a spastic response by simulating combinations of hip and knee flexion torques using musculoskeletal modeling and simulation. We explore previously collected data on a case-by-case basis to determine individual-specific quadriceps reflex thresholds based on estimated rectus femoris muscle fiber stretch velocities. We then implemented a forward simulation framework to identify the subject-specific hip-knee assistance prescription to improve knee range of motion without initiating a spastic response. The obtained subject-specific assistive prescription informs the development of new gait assistance strategies for post-stroke gait and could be extended to other neuromuscular gait impairments.
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Moissenet F, Bélaise C, Piche E, Michaud B, Begon M. An Optimization Method Tracking EMG, Ground Reactions Forces, and Marker Trajectories for Musculo-Tendon Forces Estimation in Equinus Gait. Front Neurorobot 2019; 13:48. [PMID: 31379547 PMCID: PMC6646662 DOI: 10.3389/fnbot.2019.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Abstract
In the context of neuro-orthopedic pathologies affecting walking and thus patients' quality of life, understanding the mechanisms of gait deviations and identifying the causal motor impairments is of primary importance. Beside other approaches, neuromusculoskeletal simulations may be used to provide insight into this matter. To the best of our knowledge, no computational framework exists in the literature that allows for predictive simulations featuring muscle co-contractions, and the introduction of various types of perturbations during both healthy and pathological gait types. The aim of this preliminary study was to adapt a recently proposed EMG-marker tracking optimization process to a lower limb musculoskeletal model during equinus gait, a multiphase problem with contact forces. The resulting optimization method tracking EMG, ground reactions forces, and marker trajectories allowed an accurate reproduction of joint kinematics (average error of 5.4 ± 3.3 mm for pelvis translations, and 1.9 ± 1.3° for pelvis rotation and joint angles) and ensured good temporal agreement in muscle activity (the concordance between estimated and measured excitations was 76.8 ± 5.3 %) in a relatively fast process (3.88 ± 1.04 h). We have also highlighted that the tracking of ground reaction forces was possible and accurate (average error of 17.3 ± 5.5 N), even without the use of a complex foot-ground contact model.
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Affiliation(s)
- Florent Moissenet
- Centre National de Rééducation Fonctionnelle et de Réadaptation-Rehazenter, Luxembourg, Luxembourg
| | - Colombe Bélaise
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada
| | - Elodie Piche
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada
| | - Benjamin Michaud
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada.,Sainte-Justine Hospital Research Center, Montreal, QC, Canada
| | - Mickaël Begon
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada.,Sainte-Justine Hospital Research Center, Montreal, QC, Canada
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Computational modeling of neuromuscular response to swing-phase robotic knee extension assistance in cerebral palsy. J Biomech 2019; 87:142-149. [PMID: 30862380 DOI: 10.1016/j.jbiomech.2019.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/29/2019] [Accepted: 02/27/2019] [Indexed: 11/20/2022]
Abstract
Predicting subject-specific responses to exoskeleton assistance may aid in maximizing functional gait outcomes, such as achieving full knee-extension at foot contact in individuals with crouch gait from cerebral palsy (CP). The purpose of this study was to investigate the role of volitional and non-volitional muscle activity in subject-specific responses to knee extension assistance during walking with an exoskeleton. We developed a simulation framework to predict responses to exoskeleton torque by applying a stretch-reflex spasticity model with muscle excitations computed during unassisted walking. The framework was validated with data collected from six individuals with CP. Framework-predicted knee angle at terminal swing was within 4 ± 4° (mean ± sd) of the knee angle measured experimentally without the addition of spasticity. Kinematic responses in two-thirds of the participants could be accurately modeled using only underlying muscle activity and the applied exoskeleton torque; incorporating hamstring spasticity was necessary to recreate the measured kinematics to within 1 ± 1° in the remaining participants. We observed strong positive linear relationships between knee extension and exoskeleton assistance, and strong negative quadratic relationships between knee extension and spasticity. We utilized our framework to identify optimal torque profiles necessary to achieve full knee-extension at foot contact. An angular impulse of 0.061 ± 0.025 Nm·s·kg-1·deg-1 with 0.013 ± 0.002 Nm·kg-1·deg-1 of peak torque and 4.1 ± 1.9 W·kg-1·deg-1 peak mechanical power was required to achieve full knee extension (values normalized by knee excursion). This framework may aid the prescription of exoskeleton control strategies in pathologies with muscle spasticity. https://simtk.org/projects/knee-exo-pred/.
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Akbas T, Neptune RR, Sulzer J. Neuromusculoskeletal Simulation Reveals Abnormal Rectus Femoris-Gluteus Medius Coupling in Post-stroke Gait. Front Neurol 2019; 10:301. [PMID: 31001189 PMCID: PMC6454148 DOI: 10.3389/fneur.2019.00301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Abstract
Post-stroke gait is often accompanied by muscle impairments that result in adaptations such as hip circumduction to compensate for lack of knee flexion. Our previous work robotically enhanced knee flexion in individuals post-stroke with Stiff-Knee Gait (SKG), however, this resulted in greater circumduction, suggesting the existence of abnormal coordination in SKG. The purpose of this work is to investigate two possible mechanisms of the abnormal coordination: (1) a reflex coupling between stretched quadriceps and abductors, and (2) a coupling between volitionally activated knee flexors and abductors. We used previously collected kinematic, kinetic and EMG measures from nine participants with chronic stroke and five healthy controls during walking with and without the applied knee flexion torque perturbations in the pre-swing phase of gait in the neuromusculoskeletal simulation. The measured muscle activity was supplemented by simulated muscle activations to estimate the muscle states of the quadriceps, hamstrings and hip abductors. We used linear mixed models to investigate two hypotheses: (H1) association between quadriceps and abductor activation during an involuntary period (reflex latency) following the perturbation and (H2) association between hamstrings and abductor activation after the perturbation was removed. We observed significantly higher rectus femoris (RF) activation in stroke participants compared to healthy controls within the involuntary response period following the perturbation based on both measured (H1, p < 0.001) and simulated (H1, p = 0.022) activity. Simulated RF and gluteus medius (GMed) activations were correlated only in those with SKG, which was significantly higher compared to healthy controls (H1, p = 0.030). There was no evidence of synergistic coupling between any combination of hamstrings and hip abductors (H2, p > 0.05) when the perturbation was removed. The RF-GMed coupling suggests an underlying abnormal coordination pattern in post-stroke SKG, likely reflexive in origin. These results challenge earlier assumptions that hip circumduction in stroke is simply a kinematic adaptation due to reduced toe clearance. Instead, abnormal coordination may underlie circumduction, illustrating the deleterious role of abnormal coordination in post-stroke gait.
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Affiliation(s)
| | | | - James Sulzer
- Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, United States
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Abedi M, Moghaddam MM, Fallah D. A Poincare map based analysis of stroke patients' walking after a rehabilitation by a robot. Math Biosci 2018. [PMID: 29518402 DOI: 10.1016/j.mbs.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Since the past decade, rehabilitation robots have become common technologies for recovering gait ability after a stroke. Nevertheless, it is believed that these robots can be further enhanced. Hence, several researches are making progress in optimizing gait rehabilitation robots. However, most of these researches have only assessed the robots and their controllers in improving spatiotemporal and kinetic features of walking. There are not many researchers have focused on the robots' controllers' effects on the central nervous or neuromuscular systems. On the other hand, recently computational methods have been utilized to investigate the rehabilitations of neural disorders, through developing neuromechanical models. However, these methods have neither studied the robot-assisted gait rehabilitation, nor have they theoretically proved why rehabilitation exercises enhance patients' walking ability. Therefore, this paper merged a theoretical approach into a computational method to investigate the effects of gait rehabilitation robots on post-stroke neuromuscular system. To this end, a neuromechanical model of gait has been developed and thereby, the Poincare maps of intact and stroke people have been obtained. Comparison of these maps revealed why a stroke reduces the stability of walking. Then, the effect of an impedance controller, which is used in a rehabilitative robot, is scrutinized in stabilizing a walking motion. Obtaining the Poincare map of this close-loop system, proved that this controller improves motion stability. Finally, the effect of this controller is investigated by simulations and experiments. The experimental tests are performed by Arman rehabilitative robot. Clinical Reference Number: IR.TMU.REC.1394.254.
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Affiliation(s)
- Mohsen Abedi
- Department of Mechanical Engineering, Tarbiat Modares University, Nasr Bridge, Jalal Al Ahmad Street, Tehran, Iran
| | - Majid M Moghaddam
- Department of Mechanical Engineering, Tarbiat Modares University, Nasr Bridge, Jalal Al Ahmad Street, Tehran, Iran.
| | - Davoud Fallah
- Department of Mechanical Engineering, Tarbiat Modares University, Nasr Bridge, Jalal Al Ahmad Street, Tehran, Iran
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Caiafa RC, Orsini M, Felicio LR, Puccioni-Sohler M. Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:280-6. [PMID: 27096999 DOI: 10.1590/0004-282x20160019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022]
Abstract
UNLABELLED HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities. OBJECTIVE To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients. METHOD We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients. RESULTS The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings. CONCLUSION The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients.
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Affiliation(s)
| | - Marco Orsini
- Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Lilian R Felicio
- Faculdade de Fisioterapia, Universidade Federal de Uberlândia, Uberlandia, MG, Brazil
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van der Krogt MM, Bar-On L, Kindt T, Desloovere K, Harlaar J. Neuro-musculoskeletal simulation of instrumented contracture and spasticity assessment in children with cerebral palsy. J Neuroeng Rehabil 2016; 13:64. [PMID: 27423898 PMCID: PMC4947289 DOI: 10.1186/s12984-016-0170-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 06/29/2016] [Indexed: 11/21/2022] Open
Abstract
Background Increased resistance in muscles and joints is an important phenomenon in patients with cerebral palsy (CP), and is caused by a combination of neural (e.g. spasticity) and non-neural (e.g. contracture) components. The aim of this study was to simulate instrumented, clinical assessment of the hamstring muscles in CP using a conceptual model of contracture and spasticity, and to determine to what extent contracture can be explained by altered passive muscle stiffness, and spasticity by (purely) velocity-dependent stretch reflex. Methods Instrumented hamstrings spasticity assessment was performed on 11 children with CP and 9 typically developing children. In this test, the knee was passively stretched at slow and fast speed, and knee angle, applied forces and EMG were measured. A dedicated OpenSim model was created with motion and muscles around the knee only. Contracture was modeled by optimizing the passive muscle stiffness parameters of vasti and hamstrings, based on slow stretch data. Spasticity was modeled using a velocity-dependent feedback controller, with threshold values derived from experimental data and gain values optimized for individual subjects. Forward dynamic simulations were performed to predict muscle behavior during slow and fast passive stretches. Results Both slow and fast stretch data could be successfully simulated by including subject-specific levels of contracture and, for CP fast stretches, spasticity. The RMS errors of predicted knee motion in CP were 1.1 ± 0.9° for slow and 5.9 ± 2.1° for fast stretches. CP hamstrings were found to be stiffer compared with TD, and both hamstrings and vasti were more compliant than the original generic model, except for the CP hamstrings. The purely velocity-dependent spasticity model could predict response during fast passive stretch in terms of predicted knee angle, muscle activity, and fiber length and velocity. Only sustained muscle activity, independent of velocity, was not predicted by our model. Conclusion The presented individually tunable, conceptual model for contracture and spasticity could explain most of the hamstring muscle behavior during slow and fast passive stretch. Future research should attempt to apply the model to study the effects of spasticity and contracture during dynamic tasks such as gait. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0170-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marjolein Margaretha van der Krogt
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Thalia Kindt
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Involvement of PARP1 in the regulation of alternative splicing. Cell Discov 2016; 2:15046. [PMID: 27462443 PMCID: PMC4860959 DOI: 10.1038/celldisc.2015.46] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 12/18/2022] Open
Abstract
Specialized chromatin structures such as nucleosomes with specific histone modifications decorate exons in eukaryotic genomes, suggesting a functional connection between chromatin organization and the regulation of pre-mRNA splicing. Through profiling the functional location of Poly (ADP) ribose polymerase, we observed that it is associated with the nucleosomes at exon/intron boundaries of specific genes, suggestive of a role for this enzyme in alternative splicing. Poly (ADP) ribose polymerase has previously been implicated in the PARylation of splicing factors as well as regulation of the histone modification H3K4me3, a mark critical for co-transcriptional splicing. In light of these studies, we hypothesized that interaction of the chromatin-modifying factor, Poly (ADP) ribose polymerase with nucleosomal structures at exon–intron boundaries, might regulate pre-mRNA splicing. Using genome-wide approaches validated by gene-specific assays, we show that depletion of PARP1 or inhibition of its PARylation activity results in changes in alternative splicing of a specific subset of genes. Furthermore, we observed that PARP1 bound to RNA, splicing factors and chromatin, suggesting that Poly (ADP) ribose polymerase serves as a gene regulatory hub to facilitate co-transcriptional splicing. These studies add another function to the multi-functional protein, Poly (ADP) ribose polymerase, and provide a platform for further investigation of this protein’s function in organizing chromatin during gene regulatory processes.
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Mansouri M, Clark AE, Seth A, Reinbolt JA. Rectus femoris transfer surgery affects balance recovery in children with cerebral palsy: A computer simulation study. Gait Posture 2016; 43:24-30. [PMID: 26669947 DOI: 10.1016/j.gaitpost.2015.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 02/02/2023]
Abstract
Stiff-knee gait is a troublesome movement disorder among children with cerebral palsy (CP), where peak swing phase knee flexion is diminished due to over-activity of the rectus femoris muscle. A common treatment for stiff-knee gait, rectus femoris transfer surgery, moves the muscle's distal tendon from the patella to the sartorius insertion on the tibia. As a biarticular muscle, rectus femoris may play a role in motor control and have unrecognized benefits for maintaining balance. We used musculoskeletal modeling, neuromuscular control, and forward dynamic simulation to investigate the role of rectus femoris tendon transfer surgery on balance recovery after support-surface perturbations for children with CP adopting two different crouched postures. We combined both high-level supraspinal and low-level spinal signals to generate 92 muscle excitations for tracking experimental whole body center of mass positions and velocities. Stability during balance recovery was evaluated by the minimum distance between the extrapolated center of mass and base of support boundary (bmin) and the minimum time to reach the boundary (TtBmin). The balance recovery of pre-surgical simulations (bmin=2.3+1.1cm, TtBmin=0.2+0.1s) were different (p=0.02), on average, than post-surgical simulations (bmin=-4.9+11.4cm, TtBmin=-0.1+0.3s) of rectus femoris transfers. The moderate crouch simulations (bmin=2.4+0.4cm, TtBmin=0.2+0.03s) were more stable than the mild crouch simulations (bmin=1.2+0.3cm, TtBmin=0.1+0.02s) following anterior translations of the support surface. These findings suggest that tendon transfer of rectus femoris affects balance recovery in children with CP.
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Affiliation(s)
- Misagh Mansouri
- Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA.
| | - Ashley E Clark
- Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Ajay Seth
- Bioengineering, Stanford University, Stanford, CA, USA
| | - Jeffrey A Reinbolt
- Mechanical, Aerospace and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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Abedi M, Moghaddam MM, Firoozabadi M. A neuromechanical modeling of spinal cord injury locomotor system for simulating the rehabilitation effects. Biocybern Biomed Eng 2016. [DOI: 10.1016/j.bbe.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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