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Chen Y, Cao S, Chen W, Zhang C, Huang J, Wang X, Ma X. Pain alleviation improves balance control and muscular coordination of lower limbs in patients with chronic ankle instability during sinusoidal perturbations. Clin Biomech (Bristol, Avon) 2024; 111:106165. [PMID: 38159328 DOI: 10.1016/j.clinbiomech.2023.106165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND It is well established that individuals with chronic ankle instability manifest deficits in balance control and muscle activation. Given the prevalence of pain as a prominent symptom in this population, there is a need for in-depth investigation of its role in contributing to these impairments. METHODS A Stewart platform was used to generate translational sinusoidal perturbations in the antero-posterior direction. Eighteen individuals with chronic ankle instability and concurrent ankle pain were recruited. They were instructed to assume a central stance on the support surface with open eyes both before and 30 min after local analgesia. Data of center of pressure and electromyography of the tibialis anterior and medial gastrocnemius were recorded. Statistical analysis was performed to make comparisons pre- and post-analgesia using two-tailed paired t-test for the continuous variables. FINDINGS Pain intensity was significantly decreased after local anesthetic injections. Antero-posterior center of pressure parameters significantly decreased following the injection. Also, there was an increase in the regularity of the center of pressure pattern. The electromyographic pattern of the tibialis anterior and medial gastrocnemius exhibited various activation patterns. After pain alleviation, the characteristic electromyographic response of the tibialis anterior and medial gastrocnemius was reciprocal contraction and relaxation that corresponded with the sinusoidal pattern of the perturbations. INTERPRETATION Individuals who had chronic ankle instability and ankle pain demonstrated impaired balance control during sinusoidal perturbations. Mitigating pain improved their balance performance, evident in the center of pressure pattern and the coordination of lower limb muscles.
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Affiliation(s)
- Yungu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Wenming Chen
- Institute of Biomedical Engineering, Academy for Engineering & Technology, Fudan University, 220 Handan Road, Yangpu District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China; Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China.
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Fujio K, Obata H, Takeda K, Kawashima N. Cortical oscillations and interareal synchronization as a preparatory activity for postural response. Eur J Neurosci 2023; 57:1516-1528. [PMID: 36878880 DOI: 10.1111/ejn.15956] [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: 11/28/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
Neural mechanisms of human standing are expected to be elucidated for preventing fallings. Postural response evoked by sudden external perturbation originates from various areas in the central nervous system. Recent studies have revealed that the corticospinal pathway is one of the key nodes for an appropriate postural response. The corticospinal pathway that mediates the early part of the electromyographic response is modulated with prediction before a perturbation occurs. Temporal prediction explicitly exhibiting an onset timing contributes to enhancing corticospinal excitability. However, how the cortical activities in the sensorimotor area with temporal prediction are processed before the corticospinal pathway enhancement remains unclear. In this study, using electroencephalography, we investigated how temporal prediction affects both neural oscillations and synchronization between sensorimotor and distal areas. Our results revealed that desynchronization of cortical oscillation at α- and β-bands was observed in the sensorimotor and parietooccipital areas (Cz, CPz, Pz and POz), and those are nested in the phase at θ-band frequency. Furthermore, a reduction in the interareal phase synchrony in the α-band was induced after the timing cue for the perturbation onset. The phase synchrony at the low frequency can relay the temporal prediction among the distant areas and initiate the modulation of the local cortical activities. Such modulations contribute to the preparation for sensory processing and motor execution that are necessary for optimal responses.
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Affiliation(s)
- Kimiya Fujio
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - Hiroki Obata
- Department of Humanities and Social Science Laboratory, Institute of Liberal Arts, Kyushu Institute of Technology, Fukuoka, Japan
| | - Kenta Takeda
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - Noritaka Kawashima
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
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Hu N, Avela J, Kidgell DJ, Nevanperä S, Walker S, Piirainen JM. Reliability of transcranial magnetic stimulation and H-reflex measurement during balance perturbation tasks. Front Physiol 2022; 13:957650. [PMID: 36311220 PMCID: PMC9614306 DOI: 10.3389/fphys.2022.957650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Following ankle movement, posterior balance perturbation evokes short- (SLR ∼30–50 ms), medium- (MLR ∼50–60 ms), and long-latency responses (LLR ∼70–90 ms) in soleus muscle before voluntary muscle contraction. Transcranial magnetic stimulation (TMS) and Hoffmann-reflex (H-reflex) measurements can provide insight into the contributions of corticospinal and spinal mechanisms to each response. Motor evoked potential (MEP) and H-reflex responses have shown good reliability in some dynamic muscle contraction tasks. However, it is still unclear how reliable these methods are in dynamic balance perturbation and corticospinal modulation during long amplitude balance perturbation tasks. 14 subjects completed two test sessions in this study to evaluate the reliability of MEPs, H-reflex, and corticospinal modulation during balance perturbation. In each session, the balance perturbation system operated at 0.25 m/s, accelerating at 2.5 m/s2 over 0.3 m displacement. MEPs and H-reflexes were elicited in the right leg soleus muscle at four delays after ankle movement (10 ms, 40 ms, 80 ms, and 140 ms), respectively. Test-retest reliability of MEP and H-reflex amplitudes were assessed via intraclass correlation coefficients (ICC) both between- and within-session. Between-session test-retest reliability for MEPs was excellent (ICC = 0.928–0.947), while H-reflex demonstrated moderate-to-good reliability (ICC = 0.626–0.887). Within-session reliability for both MEPs and H-reflex was excellent (ICC = 0.927–0.983). TMS and H-reflex measurements were reliable at different delays after perturbation between- and within-sessions, which indicated that these methods can be used to measure corticospinal excitability during balance perturbation.
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Affiliation(s)
- Nijia Hu
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Nijia Hu,
| | - Janne Avela
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Dawson J. Kidgell
- School of Primary and Allied Health Care, Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Samuli Nevanperä
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Simon Walker
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jarmo M. Piirainen
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Mohamed Suhaimy MSB, Okubo Y, Hoang PD, Lord SR. Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2020; 34:675-685. [PMID: 32507036 DOI: 10.1177/1545968320929681] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim. To compare reactive balance in people with multiple sclerosis (MS) with healthy controls and to examine the ability of people with MS to adapt their reactive balance and retain training effects. Data Sources. Electronic databases (PubMed, EMBASE, PsychINFO) and reference lists of included articles from inception to February 25, 2019. Study Selection. Case-control and intervention studies that assessed reactive balance using mechanical perturbations in people with a confirmed diagnosis of MS. Results. Meta-analyses of 9 studies (n = 342) showed that people with MS have significantly worse reactive balance than healthy controls (standardized mean difference [SMD] 0.78, 95% CI 0.44-1.11, P < .0001, I2 = 47%). Specifically, people with MS have greater center of mass displacements (SMD 0.41, 95% CI 0.05-0.77, P = .02, I2 = 9%) and longer response times (MD (ms) 31.45, 95% CI 19.91-42.98, P < .0001, I2 = 75%) in response to standing perturbations than healthy controls. Subsequent meta-analyses revealed training comprising repeated exposure to perturbations improved response times (P < .001) and training effects on response times could be retained for 24 hours (P < .001) in people with MS. Conclusions. Reactive balance assessments can highlight functional impairments related to falls in people with MS, and perturbation training can acutely improve reactive balance control and such improvements can be retained for 24 hours in this population. Systematic review registration number: CRD42019126130.
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Affiliation(s)
| | - Yoshiro Okubo
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Phu D Hoang
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Stephen R Lord
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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Asín-Prieto G, Martínez-Expósito A, Barroso FO, Urendes EJ, Gonzalez-Vargas J, Alnajjar FS, González-Alted C, Shimoda S, Pons JL, Moreno JC. Haptic Adaptive Feedback to Promote Motor Learning With a Robotic Ankle Exoskeleton Integrated With a Video Game. Front Bioeng Biotechnol 2020; 8:113. [PMID: 32154239 PMCID: PMC7047324 DOI: 10.3389/fbioe.2020.00113] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Robotic devices have been used to rehabilitate walking function after stroke. Although results suggest that post-stroke patients benefit from this non-conventional therapy, there is no agreement on the optimal robot-assisted approaches to promote neurorecovery. Here we present a new robotic therapy protocol using a grounded exoskeleton perturbing the ankle joint based on tacit learning control. Method: Ten healthy individuals and a post-stroke patient participated in the study and were enrolled in a pilot intervention protocol that involved performance of ankle movements following different trajectories via video game visual feedback. The system autonomously modulated task difficulty according to the performance to increase the challenge. We hypothesized that motor learning throughout training sessions would lead to increased corticospinal excitability of dorsi-plantarflexor muscles. Transcranial Magnetic Stimulation was used to assess the effects on corticospinal excitability. Results: Improvements have been observed on task performance and motor outcomes in both healthy individuals and post-stroke patient case study. Tibialis Anterior corticospinal excitability increased significantly after the training; however no significant changes were observed on Soleus corticospinal excitability. Clinical scales showed functional improvements in the stroke patient. Discussion and Significance: Our findings both in neurophysiological and performance assessment suggest improved motor learning. Some limitations of the study include treatment duration and intensity, as well as the non-significant changes in corticospinal excitability obtained for Soleus. Nonetheless, results suggest that this robotic training framework is a potentially interesting approach that can be explored for gait rehabilitation in post-stroke patients.
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Affiliation(s)
- Guillermo Asín-Prieto
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
| | - Aitor Martínez-Expósito
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
| | - Filipe O Barroso
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
| | - Eloy J Urendes
- Department of Information Systems Engineering, University San Pablo CEU, Boadilla del Monte, Spain
| | - Jose Gonzalez-Vargas
- Department of Translations Research and Knowledge Management, OttoBock Healthcare GmbH, Duderstadt, Germany
| | - Fady S Alnajjar
- College of Information Technology, The United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | - Shingo Shimoda
- Intelligent Behaviour Control Unit, RIKEN, Nagoya, Japan
| | - Jose L Pons
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain.,Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Biomedical Engineering and Mechanical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, United States.,Department of PM&R, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
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