Muscle synergies in neuroscience and robotics: from input-space to task-space perspectives

In this paper we review the works related to muscle synergies that have been carried-out in neuroscience and control engineering. In particular, we refer to the hypothesis that the central nervous system (CNS) generates desired muscle contractions by combining a small number of predefined modules, called muscle synergies. We provide an overview of the methods that have been employed to test the validity of this scheme, and we show how the concept of muscle synergy has been generalized for the control of artificial agents. The comparison between these two lines of research, in particular their different goals and approaches, is instrumental to explain the computational implications of the hypothesized modular organization. Moreover, it clarifies the importance of assessing the functional role of muscle synergies: although these basic modules are defined at the level of muscle activations (input-space), they should result in the effective accomplishment of the desired task. This requirement is not always explicitly considered in experimental neuroscience, as muscle synergies are often estimated solely by analyzing recorded muscle activities. We suggest that synergy extraction methods should explicitly take into account task execution variables, thus moving from a perspective purely based on input-space to one grounded on task-space as well.

Adaptation after vastus lateralis denervation in rats demonstrates neural regulation of joint stresses and strains

In order to produce movements, muscles must act through joints. The translation from muscle force to limb movement is mediated by internal joint structures that permit movement in some directions but constrain it in others. Although muscle forces acting against constrained directions will not affect limb movements, such forces can cause excess stresses and strains in joint structures, leading to pain or injury. In this study, we hypothesized that the central nervous system (CNS) chooses muscle activations to avoid excessive joint stresses and strains. We evaluated this hypothesis by examining adaptation strategies after selective paralysis of a muscle acting at the rat’s knee. We show that the CNS compromises between restoration of task performance and regulation of joint stresses and strains. These results have significant implications to our understanding of the neural control of movements, suggesting that common theories emphasizing task performance are insufficient to explain muscle activations during behaviors.

Although most of us will never achieve the grace and dexterity of professional ballerina Misty Copeland, we each make sophisticated, complex movements every day. Even simple movements often involve coordinating many muscles throughout the body. Moreover, because we have so many muscles, there are often multiple ways that we could use them to make the same movement. So which ones do we use, and why?

Many studies into muscle control focus on how the muscles activate to perform a task like kicking a soccer ball. But muscles do more than just move the limbs; they also act on joints. Contracting a muscle exerts strain on bones and the ligaments that hold joints together. If these strains become excessive, they may cause pain and injury, and over a longer time may lead to arthritis. It would therefore make sense if the nervous system factored in the need to protect joints when turning on muscles.

The quadriceps are a group of muscles that stretch along the front of the thigh bone and help to straighten the knee. To investigate whether the nervous system selects muscle activations to avoid joint injuries, Alessando et al. studied rats that had one particular quadriceps muscle paralyzed. The easiest way for the rats to adapt to this paralysis would be to increase the activation of a muscle that performs the same role as the paralyzed one, but places more stress on the knee joint. Instead, Alessando et al. found that the rats increase the activation of a muscle that minimizes the stress placed on the knee, even though this made it more difficult for the rats to recover their ability to use the leg in certain tasks.

The results presented by Alessando et al. may have important implications for physical therapy. Clinicians usually work to restore limb movements so that a task is performed in a way that is similar to how it was done before the injury. But sometimes repairing the damage can change the mechanical properties of the joint – for example, reconstructive surgery may replace a damaged ligament with a graft that has a different strength or stiffness. In those cases, performing movements in the same way as before the surgery could place abnormal stress on the joint. However, much more research is needed before recommendations can be made for how to rehabilitate rats after injury, let alone humans.

Functional characterization of the enhancer blocking element of the sea urchin early histone gene cluster reveals insulator properties and three essential cis-acting sequences

Insulator elements can be functionally identified by their ability to shield promoters from regulators in a position-dependent manner or their ability to protect adjacent transgenes from position effects. We have previously reported the identification of a 265 bp sns DNA fragment at the 3' end of the sea urchin H2A early histone gene that blocked expression of a reporter gene in transgenic embryos when placed between the enhancer and the promoter. Here we show that sns interferes with enhancer-promoter interaction in a directional manner. When sns is placed between the H2A modulator and the inducible tet operator, the modulator is barred from interaction with the basal promoter. However, the tet activator (tTA) can still activate the promoter, even in the presence of sns, demonstrating that sns does not interfere with activity of a downstream enhancer. In addition, the H2A modulator can still drive expression of a divergently oriented transcription unit, suggesting that sns does not inhibit binding of transcription factor(s) to the enhancer. To identify cis-acting sequence elements within sns which are responsible for insulator activity, we have performed in vitro DNase I footprinting and EMSA analysis, and in vivo functional assays by microinjection into sea urchin embryos. We have identified three binding sites for protein complexes: a palindrome, a direct repeat, and a C+T sequence that corresponds to seven GAGA motifs on the transcribed strand. Insulator function requires all three cis-acting elements. Based on these results, we conclude that sns displays properties similar to the best characterized insulators and suggest that directional blocking of enhancer-activated transcription by sns depends on the assembly of distinct DNA-protein complexes.

A computational analysis of motor synergies by dynamic response decomposition

Analyses of experimental data acquired from humans and other vertebrates have suggested that motor commands may emerge from the combination of a limited set of modules. While many studies have focused on physiological aspects of this modularity, in this paper we propose an investigation of its theoretical foundations. We consider the problem of controlling a planar kinematic chain, and we restrict the admissible actuations to linear combinations of a small set of torque profiles (i.e., motor synergies). This scheme is equivalent to the time-varying synergy model, and it is formalized by means of the dynamic response decomposition (DRD). DRD is a general method to generate open-loop controllers for a dynamical system to solve desired tasks, and it can also be used to synthesize effective motor synergies. We show that a control architecture based on synergies can greatly reduce the dimensionality of the control problem, while keeping a good performance level. Our results suggest that in order to realize an effective and low-dimensional controller, synergies should embed features of both the desired tasks and the system dynamics. These characteristics can be achieved by defining synergies as solutions to a representative set of task instances. The required number of synergies increases with the complexity of the desired tasks. However, a possible strategy to keep the number of synergies low is to construct solutions to complex tasks by concatenating synergy-based actuations associated to simple point-to-point movements, with a limited loss of performance. Ultimately, this work supports the feasibility of controlling a non-linear dynamical systems by linear combinations of basic actuations, and illustrates the fundamental relationship between synergies, desired tasks and system dynamics.

Toward anthropomimetic robotics: development, simulation, and control of a musculoskeletal torso

Anthropomimetic robotics differs from conventional approaches by capitalizing on the replication of the inner structures of the human body, such as muscles, tendons, bones, and joints. Here we present our results of more than three years of research in constructing, simulating, and, most importantly, controlling anthropomimetic robots. We manufactured four physical torsos, each more complex than its predecessor, and developed the tools required to simulate their behavior. Furthermore, six different control approaches, inspired by classical control theory, machine learning, and neuroscience, were developed and evaluated via these simulations or in small-scale setups. While the obtained results are encouraging, we are aware that we have barely exploited the potential of the anthropomimetic design so far. But, with the tools developed, we are confident that this novel approach will contribute to our understanding of morphological computation and human motor control in the future.

Estimating muscle activation from EMG using deep learning-based dynamical systems models

Objective. To study the neural control of movement, it is often necessary to estimate how muscles are activated across a variety of behavioral conditions. One approach is to try extracting the underlying neural command signal to muscles by applying latent variable modeling methods to electromyographic (EMG) recordings. However, estimating the latent command signal that underlies muscle activation is challenging due to its complex relation with recorded EMG signals. Common approaches estimate each muscle's activation independently or require manual tuning of model hyperparameters to preserve behaviorally-relevant features.Approach. Here, we adapted AutoLFADS, a large-scale, unsupervised deep learning approach originally designed to de-noise cortical spiking data, to estimate muscle activation from multi-muscle EMG signals. AutoLFADS uses recurrent neural networks to model the spatial and temporal regularities that underlie multi-muscle activation.Main results. We first tested AutoLFADS on muscle activity from the rat hindlimb during locomotion and found that it dynamically adjusts its frequency response characteristics across different phases of behavior. The model produced single-trial estimates of muscle activation that improved prediction of joint kinematics as compared to low-pass or Bayesian filtering. We also applied AutoLFADS to monkey forearm muscle activity recorded during an isometric wrist force task. AutoLFADS uncovered previously uncharacterized high-frequency oscillations in the EMG that enhanced the correlation with measured force. The AutoLFADS-inferred estimates of muscle activation were also more closely correlated with simultaneously-recorded motor cortical activity than were other tested approaches.Significance.This method leverages dynamical systems modeling and artificial neural networks to provide estimates of muscle activation for multiple muscles. Ultimately, the approach can be used for further studies of multi-muscle coordination and its control by upstream brain areas, and for improving brain-machine interfaces that rely on myoelectric control signals.

Regulation of the sea urchin early H2A histone gene expression depends on the modulator element and on sequences located near the 3' end

Transcription of the sea urchin early histone genes occurs transiently during early cleavage, reaching the maximum at the morula stage and declining to an undetectable level at the gastrula stage. To identify the regulatory elements responsible for the timing and the levels of transcription of the H2A gene, we used promoter binding studies in nuclear extracts and microinjection of a CAT transgene driven by the early H2A promoter. We found that morula and gastrula nuclear proteins produced indistinguishable DNase I footprint patterns on the H2A promoter. Two sites of interactions, centred on the modulator/enhancer and on the CCAAT box respectively, were detected. Deletion of the modulator or coinjection of an excess of modulator sequences severely affected the expression of two transgenes driven by the enhancer-less and modulator-containing H2A promoter. Finally, a DNA fragment containing 3' coding and post-H2A spacer sequences, where upon silencing three micrococcal nuclease hypersensitive sites were previously mapped, specifically repressed at the gastrula stage the expression of the transgene driven by the H2A promoter. These results indicate that the modulator is essential for the expression of early H2A gene and that sequences for downregulation are localized near the 3' end of the H2A gene.

Dual STDP processes at Purkinje cells contribute to distinct improvements in accuracy and speed of saccadic eye movements

Saccadic eye-movements play a crucial role in visuo-motor control by allowing rapid foveation onto new targets. However, the neural processes governing saccades adaptation are not fully understood. Saccades, due to the short-time of execution (20-100 ms) and the absence of sensory information for online feedback control, must be controlled in a ballistic manner. Incomplete measurements of the movement trajectory, such as the visual endpoint error, are supposedly used to form internal predictions about the movement kinematics resulting in predictive control. In order to characterize the synaptic and neural circuit mechanisms underlying predictive saccadic control, we have reconstructed the saccadic system in a digital controller embedding a spiking neural network of the cerebellum with spike timing-dependent plasticity (STDP) rules driving parallel fiber-Purkinje cell long-term potentiation and depression (LTP and LTD). This model implements a control policy based on a dual plasticity mechanism, resulting in the identification of the roles of LTP and LTD in regulating the overall quality of saccade kinematics: it turns out that LTD increases the accuracy by decreasing visual error and LTP increases the peak speed. The control policy also required cerebellar PCs to be divided into two subpopulations, characterized by burst or pause responses. To our knowledge, this is the first model that explains in mechanistic terms the visual error and peak speed regulation of ballistic eye movements in forward mode exploiting spike-timing to regulate firing in different populations of the neuronal network. This elementary model of saccades could be extended and applied to other more complex cases in which single jerks are concatenated to compose articulated and coordinated movements.

Cardiovascular responses to leg muscle loading during head-down tilt at rest and after dynamic exercises

The physiological processes underlying hemodynamic homeostasis can be modulated by muscle activity and gravitational loading. The effects of leg muscle activity on cardiovascular regulation have been observed during orthostatic stress. Here, we evaluated such effects during head-down tilt (HDT). In this posture, the gravitational gradient along the body is different than in upright position, leading to increased central blood volume and reduced venous pooling. We compared the cardiovascular signals obtained with and without leg muscle loading during HDT in healthy human subjects, both at rest and during recovery from leg-press exercises using a robotic device. Further, we compared such cardiovascular responses to those obtained during upright position. Loading leg muscles during HDT at rest led to significantly higher values of arterial blood pressure than without muscle loading, and restored systolic values to those observed during upright posture. Maintaining muscle loading post-exercise altered the short-term cardiovascular responses, but not the values of the signals five minutes after the exercise. These results suggest that leg muscle activity modulates cardiovascular regulation during HDT. This modulation should therefore be considered when interpreting cardiovascular responses to conditions that affect both gravity loading and muscle activity, for example bed rest or microgravity.

Severe myocardial dysfunction and coronary revascularization

Severe myocardial dysfunction, characterized by global hypokinesis, or akinetic areas with hypokinesis of the remaining wall, and a very low ejection fraction (EF), has been considered to be a contraindication for coronary revascularization (CABG). However, myocardial scintigraphy and echo-stress data have shown that hypo- or akinetic areas can regain their contractility. Therefore, we expanded the indications for CABG, and performed operations even upon patients who were waiting for a heart transplant. Between January 1993 and June 1995, among 352 patients who underwent CABG, 85 had highly depressed left ventricular function. Their resting EF was lower than 0.35, and in 27 it was lower than 0.25. Viable areas of myocardium were found in all of the patients through the combination of scintigraphy and dobutamine-echocardiography: these areas depended on significant coronary lesions. The mean age of the patients was 48.2 years (range 33-62 years); angina was present in 62 patients. A mean of 3.1 grafts/patient were implanted; enoximone was used in all but 5 patients upon weaning from cardiopulmonary bypass; intra-aortic balloon pump was used in 9 cases. Operative mortality was 10.6% (9 patients), due to low-output syndrome in 5, acute myocardial infarction in 2, cerebral damage in 1, and respiratory failure in 1. At the 6-month follow-up, EF was improved in all but 7 patients, in whom it remained unchanged. Scintigraphic and echocardiographic tests revealed good function in most of the areas that had been previously recognized as hypo- or akinetic. These results suggest that the indications for standard myocardial revascularization can be expanded, and a promising option can be offered to patients who may otherwise be destined to wait for an uncertain transplantation.

Kinematics but not kinetics alterations to single-leg drop jump movements following a subject-tailored fatiguing protocol suggest an increased risk of ACL injury

Introduction

Neuromuscular fatigue causes a transient reduction of muscle force, and alters the mechanisms of motor control. Whether these alterations increase the risk of anterior cruciate ligament (ACL) injury is still debated. Here we compare the biomechanics of single-leg drop jumps before and after the execution of a fatiguing exercise, evaluating whether this exercise causes biomechanical alterations typically associated with an increased risk of ACL lesion. The intensity of the fatiguing protocol was tailored to the aerobic capacity of each participant, minimizing potential differential effects due to inter-individual variability in fitness.

Methods

Twenty-four healthy male volunteers performed single leg drop jumps, before and after a single-set fatiguing session on a cycle ergometer until exhaustion (cadence: 65-70 revolutions per minute). For each participant, the intensity of the fatiguing exercise was set to 110% of the power achieved at their anaerobic threshold, previously identified by means of a cardiopulmonary exercise test. Joint angles and moments, as well as ground reaction forces (GRF) before and after the fatiguing exercise were compared for both the dominant and the non-dominant leg.

Results

Following the fatiguing exercise, the hip joint was more extended (landing: Δ=-2.17°, p = 0.005; propulsion: Δ=-1.83°, p = 0.032) and more abducted (landing: Δ=-0.72°, p = 0.01; propulsion: Δ=-1.12°, p = 0.009). Similarly, the knee joint was more extended at landing (non-dominant leg: Δ=-2.67°, p < 0.001; dominant: Δ=-1.4°, p = 0.023), and more abducted at propulsion (both legs: Δ=-0.99°, p < 0.001) and stabilization (both legs: Δ=-1.71°, p < 0.001) hence increasing knee valgus. Fatigue also caused a significant reduction of vertical GRF upon landing (Δ=-0.21 N/kg, p = 0.003), but not during propulsion. Fatigue did not affect joint moments significantly.

Conclusion

The increased hip and knee extension, as well as the increased knee abduction we observed after the execution of the fatiguing exercise have been previously identified as risk factors for ACL injury. These results therefore suggest an increased risk of ACL injury after the execution of the participant-tailored fatiguing protocol proposed here. However, the reduced vertical GRF upon landing and the preservation of joint moments are intriguing, as they may suggest the adoption of protective strategies in the fatigued condition to be evaluated in future studied.

Effects of localized and general fatigue on postural adjustments coupling during predictable external perturbations

PURPOSE

The central nervous system (CNS) coordinates anticipatory (APA) and compensatory postural adjustments (CPA) to face both self-induced and external perturbations. Neuromuscular fatigue (NMF), whether localized or general, impairs the CNS's ability to maintain postural stability, but the differential effects of these fatigue types on the coupling between APA and CPA remain unclear. This study aimed to investigate how localized and general NMF influence the neuromuscular control of postural adjustments during predictable external perturbations.

METHODS

Fourteen participants were exposed to two exercise protocols: intermittent isometric exercise to induce localized NMF and prolonged upper body exercise at high cardiometabolic effort to induce general NMF. Exercise intensity was monitored by measuring cardiometabolic parameters during exercise and recovery. Postural adjustments were assessed before and after NMF (recovery period) using electromyography and kinematic analyses while participants were exposed to predictable perturbations.

RESULTS

Localized NMF led to decreased muscle activation and co-activation across both fatigued and non-fatigued muscles during APA, with persistent kinematic changes in lower limb joints. In contrast, general NMF induced short-lived increases in EMG activity and co-activation, reflecting a strategic CNS adaptation to maintain stability.

CONCLUSIONS

The results suggest that localized NMF induces a more extensive and enduring impact on postural control mechanisms, likely due to altered proprioceptive feedback, whereas general NMF effects are more transient, aligning with the rapid recovery of cardiometabolic parameters. These findings highlight the CNS's role in differentially adapting postural strategies depending on the type of fatigue, with implications for understanding how fatigue impacts stability in dynamic environments.

Inhibition of knee joint sensory afferents alters covariation across strides between quadriceps muscles during locomotion

Sport-related injuries to articular structures often alter the sensory information conveyed by joint structures to the nervous system. However, the role of joint sensory afferents in motor control is still unclear. Here, we evaluate the role of knee joint sensory afferents in the control of quadriceps muscles, hypothesizing that such sensory information modulates control strategies that limit patellofemoreal joint loading. We compared locomotor kinematics and muscle activity before and after inhibition of knee sensory afferents by injection of lidocaine into the knee capsule of rats. We evaluated whether this inhibition reduced the strength of correlation between the activity of vastus medialis (VM) and vastus lateralis (VL) both across strides and within each stride, coordination patterns that limit net mediolateral patellofemoral forces. We also evaluated whether this inhibition altered correlations among the other quadriceps muscle activity, the time-profiles of individual EMG envelopes, or movement kinematics. Neither the EMG envelopes nor limb kinematics was affected by the inhibition of knee sensory afferents. This perturbation also did not affect the correlations between VM and VL, suggesting that the regulation of patellofemoral joint loading is mediated by different mechanisms. However, inhibition of knee sensory afferents caused a significant reduction in the correlation between vastus intermedius (VI) and both VM and VL across, but not within, strides. Knee joint sensory afferents may therefore modulate the coordination between the vasti muscles but only at coarse time scales. Injuries compromising joint afferents might result in altered muscle coordination, potentially leading to persistent internal joint stresses and strains.NEW & NOTEWORTHY Sensory afferents originating from knee joint receptors provide the nervous system with information about the internal state of the joint. In this study, we show that these sensory signals are used to modulate the covariations among the activity of a subset of vasti muscles across strides of locomotion. Sport-related injuries that damage joint receptors may therefore compromise these mechanisms of muscle coordination, potentially leading to persistent internal joint stresses and strains.

3D kinematics of noncontact and indirect contact ACL injuries in elite male football players

PURPOSE

Our primary goal was to deepen the understanding of the mechanisms leading to anterior cruciate ligament (ACL) injuries by reconstructing the three-dimensional (3D) joint kinematics of ACL injuries that occurred in professional male football matches. In particular, we aimed to compare the time courses of trunk and injured limb joint angles between noncontact and indirect contact injury mechanisms.

METHODS

In this cross-sectional observational study, we analysed a total of 27 cases (18 noncontact, 9 indirect contact). Whole-body 3D kinematics preceding and during ACL injuries was reconstructed using the Model-Based Image-Matching technique, implemented in Blender. For each injury, television footage from multiple perspectives (≥2, nine frames per view) were used, and Euler's joint angles across all the anatomical planes were extracted. The joint angle time courses of both the trunk and the injured limb, comprising 12 waveforms in total, were compared between injury mechanisms and Statistical Parametric Mapping was used to detect significant clusters.

RESULTS

Compared to noncontact injuries, indirect contact cases showed a lower hip abduction (-16°, p = 0.003), knee internal rotation (~3°, p < 0.001) at the initial contact with the ground, and ankle dorsiflexion (~7°, p = 0.035) at instants before the initial ground contact. These differences resulted from the player's adaptation to the sudden (yet variable) mechanical perturbation due to the contact with the opponent.

CONCLUSION

Mechanical interactions with other players impact segmental kinematics before and during ACL injuries in professional male football. These findings reinforce the importance of considering the sport-specificity of mechanisms in injury prevention.

LEVEL OF EVIDENCE

Level IV.

Quadriceps and hamstring muscles strength differences in adolescent and adult recreational athletes 6 months after autograft bone-patellar-tendon-bone anterior cruciate ligament reconstruction: A retrospective study

BACKGROUND

Knee muscle strength recovery after anterior cruciate ligament reconstruction (ACLR) is crucial for a safe return to sport (RTS) but it is poorly described in the adolescent population. Therefore, we compared the knee muscle strength at 6 months post-surgery in adults and adolescents. We hypothesized a greater muscular strength in adolescents 6 months after ACLR.

METHODS

This was a retrospective analysis of 55 adolescents (13-18 years old) and 76 adults (19-39 years old) who underwent ACLR with autograft bone-patellar-tendon-bone (BPTB), subjected to isokinetic tests 6 months after surgery. The following outcomes were analyzed: (1) the maximum torque of hamstrings (H) and quadriceps (Q) during flexion and extension at 30°/s normalized by body weight; (2) hamstrings to quadriceps strength ratio (HQ ratio); (3) injured to uninjured leg muscle strength ratio (limb-symmetry index, LSI).

RESULTS

Both adults and adolescents produced lower Q torque with the injured leg compared with uninjured, but similar H torque. In adolescents, the injured Q torque and the Q-LSI were higher compared with adults. In both populations, the Q-LSI was lower than the H-LSI and the HQ ratio in the injured leg was higher compared with uninjured. Adolescents showed a lower HQ ratio in injured legs.

CONCLUSIONS

At 6 months after ACLR both adolescents and adults did not recover Q strength in the injured leg. However, adolescents showed larger Q strength compared with adults. The HQ ratio analysis showed that 6 months after surgery both groups are not ready for a safe RTS.

The Effects of Mechanical Scale on Neural Control and the Regulation of Joint Stability

Recent work has demonstrated how the size of an animal can affect neural control strategies, showing that passive viscoelastic limb properties have a significant role in determining limb movements in small animals but are less important in large animals. We extend that work to consider effects of mechanical scaling on the maintenance of joint integrity; i.e., the prevention of aberrant contact forces within joints that might lead to joint dislocation or cartilage degradation. We first performed a literature review to evaluate how properties of ligaments responsible for joint integrity scale with animal size. Although we found that the cross-sectional area of the anterior cruciate ligament generally scaled with animal size, as expected, the effects of scale on the ligament’s mechanical properties were less clear, suggesting potential adaptations in passive contributions to the maintenance of joint integrity across species. We then analyzed how the neural control of joint stability is altered by body scale. We show how neural control strategies change across mechanical scales, how this scaling is affected by passive muscle properties and the cost function used to specify muscle activations, and the consequences of scaling on internal joint contact forces. This work provides insights into how scale affects the regulation of joint integrity by both passive and active processes and provides directions for studies examining how this regulation might be accomplished by neural systems.

Cardiovascular responses to leg-press exercises during head-down tilt

Introduction

Physical exercise and gravitational load affect the activity of the cardiovascular system. How these factors interact with one another is still poorly understood. Here we investigate how the cardiovascular system responds to leg-press exercise during head-down tilt, a posture that reduces orthostatic stress, limits gravitational pooling, and increases central blood volume.

Methods

Seventeen healthy participants performed leg-press exercise during head-down tilt at different combinations of resistive force, contraction frequency, and exercise duration (30 and 60 s), leading to different exercise power. Systolic (sBP), diastolic (dBP), mean arterial pressure (MAP), pulse pressure (PP) and heart rate (HR) were measured continuously. Cardiovascular responses were evaluated by comparing the values of these signals during exercise recovery to baseline. Mixed models were used to evaluate the effect of exercise power and of individual exercise parameter on the cardiovascular responses.

Results

Immediately after the exercise, we observed a clear undershoot in sBP (Δ = -7.78 ± 1.19 mmHg), dBP (Δ = -10.37 ± 0.84 mmHg), and MAP (Δ = -8.85 ± 0.85 mmHg), an overshoot in PP (Δ = 7.93 ± 1.13 mmHg), and elevated values of HR (Δ = 33.5 ± 0.94 bpm) compared to baseline (p < 0.0001). However, all parameters returned to similar baseline values 2 min following the exercise (p > 0.05). The responses of dBP, MAP and HR were significantly modulated by exercise power (correlation coefficients: rdBP = -0.34, rMAP = -0.25, rHR = 0.52, p < 0.001). All signals' responses were modulated by contraction frequency (p < 0.05), increasing the undershoot in sBP (Δ = -1.87 ± 0.98 mmHg), dBP (Δ = -4.85 ± 1.01 and Δ = -3.45 ± 0.98 mmHg for low and high resistive force respectively) and MAP (Δ = -3.31 ± 0.75 mmHg), and increasing the overshoot in PP (Δ = 2.57 ± 1.06 mmHg) as well as the value of HR (Δ = 16.8 ± 2.04 and Δ = 10.8 ± 2.01 bpm for low and high resistive force respectively). Resistive force affected only dBP (Δ = -4.96 ± 1.41 mmHg, p < 0.0001), MAP (Δ = -2.97 ± 1.07 mmHg, p < 0.05) and HR (Δ = 6.81 ± 2.81 bpm, p < 0.0001; Δ = 15.72 ± 2.86 bpm, p < 0.0001; Δ = 15.72 ± 2.86 bpm, p < 0.05, depending on the values of resistive force and contraction frequency), and exercise duration affected only HR (Δ = 9.64 ± 2.01 bpm, p < 0.0001).

Conclusion

Leg exercises caused only immediate cardiovascular responses, potentially due to facilitated venous return by the head-down tilt position. The modulation of dBP, MAP and HR responses by exercise power and that of all signals by contraction frequency may help optimizing exercise prescription in conditions of limited orthostatic stress.

Knee kinematics during gait in patients with discoid lateral meniscus: a systematic review

INTRODUCTION

The aim of this study was to evaluate the difference between symptomatic discoid lateral meniscus (DLM) and healthy knees in terms of gait analysis.

EVIDENCE ACQUISITION

A systematic review was conducted from the electronic databases PubMed/MEDLINE, EMBASE and Scopus. The review was performed on studies that reported data on kinematics, gait analysis, biomechanics in discoid lateral meniscus, before and after surgery.

EVIDENCE SYNTHESIS

Out of 127 identified items, six full-text articles were assessed for eligibility. Three of these studies were included in the quantitative synthesis. Those studies reported a significantly slower gait speed and shorter stride length, smaller excursion during weight acceptance and mid-stance phases and during the whole gait cycle, smaller maximum flexion angle in swing phase, lower frontal excursion, smaller axial excursion in the DLM groups compared to the control groups. One study reported a significative increase in the walking speed and in the stride length, increase both in the maximum knee flexion angle during stance phase and swing phase, and in the range of flexion-extension after arthroscopic surgical treatment for symptomatic DLM.

CONCLUSIONS

Literature about gait analysis on DLM patients is still very scarce and heterogeneous. The few studies on this topic show a different gait pattern between DLM knees and healthy knees and are encouraging about the surgical outcomes of DLM in terms of gait. Larger and standardized studies should be designed to assess a more suitable number of subjects with DLM.