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Diller F, Scheuermann G, Wiebel A. Visual Cue Based Corrective Feedback for Motor Skill Training in Mixed Reality: A Survey. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2024; 30:3121-3134. [PMID: 37015488 DOI: 10.1109/tvcg.2022.3227999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
When learning a motor skill it is helpful to get corrective feedback from an instructor. This will support the learner to execute the movement correctly. With modern technology, it is possible to provide this feedback via mixed reality. In most cases, this involves visual cues to help the user understand the corrective feedback. We analyzed recent research approaches utilizing visual cues for feedback in mixed reality. The scope of this article is visual feedback for motor skill learning, which involves physical therapy, exercise, rehabilitation etc. While some of the surveyed literature discusses therapeutic effects of the training, this article focuses on visualization techniques. We categorized the literature from a visualization standpoint, including visual cues, technology and characteristics of the feedback. This provided insights into how visual feedback in mixed reality is applied in the literature and how different aspects of the feedback are related. The insights obtained can help to better adjust future feedback systems to the target group and their needs. This article also provides a deeper understanding of the characteristics of the visual cues in general and promotes future, more detailed research on this topic.
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Scano A, Lanzani V, Brambilla C, d’Avella A. Transferring Sensor-Based Assessments to Clinical Practice: The Case of Muscle Synergies. SENSORS (BASEL, SWITZERLAND) 2024; 24:3934. [PMID: 38931719 PMCID: PMC11207859 DOI: 10.3390/s24123934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Sensor-based assessments in medical practice and rehabilitation include the measurement of physiological signals such as EEG, EMG, ECG, heart rate, and NIRS, and the recording of movement kinematics and interaction forces. Such measurements are commonly employed in clinics with the aim of assessing patients' pathologies, but so far some of them have found full exploitation mainly for research purposes. In fact, even though the data they allow to gather may shed light on physiopathology and mechanisms underlying motor recovery in rehabilitation, their practical use in the clinical environment is mainly devoted to research studies, with a very reduced impact on clinical practice. This is especially the case for muscle synergies, a well-known method for the evaluation of motor control in neuroscience based on multichannel EMG recordings. In this paper, considering neuromotor rehabilitation as one of the most important scenarios for exploiting novel methods to assess motor control, the main challenges and future perspectives for the standard clinical adoption of muscle synergy analysis are reported and critically discussed.
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Affiliation(s)
- Alessandro Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), 20133 Milan, Italy; (V.L.); (C.B.)
| | - Valentina Lanzani
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), 20133 Milan, Italy; (V.L.); (C.B.)
| | - Cristina Brambilla
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), 20133 Milan, Italy; (V.L.); (C.B.)
| | - Andrea d’Avella
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179 Rome, Italy;
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy
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Does the Level of Focus in Serious Games in Immersive VR Correlate with the Quality of Movement? Preliminary Results from an Ongoing Study on Rehabilitation of Children with Cerebral Palsy. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941186 DOI: 10.1109/icorr58425.2023.10304712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Cerebral palsy (CP), one of the diseases that cause motor deficiency, is a childhood condition characterized by a motor disability (palsy) caused by a non-progressive static lesion in the brain (cerebral) [1], [2]. Rehabilitation of patients with CP is typically accomplished through exercises performed by a team of several specialists so that the patient can act independently or with as little reliance on third parties as possible. In CP, motor disorders are often present together with sensory, perceptual, cognitive, behavioural and communication disorders. Regarding motor disorders, the most frequent outcome is hemiplegia, although diplegic and paraplegic patients are also present [1].
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Lohss R, Odorizzi M, Sangeux M, Hasler CC, Viehweger E. Consequences of Virtual Reality Experience on Biomechanical Gait Parameters in Children with Cerebral Palsy: A Scoping Review. Dev Neurorehabil 2023; 26:377-388. [PMID: 37537745 DOI: 10.1080/17518423.2023.2242930] [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: 01/12/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
Virtual reality (VR), coupled with motion tracking, can investigate walking in a controlled setting while applying various walking challenges. The purpose of this review was to summarize the evidence on consequences of VR on biomechanical gait parameters in children with cerebral palsy. MEDLINE, Embase and Web of Science were searched. Among 7.574 studies, screened by two independent reviewers, seven studies were included, analyzing treadmill (n = 6) or overground walking (n = 1) under VR. Most frequently reported were the spatiotemporal parameters walking speed, stride length, step width, stance phase, and the kinematic parameters range of knee flexion and peak ankle dorsiflexion. However, methodological approaches and reporting of the results were inconsistent among studies. This review reveals that VR can complement information gained from clinical gait analysis. However, this is still an emerging field of research and there is limited knowledge on the effect of VR on gait parameters, notably during overground walking.
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Affiliation(s)
- Regine Lohss
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Marco Odorizzi
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Morgan Sangeux
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Carol-Claudius Hasler
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
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Ma Y, Ye S, Zhao D, Liu X, Cao L, Zhou H, Zuo G, Shi C. Using different matrix factorization approaches to identify muscle synergy in stroke survivors. Med Eng Phys 2023; 117:103993. [PMID: 37331748 DOI: 10.1016/j.medengphy.2023.103993] [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: 04/22/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023]
Abstract
Over the past several decades, many scholars have investigated muscle synergy as a promising tool for evaluating motor function. However, it is challenging to obtain favorable robustness using the general muscle synergy identification algorithms, namely non-negative matrix factorization (NMF), independent component analysis (ICA), and factor analysis (FA). Some scholars have proposed improved muscle synergy identification algorithms to overcome the shortcomings of these approaches, such as singular value decomposition NMF (SVD-NMF), sparse NMF (S-NMF), and multivariate curve resolution-alternating least squares (MCR-ALS). However, performance comparisons of these algorithms are seldom conducted. In this study, experimental electromyography (EMG) data collected from healthy individuals and stroke survivors were applied to assess the repeatability and intra-subject consistency of NMF, SVD-NMF, S-NMF, ICA, FA, and MCR-ALS. MCR-ALS presented higher repeatability and intra-subject consistencies than the other algorithms. More synergies and lower intra-subject consistencies were observed in stroke survivors than in healthy individuals. Thus, MCR-ALS is considered a favorable muscle synergy identification algorithm for patients with neural system disorders.
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Affiliation(s)
- Yehao Ma
- Robotics Institute, Ningbo University of Technology, Ningbo 315211, China
| | - Sijia Ye
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo,315201, China; Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China
| | - Dazheng Zhao
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo,315201, China; Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China
| | | | - Ling Cao
- Ningbo Rehabilitation Hospital, Ningbo, China
| | - Huilin Zhou
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo,315201, China; Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China
| | - Guokun Zuo
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo,315201, China; Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China
| | - Changcheng Shi
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo,315201, China; Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China.
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Spomer AM, Yan RZ, Schwartz MH, Steele KM. Motor control complexity can be dynamically simplified during gait pattern exploration using motor control-based biofeedback. J Neurophysiol 2023; 129:984-998. [PMID: 37017327 PMCID: PMC10125030 DOI: 10.1152/jn.00323.2022] [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: 07/31/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
Understanding how the central nervous system coordinates diverse motor outputs has been a topic of extensive investigation. Although it is generally accepted that a small set of synergies underlies many common activities, such as walking, whether synergies are equally robust across a broader array of gait patterns or can be flexibly modified remains unclear. Here, we evaluated the extent to which synergies changed as nondisabled adults (n = 14) explored gait patterns using custom biofeedback. Secondarily, we used Bayesian additive regression trees to identify factors that were associated with synergy modulation. Participants explored 41.1 ± 8.0 gait patterns using biofeedback, during which synergy recruitment changed depending on the type and magnitude of gait pattern modification. Specifically, a consistent set of synergies was recruited to accommodate small deviations from baseline, but additional synergies emerged for larger gait changes. Synergy complexity was similarly modulated; complexity decreased for 82.6% of the attempted gait patterns, but distal gait mechanics were strongly associated with these changes. In particular, greater ankle dorsiflexion moments and knee flexion through stance, as well as greater knee extension moments at initial contact, corresponded to a reduction in synergy complexity. Taken together, these results suggest that the central nervous system preferentially adopts a low-dimensional, largely invariant control strategy but can modify that strategy to produce diverse gait patterns. Beyond improving understanding of how synergies are recruited during gait, study outcomes may also help identify parameters that can be targeted with interventions to alter synergies and improve motor control after neurological injury.NEW & NOTEWORTHY We used a motor control-based biofeedback system and machine learning to characterize the extent to which nondisabled adults can modulate synergies during gait pattern exploration. Results revealed that a small library of synergies underlies an array of gait patterns but that recruitment from this library changes as a function of the imposed biomechanical constraints. Our findings enhance understanding of the neural control of gait and may inform biofeedback strategies to improve synergy recruitment after neurological injury.
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Affiliation(s)
- Alyssa M Spomer
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, United States
| | - Robin Z Yan
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, United States
| | - Michael H Schwartz
- James R. Gage Center for Gait & Motion Analysis, Gillette Children's Specialty Healthcare, Saint Paul, Minnesota, United States
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, United States
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, United States
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Saraswat P, Carson LT, Shull ER, Hyer LC, Westberry DE. Does use of ankle foot orthoses affect the dynamic motor control index during walking in cerebral palsy and idiopathic toe walking populations? Gait Posture 2023; 102:100-105. [PMID: 36958157 DOI: 10.1016/j.gaitpost.2023.03.007] [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: 09/27/2022] [Revised: 12/27/2022] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The dynamic motor control (walk-DMC) index during walking is a measure of the complexity of muscle activation pattern. Ankle Foot Orthoses (AFO) are frequently used to improve the gait of children with Cerebral Palsy (CP) and Idiopathic Toe Walking (ITW). The purpose of this study was to assess the change in walk-DMC index secondary to AFO use. RESEARCH QUESTION Does the change in walk-DMC reflect the change in walking kinematics with the use of AFO. METHODS Individuals with diagnosis of CP or ITW with gait analysis data available for barefoot and AFO condition were retrospectively identified. For each individual, the walk-DMC index, Gait Deviation Index (GDI) and Gait Variable Scores (GVS) of knee and ankle kinematics were computed for BF and AFO conditions. Paired t-tests were used to compare key variables between BF and AFO conditions. Multi-variate stepwise regression analysis was performed to identify variables that may predict the increase in walk-DMC between BF and AFO condition. RESULTS 253 individuals were included in the study. For CP individuals (n = 208), statistically significant but quantitatively minimal improvement was observed in walk-DMC (1 ± 9), GDI (2 ± 9) and ankle GVS (2 ± 7). For ITW individuals (n = 45), larger improvements were observed in walk-DMC (11 ± 13), GDI (9 ± 11) and ankle GVS (6 ± 7). Diagnosis of ITW, use of Solid-AFO and Posterior Leaf Spring-AFO were the significant predictor of increase in walk-DMC with AFO. Higher ankle GVS at BF condition (larger deviation from TD) led to larger increase in walk-DMC. Higher knee GVS (larger deviation from TD) led to smaller increase in walk-DMC. SIGNIFICANCE Use of AFO can lead to improvement in walking kinematics that is reflected in increase in walk-DMC with AFO compared to BF for ITW individuals. The change in kinematics and walk-DMC with use of AFO was minimal for CP individuals.
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Affiliation(s)
- Prabhav Saraswat
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA.
| | - Lisa T Carson
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA
| | - Emily R Shull
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA
| | - Lauren C Hyer
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA
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Beltrame G, Scano A, Marino G, Peccati A, Molinari Tosatti L, Portinaro N. Recent developments in muscle synergy analysis in young people with neurodevelopmental diseases: A Systematic Review. Front Bioeng Biotechnol 2023; 11:1145937. [PMID: 37180039 PMCID: PMC10174248 DOI: 10.3389/fbioe.2023.1145937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
The central nervous system simplifies motor control by sending motor commands activating groups of muscles, known as synergies. Physiological locomotion can be described as a coordinated recruitment of four to five muscle synergies. The first studies on muscle synergies in patients affected by neurological diseases were on stroke survivors. They showed that synergies can be used as biomarkers for motor impairment as they vary in patients with respect to healthy people. Likewise, muscle synergy analysis has been applied to developmental diseases (DD). The need for a comprehensive view of the present findings is crucial for comparing results achieved so far and promote future directions in the field. In the present review, we screened three scientific databases and selected thirty-six papers investigating muscle synergies extracted from locomotion in children affected by DD. Thirty-one articles investigate how cerebral palsy (CP) influences motor control, the currently exploited method in studying motor control in CP and finally the effects of treatments in these patients in terms of synergies and biomechanics; two articles investigate how muscle synergies vary in Duchenne muscular dystrophy (DMD), and three other articles assess other developmental pathologies, such as chronic and acute neuropathic pain. For CP, most of the studies demonstrate that the number of synergies is lower and that the synergy composition varies in the affected children with respect to normal controls. Still, the predictability of treatment's effects and the etiology of muscle synergy variation are open questions, as it has been reported that treatments minimally modify synergies, even if they improve biomechanics. The application of different algorithms in extracting synergies might bring about more subtle differences. Considering DMD, no correlation was found between non-neural muscle weakness and muscle modules' variation, while in chronic pain a decreased number of synergies was observed as a possible consequence of plastic adaptations. Even if the potential of the synergistic approach for clinical and rehabilitation practices is recognized, there is not full consensus on protocols nor widely accepted guidelines for the systematic clinical adoption of the method in DD. We critically commented on the current findings, on the methodological issues and the relative open points, and on the clinical impact of muscle synergies in neurodevelopmental diseases to fill the gap for applying the method in clinical practice.
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Affiliation(s)
- Giulia Beltrame
- Residency Program in Orthopedics and Traumatology, Universitá degli Studi di Milano, Milan, Italy
| | - Alessandro Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Milan, Italy
- *Correspondence: Alessandro Scano,
| | - Giorgia Marino
- Physiotherapy Unit, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Andrea Peccati
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Milan, Italy
| | - Nicola Portinaro
- Residency Program in Orthopedics and Traumatology, Universitá degli Studi di Milano, Milan, Italy
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Lalumiere M, Bourbonnais D, Goyette M, Perrino S, Desmeules F, Gagnon DH. Unilateral symptomatic Achilles tendinopathy has limited effects on bilateral lower limb ground reaction force asymmetries and muscular synergy attributes when walking at natural and fast speeds. J Foot Ankle Res 2022; 15:66. [PMID: 36071465 PMCID: PMC9450385 DOI: 10.1186/s13047-022-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) may affect ground reaction force (GRF) and muscle synergy (MS) during walking due to pain, biological integrity changes in the tendon and neuroplastic adaptations. The objective of this study was to compare GRF asymmetries and MS attributes between symptomatic and asymptomatic lower limbs (LL) during walking at natural and fast speeds in adults with unilateral AT. METHODS A convenience sample consisting of twenty-eight participants walked on an instrumented treadmill at natural (1.3 m/s) and fast (1.6 m/s) speeds. Peak GRF were measured in mediolateral, anteroposterior and vertical directions. Individualized electromyography (EMG) activation profiles were time- and amplitude-normalized for three consecutive gait cycles and MS were extracted using non-negative matrix factorization algorithms. MS were characterized by the number, composition (i.e., weighting of each muscle) and temporal profiles (i.e., duration and amplitude) of the MS extracted during walking. Paired Student's t-tests assessed peak GRF and MS muscle weighting differences between sides whereas Pearson correlation coefficients characterized the similarities of the individualized EMG and MS activation temporal profiles within sides. RESULTS AT had limited effects on peak GRF asymmetries and the number, composition and temporal profiles of MS between symptomatic and asymptomatic LL while walking on a level treadmill at natural and fast speeds. In most participants, four MS with a specific set of predominantly activated muscles were extracted across natural (71 and 61%) and fast (54 and 50%) walking speeds for the symptomatic and asymptomatic side respectively. Individualized EMG activation profiles were relatively similar between sides (r = 0.970 to 0.999). As for MS attributes, relatively similar temporal activation profiles (r = 0.988 to 0.998) and muscle weightings (p < 0.05) were found between sides for all four MS and the most solicited muscles. Although the faster walking speed increased the number of merged MS for both sides, it did not significantly alter MS symmetry. CONCLUSION Faster walking speed increased peak GRF values but had limited effects on GRF symmetries and MS attribute differences between the LL. Corticospinal neuroplastic adaptations associated with chronic unilateral AT may explain the preserved quasi-symmetric LL motor control strategy observed during natural and fast walking among adults with chronic unilateral AT.
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Affiliation(s)
- Mathieu Lalumiere
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Daniel Bourbonnais
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Michel Goyette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Sarah Perrino
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - François Desmeules
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, QC, Canada
| | - Dany H Gagnon
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.
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Sorek G, Goudriaan M, Schurr I, Schless SH. Influence of the number of muscles and strides on selective motor control during gait in individuals with cerebral palsy. J Electromyogr Kinesiol 2022; 66:102697. [PMID: 36027660 DOI: 10.1016/j.jelekin.2022.102697] [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: 04/07/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To evaluate the influence of the number of muscles and strides on estimating motor control accuracy during treadmill-gait, in individuals with cerebral palsy (CP). METHODS Bilateral lower limb electromyography data were extracted for 44 children/adolescents with CP. The number of synergy solutions required to explain 90 % of the variance (tVAF-threshold) and the total variance accounted for by one synergy (tVAF1) were calculated for a different number of strides (between 5 and 50) and muscles both unilaterally (four to seven) and bilaterally (eight to 14). The kappa and intraclass correlation coefficients were used to assess similarities in tVAF-threshold and tVAF1 between the different number of strides and muscle sets. RESULTS In both analyses, the number of muscles influenced the tVAF-threshold. Additionally, using <30 strides led to only substantial-moderate agreement with 50 strides (k < 0.80). In both analyses, the mean tVAF1 values demonstrated high-agreement between the different number of muscles (intraclass-correlations = 0.88-0.93) and strides (intraclass-correlations = 0.96-0.99); In the group level, it may result in an error of ≤2.3 %. However, in the individual level, using different number of muscles or <40 strides may result in an error of ≥6 %. CONCLUSION Differing numbers of muscles and strides did not influence the group mean tVAF1 value, but it influenced the tVAF-threshold value. In addition, using different number of muscles or strides can lead to a large measurement error in the individual tVAF1 value.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (ALYN PARC), Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (ALYN PARC), Jerusalem, Israel; Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel.
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11
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Ettema S, Oudenhoven LM, Roeleveld K, Buizer AI, van der Krogt MM. The effect of prolonged walking on muscle fatigue and neuromuscular control in children with cerebral palsy. Gait Posture 2022; 93:7-13. [PMID: 35042058 DOI: 10.1016/j.gaitpost.2022.01.004] [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: 06/08/2021] [Revised: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle fatigue of the lower limbs is considered a main contributor to the perceived fatigue in children with cerebral palsy (CP) and is expected to occur during prolonged walking. In adults without disabilities, muscle fatigue has been proposed to be associated with adaptations in complexity of neuromuscular control. RESEARCH QUESTION What are the effects of prolonged walking on signs of muscle fatigue and complexity of neuromuscular control in children with CP? METHODS Ten children with CP and fifteen typically developing (TD) children performed a standardised protocol on an instrumented treadmill consisting of three stages: six-minutes walking at preferred speed (6 MW), moderate-intensity walking (MIW, with two minutes at heart rate > 70% of predicted maximal heart rate) and four-minutes walking at preferred speed (post-MIW). Electromyography (EMG) data were analysed for eight muscles of one leg during three time periods: 6 MW-start, 6 MW-end and post-MIW. Signs of muscle fatigue were quantified as changes in EMG median frequency and EMG root mean square (RMS). Complexity of neuromuscular control was quantified by total variance accounted for by one synergy (tVAF1). Muscle coactivation was assessed for antagonistic muscle pairs. RESULTS EMG median frequency was decreased at 6 MW-end and post-MIW compared to 6 MW-start in children with CP (p < 0.05), but not in TD children. In both groups, EMG-RMS (p < 0.01) and muscle coactivation (p < 0.01) were decreased at 6 MW-end and post-MIW compared to 6 MW-start. tVAF1 decreased slightly at 6 MW-end and post-MIW compared to 6 MW-start in both groups (p < 0.05). Changes were most pronounced from 6 MW-start to 6 MW-end. SIGNIFICANCE Children with CP presented signs of muscle fatigue after prolonged walking, while no effects were found for TD. Both groups showed minimal changes in tVAF1, suggesting signs of muscle fatigue are not associated with changes in complexity of neuromuscular control.
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Affiliation(s)
- Sanne Ettema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, Netherlands; Department of Research and Development, Wijk aan Zee, Heliomare Netherlands.
| | - Laura M Oudenhoven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, Netherlands.
| | - Karin Roeleveld
- Department of Neuromedicine and Movement Sciene, NTNU- Norwegian University of Science and Technology, N-7491 Trondheim, Norway.
| | - Annemieke I Buizer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, Netherlands; Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, Netherlands.
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Spomer AM, Yan RZ, Schwartz MH, Steele KM. Synergies are minimally affected during emulation of cerebral palsy gait patterns. J Biomech 2022; 133:110953. [PMID: 35092908 PMCID: PMC8916095 DOI: 10.1016/j.jbiomech.2022.110953] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
Muscle synergy analysis is commonly used to characterize motor control during dynamic tasks like walking. For clinical populations, such as children with cerebral palsy (CP), synergies are altered compared to nondisabled (ND) peers and have been associated with both function and treatment outcomes. However, the factors that contribute to altered synergies remain unclear. In particular, the extent to which synergies reflect altered biomechanics (e.g., changes in gait) or underlying neurologic injury is debated. To evaluate the effect that altered biomechanics have on synergies, we compared synergy complexity and structure while ND individuals (n = 14) emulated four common CP gait patterns (equinus, equinus-crouch, mild-crouch, and moderate crouch). Secondarily, we compared the similarity of ND synergies during emulation to synergies from a retrospective cohort of individuals with CP walking in similar gait patterns (n = 28 per pattern). During emulation, ND individuals recruited similar synergies as baseline walking. However, pattern-specific deviations in synergy activations and complexity emerged. In particular, equinus gait altered plantarflexor activation timing and reduced synergy complexity. Importantly, ND synergies during emulation were distinct from those observed in CP for all gait patterns. These results suggest that altered gait patterns are not primarily driving the changes in synergies observed in CP, highlighting the value of using synergies as a tool to capture patient-specific differences in motor control. However, they also highlight the sensitivity of both synergy activations and complexity to altered biomechanics, which should be considered when using these measures in clinical care.
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Affiliation(s)
- Alyssa M Spomer
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
| | - Robin Z Yan
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Michael H Schwartz
- James R. Gage Center for Gait & Motion Analysis, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA; University of Minnesota, Minneapolis, MN, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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13
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Bourbonnais D, Pelletier R, Azar J, Sille C, Goyette M. Training muscle activation patterns of the lower paretic extremity using directional exertion improves mobility in persons with hemiparesis: a pilot study. BMC Biomed Eng 2021; 3:12. [PMID: 34715935 PMCID: PMC8555217 DOI: 10.1186/s42490-021-00057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background Controlled static exertion performed in the sagittal plane on a transducer attached to the foot requires coordinated moments of force of the lower extremity. Some exertions and plantarflexion recruit muscular activation patterns similar to synergies previously identified during gait. It is currently unknown if persons with hemiparesis following stroke demonstrate similar muscular patterns, and if force feedback training utilizing static exertion results in improved mobility in this population. Methods Electromyographic (EMG) activity of eight muscles of the lower limb were recorded using surface electrodes in healthy participants (n = 10) and in persons with hemiparesis (n = 8) during an exertion exercise (task) performed in eight directions in the sagittal plane of the foot and a plantarflexion exercise performed at 20 and 40% maximum voluntary effort (MVE). Muscle activation patterns identified during these exertion exercises were compared between groups and to synergies reported in the literature during healthy gait using cosine similarities (CS). Functional mobility was assessed in four participants with hemiparesis using GAITRite® and the Timed Up and Go (TUG) test at each session before, during and after static force feedback training. Tau statistics were used to evaluate the effect on mobility before and after training. Measures of MVE and the accuracy of directional exertion were compared before and after training using ANOVAs. Spearman Rho correlations were also calculated between changes in these parameters and changes in mobility before and after the training. Results Muscle activation patterns during directional exertion and plantarflexion were similar for both groups of participants (CS varying from 0.845 to 0.977). Muscular patterns for some of the directional and plantarflexion were also similar to synergies recruited during gait (CS varying from 0.847 to 0.951). Directional exertion training in hemiparetic subjects resulted in improvement in MVE (p < 0.040) and task performance accuracy (p < 0.001). Hemiparetic subjects also demonstrated significant improvements in gait velocity (p < 0.032) and in the TUG test (p < 0.022) following training. Improvements in certain directional efforts were correlated with changes in gait velocity (p = 0.001). Conclusion Static force feedback training following stroke improves strength and coordination of the lower extremity while recruiting synergies reported during gait and is associated with improved mobility.
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Affiliation(s)
- Daniel Bourbonnais
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Pavillon du Parc, Bureau 403-8, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada.
| | - René Pelletier
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
| | - Joëlle Azar
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Pavillon du Parc, Bureau 403-8, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
| | - Camille Sille
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
| | - Michel Goyette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
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14
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States RA, Krzak JJ, Salem Y, Godwin EM, Bodkin AW, McMulkin ML. Instrumented gait analysis for management of gait disorders in children with cerebral palsy: A scoping review. Gait Posture 2021; 90:1-8. [PMID: 34358847 DOI: 10.1016/j.gaitpost.2021.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of Instrumented Gait Analysis (IGA) for the clinical management of individuals with cerebral palsy (CP) has increased in recent years. Previous systematic reviews have been completed to evaluate and summarize the evidence related to the efficacy of IGA in general. However, a focused summary of research studies on IGA for children with CP related gait disorders is needed. RESEARCH QUESTION The purpose of the current work was to perform a scoping review to describe and categorize the range of existing literature about IGA as applied to the clinical management of children with CP related gait disorders. METHOD A health sciences librarian developed a search strategy to include four key inclusion criteria of original research study, population included children with CP, study employed IGA, available in English. The available literature was organized into six study categories: reliability and validity, documentation of subgroups or model development, IGA for clinical decision making, effectiveness of treatments that depend on IGA, cost effectiveness, IGA used to evaluate the outcome of surgical, medical or rehabilitation treatment. RESULTS 909 studies met the inclusion criteria and were placed into the six study categories. 14 % of studies were in reliability and validity, 33 % in subgroups or modeling, 2% in IGA for clinical decision making, 2% in treatments that depend on IGA, 1% in cost effectiveness, and 49 % of studies had IGA used as an outcome measure for treatment. SIGNIFICANCE This scoping review has documented the wide range, diversity and extent of original research studies investigating the use of IGA for the clinical management of children with CP related gait disorders. The large volume of studies provides a basis for future work to develop a CPG about the use of IGA for the clinical management of children with CP related gait disorders.
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Affiliation(s)
- Rebecca A States
- Long Island University - Brooklyn, Department of Physical Therapy, United States
| | - Joseph J Krzak
- Midwestern University, Physical Therapy Program, Downers Grove, IL, United States; Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, United States
| | - Yasser Salem
- Hofstra University, School of Health Professions and Human Services, United States; Cairo University, Faculty of Physical Therapy, Egypt
| | - Ellen M Godwin
- Long Island University - Brooklyn, Department of Physical Therapy, United States
| | - Amy Winter Bodkin
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Mark L McMulkin
- Walter E. & Agnes M. Griffin Motion Analysis Center, Shriners Hospitals for Children, Spokane, WA, United States.
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15
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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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16
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Bekius A, Bach MM, van de Pol LA, Harlaar J, Daffertshofer A, Dominici N, Buizer AI. Early Development of Locomotor Patterns and Motor Control in Very Young Children at High Risk of Cerebral Palsy, a Longitudinal Case Series. Front Hum Neurosci 2021; 15:659415. [PMID: 34149378 PMCID: PMC8209291 DOI: 10.3389/fnhum.2021.659415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
The first years of life might be critical for encouraging independent walking in children with cerebral palsy (CP). We sought to identify mechanisms that may underlie the impaired development of walking in three young children with early brain lesions, at high risk of CP, via comprehensive instrumented longitudinal assessments of locomotor patterns and muscle activation during walking. We followed three children (P1–P3) with early brain lesions, at high risk of CP, during five consecutive gait analysis sessions covering a period of 1 to 2 years, starting before the onset of independent walking, and including the session during the first independent steps. In the course of the study, P1 did not develop CP, P2 was diagnosed with unilateral and P3 with bilateral CP. We monitored the early development of locomotor patterns over time via spatiotemporal gait parameters, intersegmental coordination (estimated via principal component analysis), electromyography activity, and muscle synergies (determined from 11 bilateral muscles via nonnegative matrix factorization). P1 and P2 started to walk independently at the corrected age of 14 and 22 months, respectively. In both of them, spatiotemporal gait parameters, intersegmental coordination, muscle activation patterns, and muscle synergy structure changed from supported to independent walking, although to a lesser extent when unilateral CP was diagnosed (P2), especially for the most affected leg. The child with bilateral CP (P3) did not develop independent walking, and all the parameters did not change over time. Our exploratory longitudinal study revealed differences in maturation of locomotor patterns between children with divergent developmental trajectories. We succeeded in identifying mechanisms that may underlie impaired walking development in very young children at high risk of CP. When verified in larger sample sizes, our approach may be considered a means to improve prognosis and to pinpoint possible targets for early intervention.
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Affiliation(s)
- Annike Bekius
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Universitair Medisch Centrum, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Margit M Bach
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Laura A van de Pol
- Department of Pediatric Neurology, Amsterdam Universitair Medisch Centrum, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Universitair Medisch Centrum, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Andreas Daffertshofer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Universitair Medisch Centrum, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Emma Children's Hospital, Amsterdam Universitair Medisch Centrum, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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17
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Bach MM, Daffertshofer A, Dominici N. Muscle Synergies in Children Walking and Running on a Treadmill. Front Hum Neurosci 2021; 15:637157. [PMID: 34040508 PMCID: PMC8143190 DOI: 10.3389/fnhum.2021.637157] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/08/2021] [Indexed: 12/31/2022] Open
Abstract
Muscle synergies reflect the presence of a common neural input to multiple muscles. Steering small sets of synergies is commonly believed to simplify the control of complex motor tasks like walking and running. When these locomotor patterns emerge, it is likely that synergies emerge as well. We hence hypothesized that in children learning to run the number of accompanying synergies increases and that some of the synergies' activities display a temporal shift related to a reduced stance phase as observed in adults. We investigated the development of locomotion in 23 children aged 2-9 years of age and compared them with seven young adults. Muscle activity of 15 bilateral leg, trunk, and arm muscles, ground reaction forces, and kinematics were recorded during comfortable treadmill walking and running, followed by a muscle synergy analysis. We found that toddlers (2-3.5 years) and preschoolers (3.5-6.5 years) utilize a "walk-run strategy" when learning to run: they managed the fastest speeds on the treadmill by combining double support (DS) and flight phases (FPs). In particular the activity duration of the medial gastrocnemius muscle was weakly correlated with age. The number of synergies across groups and conditions needed to cover sufficient data variation ranged between four and eight. The number of synergies tended to be smaller in toddlers than it did in preschoolers and school-age children but the adults had the lowest number for both conditions. Against our expectations, the age groups did not differ significantly in the timing or duration of synergies. We believe that the increase in the number of muscle synergies in older children relates to motor learning and exploration. The ability to run with a FP is clearly associated with an increase in the number of muscle synergies.
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Affiliation(s)
- Margit M Bach
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Andreas Daffertshofer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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18
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Bach MM, Daffertshofer A, Dominici N. The development of mature gait patterns in children during walking and running. Eur J Appl Physiol 2021; 121:1073-1085. [PMID: 33439307 PMCID: PMC7966230 DOI: 10.1007/s00421-020-04592-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/17/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE We sought to identify the developing maturity of walking and running in young children. We assessed gait patterns for the presence of flight and double support phases complemented by mechanical energetics. The corresponding classification outcomes were contrasted via a shotgun approach involving several potentially informative gait characteristics. A subsequent clustering turned out very effective to classify the degree of gait maturity. METHODS Participants (22 typically developing children aged 2-9 years and 7 young, healthy adults) walked/ran on a treadmill at comfortable speeds. We determined double support and flight phases and the relationship between potential and kinetic energy oscillations of the center-of-mass. Based on the literature, we further incorporated a total of 93 gait characteristics (including the above-mentioned ones) and employed multivariate statistics comprising principal component analysis for data compression and hierarchical clustering for classification. RESULTS While the ability to run including a flight phase increased with age, the flight phase did not reach 20% of the gait cycle. It seems that children use a walk-run-strategy when learning to run. Yet, the correlation strength between potential and kinetic energies saturated and so did the amount of recovered mechanical energy. Clustering the set of gait characteristics allowed for classifying gait in more detail. This defines a metric for maturity in terms of deviations from adult gait, which disagrees with chronological age. CONCLUSIONS The degree of gait maturity estimated statistically using various gait characteristics does not always relate directly to the chronological age of the child.
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Affiliation(s)
- Margit M Bach
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andreas Daffertshofer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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19
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Cappellini G, Sylos-Labini F, Assenza C, Libernini L, Morelli D, Lacquaniti F, Ivanenko Y. Clinical Relevance of State-of-the-Art Analysis of Surface Electromyography in Cerebral Palsy. Front Neurol 2020; 11:583296. [PMID: 33362693 PMCID: PMC7759523 DOI: 10.3389/fneur.2020.583296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Surface electromyography (sEMG) can be used to assess the integrity of the neuromuscular system and its impairment in neurological disorders. Here we will consider several issues related to the current clinical applications, difficulties and limited usage of sEMG for the assessment and rehabilitation of children with cerebral palsy. The uniqueness of this methodology is that it can determine hyperactivity or inactivity of selected muscles, which cannot be assessed by other methods. In addition, it can assist for intervention or muscle/tendon surgery acts, and it can evaluate integrated functioning of the nervous system based on multi-muscle sEMG recordings and assess motor pool activation. The latter aspect is especially important for understanding impairments of the mechanisms of neural controllers rather than malfunction of individual muscles. Although sEMG study is an important tool in both clinical research and neurorehabilitation, the results of a survey on the clinical relevance of sEMG in a typical department of pediatric rehabilitation highlighted its limited clinical usage. We believe that this is due to limited knowledge of the sEMG and its neuromuscular underpinnings by many physiotherapists, as a result of lack of emphasis on this important methodology in the courses taught in physical therapy schools. The lack of reference databases or benchmarking software for sEMG analysis may also contribute to the limited clinical usage. Despite the existence of educational and technical barriers to a widespread use of, sEMG does provide important tools for planning and assessment of rehabilitation treatments for children with cerebral palsy.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Carla Assenza
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Laura Libernini
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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20
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Cappellini G, Sylos-Labini F, Dewolf AH, Solopova IA, Morelli D, Lacquaniti F, Ivanenko Y. Maturation of the Locomotor Circuitry in Children With Cerebral Palsy. Front Bioeng Biotechnol 2020; 8:998. [PMID: 32974319 PMCID: PMC7462003 DOI: 10.3389/fbioe.2020.00998] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
The first years of life represent an important phase of maturation of the central nervous system, processing of sensory information, posture control and acquisition of the locomotor function. Cerebral palsy (CP) is the most common group of motor disorders in childhood attributed to disturbances in the fetal or infant brain, frequently resulting in impaired gait. Here we will consider various findings about functional maturation of the locomotor output in early infancy, and how much the dysfunction of gait in children with CP can be related to spinal neuronal networks vs. supraspinal dysfunction. A better knowledge about pattern generation circuitries in infancy may improve our understanding of developmental motor disorders, highlighting the necessity for regulating the functional properties of abnormally developed neuronal locomotor networks as a target for early sensorimotor rehabilitation. Various clinical approaches and advances in biotechnology are also considered that might promote acquisition of the locomotor function in infants at risk for locomotor delays.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Arthur H Dewolf
- Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Irina A Solopova
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow, Russia
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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21
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Cappellini G, Sylos-Labini F, MacLellan MJ, Assenza C, Libernini L, Morelli D, Lacquaniti F, Ivanenko Y. Locomotor patterns during obstacle avoidance in children with cerebral palsy. J Neurophysiol 2020; 124:574-590. [DOI: 10.1152/jn.00163.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Previous studies mainly evaluated the neuromuscular pattern generation in cerebral palsy (CP) during unobstructed gait. Here we characterized impairments in the obstacle task performance associated with a limited adaptation of the task-relevant muscle module timed to the foot lift during obstacle crossing. Impaired task performance in children with CP may reflect basic developmental deficits in the adaptable control of gait when the locomotor task is superimposed with the voluntary movement.
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Affiliation(s)
- G. Cappellini
- Laboratory of Neuromotor Physiology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - F. Sylos-Labini
- Laboratory of Neuromotor Physiology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - M. J. MacLellan
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - C. Assenza
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - L. Libernini
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - D. Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - F. Lacquaniti
- Laboratory of Neuromotor Physiology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
- Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Y. Ivanenko
- Laboratory of Neuromotor Physiology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
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22
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Bekius A, Bach MM, van der Krogt MM, de Vries R, Buizer AI, Dominici N. Muscle Synergies During Walking in Children With Cerebral Palsy: A Systematic Review. Front Physiol 2020; 11:632. [PMID: 32714199 PMCID: PMC7343959 DOI: 10.3389/fphys.2020.00632] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/18/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Walking problems in children with cerebral palsy (CP) can in part be explained by limited selective motor control. Muscle synergy analysis is increasingly used to quantify altered neuromuscular control during walking. The early brain injury in children with CP may lead to a different development of muscle synergies compared to typically developing (TD) children, which might characterize the abnormal walking patterns. Objective: The overarching aim of this review is to give an overview of the existing studies investigating muscle synergies during walking in children with CP compared to TD children. The main focus is on how muscle synergies differ between children with CP and TD children, and we examine the potential of muscle synergies as a measure to quantify and predict treatment outcomes. Methods: Bibliographic databases were searched by two independent reviewers up to 22 April 2019. Studies were included if the focus was on muscle synergies of the lower limbs during walking, obtained by a matrix factorization algorithm, in children with CP. Results: The majority (n = 12) of the 16 included studies found that children with CP recruited fewer muscle synergies during walking compared to TD children, and several studies (n = 8) showed that either the spatial or temporal structure of the muscle synergies differed between children with CP and TD children. Variability within and between subjects was larger in children with CP than in TD children, especially in more involved children. Muscle synergy characteristics before treatments to improve walking function could predict treatment outcomes (n = 3). Only minimal changes in synergies were found after treatment. Conclusions: The findings in this systematic review support the idea that children with CP use a simpler motor control strategy compared to TD children. The use of muscle synergy analysis as a clinical tool to quantify altered neuromuscular control and predict clinical outcomes seems promising. Further investigation on this topic is necessary, and the use of muscle synergies as a target for development of novel therapies in children with CP could be explored.
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Affiliation(s)
- Annike Bekius
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Margit M Bach
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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High day-to-day repeatability of lower extremity muscle activation patterns and joint biomechanics of dual-belt treadmill gait: A reliability study in healthy young adults. J Electromyogr Kinesiol 2020; 51:102401. [PMID: 32087511 DOI: 10.1016/j.jelekin.2020.102401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The reliability of lower extremity muscle activation patterns has not been clearly studied in a dual-belt instrumented treadmill environment. The primary study objective was to quantify the day-to-day reliability of quadriceps, hamstrings, gastrocnemius and gluteus medius activation patterns in healthy young adult gait. Secondarily, the reliability of spatiotemporal, and knee/hip motion and moment-based gait outcomes was assessed. SCOPE 20 young adults were recruited and tested on two separate days. Using standardized procedures, participants were prepared for surface electromyography and lower extremity motion capture. All individuals walked on a dual-belt instrumented treadmill while muscle activation, segment motions and ground reaction forces were recorded. Sagittal plane motion and net external sagittal and frontal plane moments were calculated. Discrete biomechanical and muscle activation measures were calculated, and non-negative matrix factorization extracted amplitude and temporal muscle activation features. Intraclass Correlation Coefficients, Standard Error of Measurement and Minimum Detectable Change were calculated. CONCLUSIONS High to excellent Intraclass correlation coefficients were found between visits for most primary and secondary outcomes. The absolute and relative reliability, including Minimum Detectable Change values, provided in this study support the use of dual-belt instrumented treadmill walking as an acceptable medium to collect biomechanical and lower extremity EMG outcomes for future studies.
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Cruz-Montecinos C, Pérez-Alenda S, Querol F, Cerda M, Maas H. Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy. Front Physiol 2020; 10:1575. [PMID: 32076411 PMCID: PMC7006441 DOI: 10.3389/fphys.2019.01575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Hemophilic arthropathy is the result of repetitive intra-articular bleeding and synovial inflammation. In people with hemophilic arthropathy (PWHA), very little is known about the neural control of individual muscles during movement. The aim of the present study was to assess if the neural control of individual muscles and coordination between antagonistic muscle pairs and joint kinematics during gait are affected in PWHA. Thirteen control subjects (CG) walked overground at their preferred and slow velocity (1 m/s), and 14 PWHA walked overground at the preferred velocity (1 m/s). Joint kinematics and temporal gait parameters were assessed using four inertial sensors. Surface electromyography (EMG) was collected from gluteus maximus (GMAX), gluteus medius (GMED), vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), medial gastrocnemius (MG), lateral gastrocnemius (LG), soleus (SOL), tibialis anterior (TA), semitendinosus (ST), and biceps femoris (BF). Waveforms were compared using the time-series analysis through statistical parametric mapping. In PWHA compared to CG, EMG amplitude during the stance phase was higher for LG (for both velocities of the CG), BF (slow velocity only), and ST (preferred velocity only) (p < 0.05). Co-contraction during the stance phase was higher for MG-TA, LG-TA, VL-BF, VM-ST, LG-VL, and MG-VM (both velocities) (p < 0.05). MG and LG were excited earlier (preferred velocity only) (p < 0.05). A later offset during the stance phase was found for VL, BF, and ST (both velocities), and BF and GMAX (preferred velocity only) (p < 0.05). In addition, the range of motion in knee and ankle joints was lower in PWHA (both velocities) and hip joint (preferred velocity only) (p < 0.05). In conclusion, the neural control of individual muscles and coordination between antagonistic muscles during gait in PWHA differs substantially from control subjects.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Felipe Querol
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mauricio Cerda
- SCIAN-Lab, Anatomy and Developmental Biology Program, Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile
- Biomedical Neuroscience Institute, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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