Measurement and Analysis of Human Infant Crawling for Rehabilitation: A Narrative Review

Reduced corticospinal drive to antagonist muscles of upper and lower limbs during hands-and-knees crawling in infants with cerebral palsy: Evidence from intermuscular EMG-EMG coherence

BACKGROUND

There is growing interest in understanding the central control of hands-and-knees crawling, especially as a significant motor developmental milestone for early assessment of motor dysfunction in infants with cerebral palsy (CP) who have not yet acquired walking ability. In particular, CP is known to be associated with walking dysfunctions caused by early damage and incomplete maturation of the corticospinal tract. However, the extent of damage to the corticospinal connections during crawling in infants with CP has not been fully clarified. Therefore, this study aimed to investigate the disparities in intermuscular EMG-EMG coherence, which serve as indicators of corticospinal drives to antagonist muscles in the upper and lower limbs during crawling, between infants with and without CP.

METHODS

This study involved 15 infants diagnosed with CP and 20 typically developing (TD) infants. Surface EMG recordings were obtained from two pairs of antagonist muscles in the upper limbs (triceps brachii (TB) and biceps brachii (BB)) and lower limbs (quadriceps femoris (QF) and hamstrings (HS)), while the infants performed hands-and-knees crawling at their self-selected velocity. Intermuscular EMG-EMG coherence was computed in two frequency bands, the beta band (15-30 Hz) and gamma band (30-60 Hz), which indicate corticospinal drive. Additionally, spatiotemporal parameters, including crawling velocity, cadence, duration, and the percentage of stance phase time, were calculated for comparison. Spearman rank correlations were conducted to assess the relationship between EMG-EMG coherence and crawling spatiotemporal parameters.

RESULTS

Infants with CP exhibited significantly reduced crawling velocity, decreased cadence, longer cycle duration, and a higher percentage of stance phase time compared to TD infants. Furthermore, CP infants demonstrated decreased coherence in the beta and gamma frequency bands (indicators of corticospinal drive) in both upper and lower limb muscles. Regarding limb-related differences in the beta and gamma coherence, significant disparities were found between upper and lower limb muscles in TD infants (p < 0.05), but not in infants with CP (p > 0.05). Additionally, significant correlations between coherence metrics and crawling spatiotemporal parameters were identified in the TD group (p < 0.05), while such correlations were not evident in the CP group.

CONCLUSIONS

Our findings suggest that the corticospinal drive may functionally influence the central control of antagonist muscles in the limbs during typical infant crawling. This functional role could be impaired by neurological conditions such as cerebral palsy. The neurophysiological markers of corticospinal drive, specifically intermuscular EMG-EMG coherence during crawling in infants with cerebral palsy, could potentially serve as a tool to assess developmental response to therapy.

Muscle synergy analysis of eight inter-limb coordination modes during human hands-knees crawling movement

In order to reveal in-depth the neuromuscular control mechanism of human crawling, this study carries out muscle synergy extraction and analysis on human hands-knees crawling under eight specific inter-limb coordination modes, which are defined according to the swing sequence of limbs and includes two-limb swing crawling modes and six single-limb swing crawling modes. Ten healthy adults participate in crawling data collection, and surface electromyography (sEMG) signals are recorded from 30 muscles of limbs and trunk. Non-negative matrix factorization (NNMF) algorithm is adopted for muscle synergy extraction, and a three-step muscle synergy analysis scheme is implemented by using the hierarchical clustering method. Based on results of muscle synergy extraction, 4 to 7 synergies are extracted from each participant in each inter-limb coordination mode, which supports the muscle synergy hypothesis to some extent, namely, central nervous system (CNS) controls the inter-limb coordination modes during crawling movement by recruiting a certain amount of muscle synergies, rather than a single muscle. In addition, when different participants crawl in the same inter-limb coordination mode, they share more temporal features in recruiting muscle synergies. Further, by extracting and analyzing intra-mode shared synergies among participants and inter-mode shared synergies among the eight inter-limb coordination modes, the CNS is found to realize single-limb swing crawling modes by recruiting the four inter-mode shared synergy structures related to the swing function of each limb in different orders, and realize the two-limb swing crawling modes by recruiting synchronously two intra-mode shared synergy structures. The research results of the muscle synergy analysis on the eight specific inter-limb coordination modes, on the one hand, provide a basis for muscle synergy hypothesis from the perspective of crawling motion, on the other hand, also provide a possible explanation for the choice of the inter-limb coordination mode in human crawling.

Peak vertical ground force of hand–knee crawling in human adults

[Purpose] Fall risk is immanent in humans because they are bipedal. Bipedalism has transited from quadrupedalism in both evolutional and developmental contexts. Past studies have measured the peak vertical ground force of forelimbs and hindlimbs in quadrupedalism; and revealed that load dominancy shifted from forelimbs to hindlimbs during evolution. The dominance of hindlimb peak vertical ground force allows forelimb freedom and is considered important for locomotor evolution toward bipedalism. With this consideration, we hypothesize that hindlimb peak vertical ground force is dominant in human adults when they designedly crawl in a quadrupedal manner. [Participants and Methods] Six healthy human adults crawled on their hands and knees over a pressure platform. We calculated the peak vertical ground force of their hands and knees by integrating the pressure of the contact area of each limb. [Results] The mean knee peak vertical ground force at 0.694 (per body weight) was significantly higher than that of the hand at 0.372 (per body weight). The mean hand/knee peak vertical ground force ratio was 0.536; therefore, it was -0.624 on the natural logarithmic scale. [Conclusions] Our findings on human adults are compatible with existing considerations on locomotor evolution toward bipedalism. Our findings contribute to the comprehensive understanding of human locomotion.