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A Study on the Evaluation of the Effect of Exercise on the Treatment of Chronic Diseases Based on a Digital Human Movement Model. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1984145. [PMID: 35140899 PMCID: PMC8820862 DOI: 10.1155/2022/1984145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to summarise the therapeutic effects of exercise interventions for common chronic diseases and to analyse the scope of application and problems of various exercise treatment protocols, with a view to guiding clinical practice and providing references for subsequent research. To this end, this paper describes how to extract feature parameters for gait analysis based on a digital human motion model. In-depth descriptions of the extraction algorithms for spatiotemporal features, centre-of-mass movement features, joint mobility, and joint contact forces are presented, and the reliability of the knee contact force extraction algorithm is analysed in particular. To analyse the effect of exercise on the treatment of chronic diseases, 50 cases of elderly chronic disease patients collected from the community were selected and subjected to healthy exercise for 1 year, before and after the healthy exercise. After the exercise, the elderly chronic disease patients' blood pressure, lipid, and blood glucose attainment rates, chronic diseases, and knowledge of nonpharmacological treatments were significantly higher, with statistically significant differences compared to the preexercise period (P < 0.05).
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Shepard CT, Pocratsky AM, Brown BL, Van Rijswijck MA, Zalla RM, Burke DA, Morehouse JR, Riegler AS, Whittemore SR, Magnuson DSK. Silencing long ascending propriospinal neurons after spinal cord injury improves hindlimb stepping in the adult rat. eLife 2021; 10:e70058. [PMID: 34854375 PMCID: PMC8639151 DOI: 10.7554/elife.70058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022] Open
Abstract
Long ascending propriospinal neurons (LAPNs) are a subpopulation of spinal cord interneurons that directly connect the lumbar and cervical enlargements. Previously we showed, in uninjured animals, that conditionally silencing LAPNs disrupted left-right coordination of the hindlimbs and forelimbs in a context-dependent manner, demonstrating that LAPNs secure alternation of the fore- and hindlimb pairs during overground stepping. Given the ventrolateral location of LAPN axons in the spinal cord white matter, many likely remain intact following incomplete, contusive, thoracic spinal cord injury (SCI), suggesting a potential role in the recovery of stepping. Thus, we hypothesized that silencing LAPNs after SCI would disrupt recovered locomotion. Instead, we found that silencing spared LAPNs post-SCI improved locomotor function, including paw placement order and timing, and a decrease in the number of dorsal steps. Silencing also restored left-right hindlimb coordination and normalized spatiotemporal features of gait such as stance and swing time. However, hindlimb-forelimb coordination was not restored. These data indicate that the temporal information carried between the spinal enlargements by the spared LAPNs post-SCI is detrimental to recovered hindlimb locomotor function. These findings are an illustration of a post-SCI neuroanatomical-functional paradox and have implications for the development of neuronal- and axonal-protective therapeutic strategies and the clinical study/implementation of neuromodulation strategies.
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Affiliation(s)
- Courtney T Shepard
- Interdisciplinary Program in Translational Neuroscience, School of Interdisciplinary and Graduate Studies, University of LouisvilleLouisvilleUnited States
- Department of Anatomical Sciences and Neurobiology, University of Louisville, LouisvilleLouisvilleUnited States
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
| | - Amanda M Pocratsky
- Department of Anatomical Sciences and Neurobiology, University of Louisville, LouisvilleLouisvilleUnited States
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
| | - Brandon L Brown
- Interdisciplinary Program in Translational Neuroscience, School of Interdisciplinary and Graduate Studies, University of LouisvilleLouisvilleUnited States
- Department of Anatomical Sciences and Neurobiology, University of Louisville, LouisvilleLouisvilleUnited States
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
| | - Morgan A Van Rijswijck
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
- Speed School of Engineering, University of LouisvilleLouisvilleUnited States
| | - Rachel M Zalla
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
- Speed School of Engineering, University of LouisvilleLouisvilleUnited States
| | - Darlene A Burke
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
- Department of Neurological Surgery, University of LouisvilleLouisvilleUnited States
| | - Johnny R Morehouse
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
- Department of Neurological Surgery, University of LouisvilleLouisvilleUnited States
| | - Amberley S Riegler
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
- Department of Neurological Surgery, University of LouisvilleLouisvilleUnited States
| | - Scott R Whittemore
- Interdisciplinary Program in Translational Neuroscience, School of Interdisciplinary and Graduate Studies, University of LouisvilleLouisvilleUnited States
- Department of Anatomical Sciences and Neurobiology, University of Louisville, LouisvilleLouisvilleUnited States
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
- Department of Neurological Surgery, University of LouisvilleLouisvilleUnited States
| | - David SK Magnuson
- Interdisciplinary Program in Translational Neuroscience, School of Interdisciplinary and Graduate Studies, University of LouisvilleLouisvilleUnited States
- Department of Anatomical Sciences and Neurobiology, University of Louisville, LouisvilleLouisvilleUnited States
- Kentucky Spinal Cord Injury Research Center, University of LouisvilleLouisvilleUnited States
- Speed School of Engineering, University of LouisvilleLouisvilleUnited States
- Department of Neurological Surgery, University of LouisvilleLouisvilleUnited States
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Hofstoetter US, Freundl B, Lackner P, Binder H. Transcutaneous Spinal Cord Stimulation Enhances Walking Performance and Reduces Spasticity in Individuals with Multiple Sclerosis. Brain Sci 2021; 11:brainsci11040472. [PMID: 33917893 PMCID: PMC8068213 DOI: 10.3390/brainsci11040472] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
Gait dysfunction and spasticity are common debilitating consequences of multiple sclerosis (MS). Improvements of these motor impairments by lumbar transcutaneous spinal cord stimulation (tSCS) have been demonstrated in spinal cord injury. Here, we explored for the first time the motor effects of lumbar tSCS applied at 50 Hz for 30 min in 16 individuals with MS and investigated their temporal persistence post-intervention. We used a comprehensive protocol assessing walking ability, different presentations of spasticity, standing ability, manual dexterity, and trunk control. Walking ability, including walking speed and endurance, was significantly improved for two hours beyond the intervention and returned to baseline after 24 h. Muscle spasms, clonus duration, and exaggerated stretch reflexes were reduced for two hours, and clinically assessed lower-extremity muscle hypertonia remained at improved levels for 24 h post-intervention. Further, postural sway during normal standing with eyes open was decreased for two hours. No changes were detected in manual dexterity and trunk control. Our results suggest that transcutaneous lumbar SCS can serve as a clinically accessible method without known side effects that holds the potential for substantial clinical benefit across the disability spectrum of MS.
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Affiliation(s)
- Ursula S. Hofstoetter
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Brigitta Freundl
- Neurological Center, Klinik Penzing—Wiener Gesundheitsverbund, 1140 Vienna, Austria; (B.F.); (P.L.); (H.B.)
| | - Peter Lackner
- Neurological Center, Klinik Penzing—Wiener Gesundheitsverbund, 1140 Vienna, Austria; (B.F.); (P.L.); (H.B.)
| | - Heinrich Binder
- Neurological Center, Klinik Penzing—Wiener Gesundheitsverbund, 1140 Vienna, Austria; (B.F.); (P.L.); (H.B.)
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Hofstoetter US, Freundl B, Danner SM, Krenn MJ, Mayr W, Binder H, Minassian K. Transcutaneous Spinal Cord Stimulation Induces Temporary Attenuation of Spasticity in Individuals with Spinal Cord Injury. J Neurotrauma 2019; 37:481-493. [PMID: 31333064 DOI: 10.1089/neu.2019.6588] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Epidural spinal cord stimulation (SCS) is currently regarded as a breakthrough procedure for enabling movement after spinal cord injury (SCI), yet one of its original applications was for spinal spasticity. An emergent method that activates similar target neural structures non-invasively is transcutaneous SCS. Its clinical value for spasticity control would depend on inducing carry-over effects, because the surface-electrode-based approach cannot be applied chronically. We evaluated single-session effects of transcutaneous lumbar SCS in 12 individuals with SCI by a test-battery approach, before, immediately after and 2 h after intervention. Stimulation was applied for 30 min at 50 Hz with an intensity sub-threshold for eliciting reflexes in lower extremity muscles. The tests included evaluations of stretch-induced spasticity (Modified Ashworth Scale [MAS] sum score, pendulum test, electromyography-based evaluation of tonic stretch reflexes), clonus, cutaneous-input-evoked spasms, and the timed 10 m walk test. Across participants, the MAS sum score, clonus, and spasms were significantly reduced immediately after SCS, and all spasticity measures were improved 2 h post-intervention, with large effect sizes and including clinically meaningful improvements. The effect on walking speed varied across individuals. We further conducted a single-case multi-session study over 6 weeks to explore the applicability of transcutaneous SCS as a home-based therapy. Self-application of the intervention was successful; weekly evaluations suggested progressively improving therapeutic effects during the active period and carry-over effects for 7 days. Our results suggest that transcutaneous SCS can be a viable non-pharmacological option for managing spasticity, likely working through enhancing pre- and post-synaptic spinal inhibitory mechanisms, and may additionally serve to identify responders to treatments with epidural SCS.
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Affiliation(s)
- Ursula S Hofstoetter
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Brigitta Freundl
- Neurological Center, SMZ Baumgartner Hoehe, Otto-Wagner-Hospital, Vienna, Austria
| | - Simon M Danner
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Matthias J Krenn
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi.,Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Heinrich Binder
- Neurological Center, SMZ Baumgartner Hoehe, Otto-Wagner-Hospital, Vienna, Austria
| | - Karen Minassian
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Control of functional movements in healthy and post-stroke subjects: Role of neural interlimb coupling. Clin Neurophysiol 2016; 127:2286-93. [DOI: 10.1016/j.clinph.2016.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/08/2016] [Accepted: 02/19/2016] [Indexed: 11/21/2022]
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Butler JE, Godfrey S, Thomas CK. Interlimb Reflexes Induced by Electrical Stimulation of Cutaneous Nerves after Spinal Cord Injury. PLoS One 2016; 11:e0153063. [PMID: 27049521 PMCID: PMC4822972 DOI: 10.1371/journal.pone.0153063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/23/2016] [Indexed: 01/31/2023] Open
Abstract
Whether interlimb reflexes emerge only after a severe insult to the human spinal cord is controversial. Here the aim was to examine interlimb reflexes at rest in participants with chronic (>1 year) spinal cord injury (SCI, n = 17) and able-bodied control participants (n = 5). Cutaneous reflexes were evoked by delivering up to 30 trains of stimuli to either the superficial peroneal nerve on the dorsum of the foot or the radial nerve at the wrist (5 pulses, 300 Hz, approximately every 30 s). Participants were instructed to relax the test muscles prior to the delivery of the stimuli. Electromyographic activity was recorded bilaterally in proximal and distal arm and leg muscles. Superficial peroneal nerve stimulation evoked interlimb reflexes in ipsilateral and contralateral arm and contralateral leg muscles of SCI and control participants. Radial nerve stimulation evoked interlimb reflexes in the ipsilateral leg and contralateral arm muscles of control and SCI participants but only contralateral leg muscles of control participants. Interlimb reflexes evoked by superficial peroneal nerve stimulation were longer in latency and duration, and larger in magnitude in SCI participants. Interlimb reflex properties were similar for both SCI and control groups for radial nerve stimulation. Ascending interlimb reflexes tended to occur with a higher incidence in participants with SCI, while descending interlimb reflexes occurred with a higher incidence in able-bodied participants. However, the overall incidence of interlimb reflexes in SCI and neurologically intact participants was similar which suggests that the neural circuitry underlying these reflexes does not necessarily develop after central nervous system injury.
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Affiliation(s)
- Jane E. Butler
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Neuroscience Research Australia, Sydney, Australia
- University of New South Wales, Sydney, Australia
- * E-mail:
| | - Sharlene Godfrey
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Christine K. Thomas
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Analysis of descriptive electrophysiological parameters in contralateral interlimb reflexes on tetraplegic patients. Spinal Cord 2014; 52:894-900. [PMID: 25288037 DOI: 10.1038/sc.2014.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/06/2014] [Accepted: 07/07/2014] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES The present study aims to analyze and correlate the interlimb reflexes (ILRs), through a standard methodology, in tetraplegic and healthy subjects. The study of the connectivity between the injured spinal cord and the ILR transmission empowers new rehabilitation pathways for tetraplegic patients. SETTING University Hospital-UNICAMP, Campinas, Brazil. METHODS A total of 15 chronic tetraplegic patients and 10 healthy subjects were analyzed with the same methodology. Two tests were performed: (i) In test 1, the stimulus was applied to the right-arm radial nerve and the electromyography (EMG) signal collected in contralateral left tibial muscle. (ii) In test 2, the stimulus was applied to the left-leg fibular nerve and EMG collected in contralateral limb biceps, exploring the opposite direction of the pathway. In both tests, the subjects were stimulated with intensities from 5 to 30 mA (5 mA step) and 40 × 500 μs current modulated pulses. Reflexes were detected from the averaging of the 40 EMG sweeps. RESULTS Each group was analyzed with regard to the reflexes' incidence, amplitude and latency. ILRs were found with similar prominence in both groups. A correlation between the ILR amplitude and the subject injury level was verified. Significant differences were found in the correlation of ILR latency with stimulation charge between healthy and tetraplegic subjects. CONCLUSION The ILR transmission parameters of healthy and tetraplegic subjects were studied. The results obtained strongly suggest a different ILR transmission between healthy and tetraplegic subjects, reinforcing the hypothesis of nerve regeneration after injury.
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