Frequency-dependent changes in neuromuscular responses to cyclic lumbar flexion

Repetitive lifting in the workplace has been identified to be a cause of low back disorders. Epidemiologic data further supports an hypothesis that higher repetition rate (i.e. frequency) is an added risk factor. The objective of this study was to provide experimental data testing the above hypothesis. An in vivo feline model was subjected to 20-min of cyclic lumbar loading at frequencies of 0.1 Hz and 0.5 Hz while monitoring the EMG from the L-3/4-L-5/6 multifidus muscles and the creep at the L-4/5 level. Seven hours of rest were allowed after the cyclic flexion/extension was terminated. During this rest period, a single test cycle was performed every hour to assess recovery of EMG and lumbar creep. The results demonstrate that cyclic lumbar flexion elicits a transient neuromuscular disorder consisting of EMG spasms during the cyclic loading and initial and delayed muscular hyperexcitabilities during the rest period. Cyclic loading at 0.5 Hz resulted in significant (p<0.05) increase in the hyperexcitability magnitude and duration during the recovery period. It was concluded that repetitive lumbar loading at fast rates is indeed a risk factor as it induces larger creep in the lumbar viscoelastic tissues which in turn intensify the resulting neuromuscular disorder.

Biomechanics and electromyography of a cumulative lumbar disorder: response to static flexion

OBJECTIVE

To assess the mechanical and neurological processes active in the development of a cumulative trauma disorder (CTD) associated with repetitive exposure to periods of static lumbar flexion.

METHODS

The spine of the feline model was subjected to a series of three 10 min sessions of static lumbar flexion with each session followed by a 10 min rest. A 7 h rest period was implemented after the series of three flexion-rest sessions while monitoring viscoelastic (disks, ligaments, etc.) creep and multifidus EMG. A model was fitted to the experimental data from the flexion-rest period and the 7 h recovery period.

RESULTS

The creep developed in each 10 min static flexion period did not fully recovery during the following 10 min rest, resulting in a large cumulative creep at the end of the flexion-rest period. The cumulative creep did not fully recover over the following 7 h rest period. A neuromuscular disorder consisting of reduced muscular activity superimposed by spasms during static flexion periods and hyperexcitability during the 7 h recovery was evident. Comparison of the data to previous tests of continuous static flexion for 20 min reveal that the neuromuscular disorder elicited by the series of three 10 min flexion-rest was substantially attenuated when compared to a single 20 min static flexion although the overall work time was 50% larger.

CONCLUSIONS

Frequent rest periods are highly beneficial in attenuating the development of a CTD, yet not able to prevent it, as viscoelastic tissues residual creep accumulates and its recovery is of extremely long duration.

RELEVANCE

The data provides direct biomechanical and physiological evidence that explain the development of a CTD due to prolonged exposure to static lumbar flexion as well as confirms the epidemiological data correlating such work conditions with substantial increase in symptoms of low back disorders. The benefit of frequent rest periods in attenuating the risk of such a disorder is validated as an effective intervention.

Muscular dysfunction elicited by creep of lumbar viscoelastic tissue

The biomechanics, histology and electromyography of the lumbar viscoelastic tissues and multifidus muscles of the in vivo feline were investigated during 20 min of static as well as cyclic flexion under load control and during 7 h of rest following the flexion. It was shown that the creep developed in the viscoelastic tissues during the 20 min of static or cyclic flexion did not fully recover over the 7 h of following rest. It was further seen that a neuromuscular disorder with five distinct components developed during and after the static and cyclic flexion. The neuromuscular disorder consisted of a decreasing magnitude of reflexive EMG from the multifidus upon flexion as well as of superimposed spasms. The recovery period was characterized by an initial muscle hyperexcitability, a slowly increasing reflexive EMG and a delayed hyperexcitability. Histological data from the supraspinous ligament demonstrate significant increase (x 10) in neutrophil density in the ligament 2 h into the recovery and even larger increase (x 100) 6 h into the recovery from the 20 min flexion, indicating an acute soft tissue inflammation. It was concluded that sustained static or cyclic loading of lumbar viscoelastic tissues may cause micro-damage in the collagen structure, which in turn reflexively elicit spasms in the multifidus as well as hyperexcitability early in the recovery when the majority of the creep recovers. The micro-damage, however, results in the time dependent development of inflammation. In all cases, the spasms, initial and delayed hyperexcitabilities represent increased muscular forces applied across the intervertebral joints in an attempt to limit the range of motion and unload the viscoelastic tissues in order to prevent further damage and to promote healing. It is suggested that a significant insight is gained as to the development and implications of a common idiopathic low back disorder as well as to the development of cumulative trauma disorders.

Neuromuscular disorders associated with static lumbar flexion: a feline model

Static flexion of the lumbar spine with constant load applied to the viscoelastic structures for 20 minutes and for 50 minutes resulted in development of spasms and inhibition in the multifidus muscles (e.g., deep erector spinae) and in creep of the supraspinous ligament in the feline model. The development of spasms and inhibition was not dependent on load magnitude. It is suggested that occupational and sports activities which require prolonged static lumbar flexion within the physiological range can cause a "sprain"-like injury to the ligaments, which in turn reflexively induce spasms and inhibition in some erector spinae muscles. Such disorder may take a long time to recover, in the order of days to weeks, depending on the level of creep developed in the tissues.

Neuromuscular neutral zones associated with viscoelastic hysteresis during cyclic lumbar flexion

STUDY DESIGN

The reflexive EMG from the L3-L4 to L5-L6 multifidus of the in vivo feline was recorded during application of single passive flexion-extension cycle of the lumbar spine.

OBJECTIVE

To determine the effect of viscoelastic hysteresis associated with a single-cycle flexion-extension and of increasing cycle frequency on the initiation and cessation displacement and tension thresholds of reflexive EMG from the multifidus muscles.

SUMMARY OF BACKGROUND DATA

It is known that reflexive EMG can be recorded from some paraspinal muscles as a result of mechanical stimulation of lumbar ligaments and other viscoelastic structures. It is also known that mechanical neutral zones exist in the spine, that viscoelastic hysteresis is associated with a stretch-release cycle, and that the rate of stretch and release has a profound impact on viscoelastic tissue responses. It is unknown what are the neurologic neutral zones of the spine within which reflexive EMG does not exist, as well as the dependence of such neurologic neutral zones on viscoelastic hysteresis and increasing frequency of a flexion-extension cycle.

METHODS

Single passive flexion-extension cycles of frequencies ranging from 0.1 to 1.0 Hz were applied to the lumbar spine of the feline while recording intramuscular EMG from the L3-L4 to L5-L6 multifidus. The displacement and tension thresholds associated with the initiation and cessation of EMG activity during the cycle were analyzed with respect to the cycles' viscoelastic hysteresis and frequency. The peak EMG discharge was tested for relationships with cycle frequency.

RESULTS

The displacement and tension thresholds during the flexion phase of the cycle were significantly lower than the corresponding thresholds in the extension phase of the cycle. As the cycle frequency increased, EMG was triggered significantly earlier (lower displacement and tension thresholds) in the flexion phase and terminated earlier (higher displacement and tension thresholds) in the extension phase. The peak EMG was significantly larger as cycle frequency increased.

CONCLUSIONS

Reflexive muscle forces are triggered at lower displacement or tension during flexion but diminish early during extension, leaving the spine unprotected for a substantial part of the extension movement. The muscle forces are recruited earlier and with larger intensity as the velocity of the movement increases, lending more protection to the spine. Faster extension movement, however, creates a larger window during which the spine is exposed to instability and injury because of lack of muscle forces.

The effect of placing a tensioned graft across open growth plates. A gross and histologic analysis

BACKGROUND

Midsubstance tears of the anterior cruciate ligament in skeletally immature patients are increasingly common and are a challenging problem. The results of nonoperative treatment are no better in children than they are in adults. Physeal-sparing reconstructive procedures have yielded poor results. Reconstructive procedures that are utilized in adults violate the physis, potentially resulting in growth abnormalities. The objective of this study was to provide a model for reconstruction of the anterior cruciate ligament in skeletally immature patients by evaluating the effects of a tensioned connective-tissue graft placed across the canine physis.

METHODS

Twelve ten-week-old beagles underwent reconstruction of the anterior cruciate ligament consisting of placement of fascia lata autograft through drill-holes across the femoral and tibial physes, tensioning of the graft to 80 N, and fixing it with screws and washers. The contralateral limb served as a control. One dog was eliminated from the study secondary to a postoperative infection. Four months postoperatively, the dogs were killed and were inspected grossly, radiographically, and histologically for any evidence of growth disturbance.

RESULTS

Significant valgus deformity of the distal part of the femur (p < 0.001) and significant varus deformity of the proximal part of the tibia (p = 0.03) developed in the treated limbs. Neither radiographic nor histologic examination demonstrated any evidence of physeal bar formation.

CONCLUSIONS

Significant growth disturbances occur with excessively tensioned transphyseal reconstruction of the anterior cruciate ligament in the canine model. These growth disturbances occur without radiographic or histologic evidence of physeal bar formation.

Multifidus EMG and tension-relaxation recovery after prolonged static lumbar flexion

STUDY DESIGN

The electromyogram (EMG) from the in vivo feline L1 to the L7 multifidus was recorded during the application of a 20-minute static lumbar flexion and after 7 hours of rest.

OBJECTIVE

To determine the recovery of tension-relaxation and laxity in the lumbar viscoelastic structures as well as the recovery of reflexive EMG activity in the multifidus after prolonged static flexion.

SUMMARY OF BACKGROUND

It has been established that prolonged static flexion of the spine induces creep or tension-relaxation in its viscoelastic structures as well as a sharp decrease in the reflexive activity of the dorsal musculature and initiation of spasms. Epidemiologic studies have pointed out that such static flexion is associated with unusually high rates of low back disorders. The rate and pattern of recovery of reflexive muscular activity with rest after static flexion is still unknown.

METHODS

The lumbar spines of seven in vivo feline preparations were subjected to 20 minutes of passive anterior flexion followed by 7 hours of rest while monitoring flexion tension, EMG from the L1-L7 multifidus muscles, and the strain of the L4/L5 supraspinal ligament. A model describing the pattern of recovery of muscular activity and viscoelastic tension was developed.

RESULTS

Twenty minutes of lumbar flexion was associated with an initial sharp decrease of multifidus EMG activity followed by spasms. During rest, EMG activity demonstrated an initial hyperexcitability on flexion, followed by an exponential recovery of muscle activity. Full recovery of residual strain in the L4/L5 supraspinous ligament and multifidus activity was not obtained after 7 hours of rest.

CONCLUSIONS

Static flexion of the lumbar spine is an extremely imposing function on its viscoelastic tissues, resulting in spasms and requiring long periods of rest before normal functions are re-established.

Neuromuscular neutral zones sensitivity to lumbar displacement rate

OBJECTIVES

To determine the displacement and tension thresholds (developed during anterior lumbar flexion) which trigger reflexive muscular activity in the multifidus muscles; their variability with the velocity of flexion; and the pattern of threshold variability across the lumbar spine.Design. An in-vivo study of the feline during passive lumbar flexion applied via the L-4/5 supraspinous ligament.

METHOD

EMG from six pairs of intramuscular electrodes inserted in the L-1/2 to L-6/7 multifidus muscles was recorded while the lumbar spine was passively flexed to 75% of the physiological strain of the supraspinous ligament at rates of 17-100%/s. Three-dimensional models of tension threshold, flexion rate and lumbar levels were developed from the experimental data.

RESULTS

Displacement and tension thresholds were the lowest at the fastest flexion rate and gradually increased as flexion rates decreased. Electromyographic activity was detected at low thresholds at the center of the flexion and at gradually increasing thresholds at higher and lower lumbar segments.

CONCLUSION

Multifidus reflexive muscular activity, which stabilize the spine, is triggered at a displacement and tension thresholds of 5-15% of the physiological range. Earlier activation of muscular activity occurs as the velocity of flexion increases. Earlier activation also occurs near the center of flexion.

RELEVANCE

Sensory-motor neurological feedback maintains spine stability and is responsive to the velocity of lumbar motion. A neuromuscular silence exists in small lumbar movements in which spine stability is not protected by the musculature. Spine models constructed to predict risk factors could benefit from incorporating this new information.

Multifidus spasms elicited by prolonged lumbar flexion

STUDY DESIGN

The electromyogram of the L1-L7 multifidus muscles of the in vivo cat were recorded while applying a prolonged steady displacement to the lumbar spine through the L4-L5 supraspinous ligament, simulating a moderate anterior flexion.

OBJECTIVE

To demonstrate that tension-relaxation and laxity of the viscoelastic structures (ligaments, discs, and capsules) induced by prolonged static flexion of the spine results in loss of reflexive muscular stabilizing activity and in muscular disorders that may lead to or are associated with low back pain.

SUMMARY OF BACKGROUND

Epidemiologic data show that prolonged loading of the spine, such as in some occupational activities, can cause low back pain and muscle spasms. Direct experimental evidence linking prolonged loading to a decrease in spinal stability, low back pain, and muscle spasms was not found. It was hypothesized, however, that mechanoreceptors in the viscoelastic structures, when strained, reflexively activate the multifidus muscles to maintain intervertebral stability; that the reflexive muscular activity decreases with stress-relaxation and laxity in the viscoelastic structures; and that when severe strain and possible damage of the viscoelastic structures occurs with time, nociceptive receptors elicit spasms in the musculature and possible pain.

METHODS

The lumbar spine of seven in vivo cat preparations was displaced through the L4-L5 supraspinous ligament into moderate flexion that was steadily maintained for 50 minutes while intramuscular electromyograms were recorded from each of the multifidus muscles of L1-L2 through L6-L7. Load and electromyogram were continuously monitored and recorded. Five additional preparations were used as controls, in which dissection and recordings were identical, but the lumbar flexion was excluded.

RESULTS

Prolonged flexion of the lumbar spine resulted in initial reflexive electromyogram from the multifidus muscles that decreased to approximately 5% of its initial value as tension-relaxation began in the viscoelastic structures within the first 3 minutes, after which, random and unpredictable electromyogram discharges (i.e., spasms) of high amplitude were recorded from different levels. In some preparations the spasms were present in L1-L4, and in others in all the levels. In other preparations the spasms were recorded only at L5 and L6. The onset of the spasms was also unpredictable, because they were initiated in some cases within 2-3 minutes after the spine was loaded. In other cases, the spasms were observed anytime during the test period and up to 20 minutes after the load was removed. Spasms were also observed in the spinalis and longissimus muscles.

CONCLUSIONS

Prolonged flexion of the lumbar spine results in tension-relaxation and laxity of its viscoelastic structures, loss of reflexive muscular activity within 3 minutes and electromyogram spasms in the multifidus and other posterior muscles.

Effect of intraarticular stainless steel implants on the health of the rabbit knee joint: an experimental study

OBJECTIVE

This study was designed to investigate the histologic changes to the knee joints of rabbits after insertion of a metal implant in retrograde fashion.

DESIGN

Eighteen rabbits had a modified stainless steel screw implanted in one knee, with the other knee serving as a sham-operated control. The animals were killed after two, six, or twelve months.

OUTCOME MEASURES

The histologic status of the cartilage and synovium were graded by the Modified Mankin and Mirra criteria, respectively.

RESULTS

At the time of killing, every insertion site was covered by fibrous tissue. Statistical analysis showed no significant differences in histologic scores between implanted and control knees.

CONCLUSIONS

Insertion of a stable, well-fixed implant results in no deleterious effect to the knee joint.

Closed-loop control of muscle length through motor unit recruitment in load-moving conditions

Neuroprostheses aimed at restoring lost movement in the limbs of spinal cord injured individuals are being developed in this laboratory. As part of this program, we have designed a digital proportional-integral-derivative controller integrated with a stimulation system which effects recruitment of motor units according to the size principle. This system is intended to control muscle length while shortening against fixed loads. Feline sciatic nerves were exposed and stimulated with ramp, triangular, sinusoidal, staircase and random signals as test inputs. Changes in muscle length and effective time delay under different conditions were measured and analyzed. Differences of tracking quality between open- and closed-loop conditions were examined through analysis of variance as well as the differences between small (250g) and large (1kg) loads. The results showed that parameters used to compare muscle length output to the input signals were dramatically improved in the closed-loop trials as compared to the open-loop condition. Mean squared correlation coefficients between input and output signals for ramp signals increased by 0.019, and for triangular signals by 0.12. Mean peak cross correlation between input and output signals for sinusoidal waveforms increased by 0.06, with decreases in time to peak cross correlation (effective time delay) from 195 to 38ms. In slow random signals (power up to 0.5Hz), peak cross correlation went from 0.74 to 0.89, and time-to-peak cross correlation decreased from 205 to 55ms. In fast random signals (power up to 1Hz), peak cross correlation went from 0.82 to 0.89, and time-to-peak cross correlation from 200 to 65ms. For staircase signals, both rise times and mean steady-state errors decreased. It was found that, once the length range was set, the load weight had no effect on tracking performance. Analysis of mean square error demonstrated that for all signals tested, the feedback decreased the tracking error significantly, whereas, again, load had no effect. The results suggest that tracking is vastly improved by using a closed-loop system to control muscle length, and that load does not affect the quality of signal tracking as measured by standard control system analysis methods.

Force and surface mechanomyogram frequency responses in cat gastrocnemius

Muscle surface displacement is a mechanical event taking place simultaneously with the tension generation at the tendon. The two phenomena can be studied by the surface mechanomyogram signal (MMG) (produced by a laser distance sensor) and the force signal (from a load cell). The aim of this paper was to provide data on the reliability of the laser detected MMG in muscle mechanics research. To this purpose it was verified if the laser detected MMG was suitable to estimate a frequency response in the cat medial gastrocnemius and its frequency response was compared with the one retrieved by the force signal at the tendon level. The force and MMG from the exposed medial gastrocnemius of four cats were analysed. The frequency response was investigated by sinusoidally changing the number of orderly recruited motor units, in different trials, in the 0.4-6 Hz range. It resulted that it was possible to model the force and MMG frequency response by a critically damped second-order system with two real double poles and a pure time delay. On the average, the poles were at 1.83 Hz (with 22.6 ms delay) and at 2.75 Hz (with 38 ms delay) for force and MMG, respectively. It can be concluded that MMG appears to be a reliable tool to investigate the muscle frequency response during stimulated isometric contraction. Even though not statistically significant. the differences in the second-order system parameters suggest that different components of the muscle mechanical model may specifically affect the force or MMG.

Biexponential recovery model of lumbar viscoelastic laxity and reflexive muscular activity after prolonged cyclic loading

OBJECTIVES

To determine the rest duration required for full recovery of reflexive muscular activity and laxity/creep induced in the lumbar viscoelastic structures (e.g., ligaments, discs, etc.) after 50 min of cyclic loading, and to develop a model describing such recovery.

BACKGROUND

It is well established that steady, cyclic or vibratory loading of the lumbar spine induces laxity/creep in its viscoelastic structures. It was also shown that such viscoelastic creep does not fully recover when subjected to rest equal in duration to the loading period. Rest periods of 24 h, however, were more than sufficient to allow full recovery. The exact period of time allowing full recovery of viscoelastic laxity/creep, and its pattern is not known. It is also not known what is the duration required for full recovery of reflexive muscular activity lost due to the laxity/creep induced in the spine during cyclic loading.

METHODS

The lumbar spine of 'in vivo' feline preparations was subjected to 50 min of 0.25 Hz cyclic loading applied v ia the L4/5 supraspinal ligament. At the end of the loading period the spine was subjected to prolonged rest, interrupted by a single cycle loading applied hourly for measurement purposes until the laxity was fully recovered (>90%). Reflexive EMG activity was recorded with wire electrodes from the L-1-L-7 multifidus muscles. A biexponential model was fitted to the load and EMG recorded in the recovery period in order to represent viscous and elastic components of structures with different architecture (e.g., disc vs. ligament).

RESULTS

Full recovery of the laxity induced by 50 min of cyclic loading at 0.25 Hz required 7 h and was successfully fitted with a biexponential model. Similarly, EMG activity was fully recovered in 4 hours, and often exceeded its initial value during the following 3 h.

CONCLUSIONS

Full recovery of laxity induced in the lumbar viscoelastic structures by a given period of cyclic loading requires rest periods, which are several folds longer than the loading duration. Similarly, reflexive muscular activity requires 4 h of rest in order to be restored. Meanwhile, significant laxity can be present in the joints, exposing the spine to potential injury and low back pain. Increased EMG activity at the end of the recovery period may indicate that pain was possibly induced in the spinal structures, inducing hyperexcitability of the muscles during passive loading.

RELEVANCE

Although the data was derived from a feline model, and its extrapolation to the human model is not straightforward, the general pattern of decreasing reflexive muscular activity with cyclic loading is expected in both species. Therefore, workers who subject their spine to periods of cyclic loading may be exposed to prolonged periods of laxity beyond the neutral zone limits, without protection from the muscles and therefore the risk of possible injury and low back pain. Pain and muscle hyperexcitability could also be a factor associated with cyclic loading, being expressed several hours after work was completed.

Characterization of load-length-velocity relationships of nine different skeletal muscles

A three-dimensional characterization of muscle load, length and velocity was obtained from nine muscles in the cat's hind limb through contractions where the muscles shortened against inertial-gravitational loads. A model based on the load-length characteristic and second-order dynamics describes shortening velocity related to load and length under these conditions. We conclude that this model describes well contraction velocity as function of length and load under inertial-gravitational load conditions, with correlation coefficients higher than 0.9 in most of the tested muscles.

Biomechanics of increased exposure to lumbar injury caused by cyclic loading: Part 1. Loss of reflexive muscular stabilization

STUDY DESIGN

The recording of electromyographic responses from the in vivo lumbar multifidus of the cat, obtained while cyclic loading was applied as in occupational bending/lifting motion over time.

OBJECTIVES

To determine whether the effectiveness of stabilizing reflexive muscular activity diminishes during prolonged cyclic activity; the recovery of lost muscle activity by a 10-minute rest; and whether such diminished muscular activity is caused by fatigue, neurologic habituation, or desensitization of mechanoreceptors in spinal viscoelastic tissues resulting from its laxity.

SUMMARY OF BACKGROUND DATA

The literature repeatedly confirms observation that cyclic occupational functions expose workers to a 10-fold increase in episodes of low back injury and pain. The biomechanical evidence indicates that creep in the viscoelastic tissues of the spine causes increased laxity in the intervertebral joints. The impact of cyclic activity on the function of the muscles, which are the major stabilizing structures of the spine, is not known.

METHODS

Electromyography was performed from the L1 to L7 in vivo multifidus muscles of the cat, while cyclic passive loading of 0.25 Hz was applied to L4-L5. Cyclic loading was applied for 50 minutes, followed by 10 minutes rest and a second 50-minute cyclic loading session. A third 50-minute cyclic loading period also was applied after the preload was reset to 0.5 N to offset the effect of laxity.

RESULTS

Reflexive muscular activity was recorded from the multifidus muscles of all lumbar levels at the initiation of the first 50 minutes of cyclic loading. Activity recorded on electromyography quickly diminished with each cycle during the first 8 minutes of loading to 15% of its initial value. A slower decrease in muscular activity was evident throughout the remaining period, settling at 5% to 10% of its initial level by the end of 50 minutes. A 10-minute rest provided a 20% to 25% recovery of the electromyographic activity, but that was lost within the first minute of cycling. Offsetting the laxity in the spine resulted in full restoration of the electromyographic activity at all lumbar levels.

CONCLUSIONS

The creep induced in the viscoelastic tissues of the spine as a result of cyclic loading desensitizes the mechanoreceptors within, which is manifest in dramatically diminished muscular activity, allowing full exposure to instability and injury, even before fatigue of the musculature sets in.

Biomechanics of increased exposure to lumbar injury caused by cyclic loading. Part 2. Recovery of reflexive muscular stability with rest

STUDY DESIGN

Electromyographic responses from the lumbar multifidus muscle of the cat were recorded in vivo during 50 minutes of cyclic loading followed by 2 hours of rest.

OBJECTIVE

To determine the rate of recovery of reflexive muscular stabilizing activity resulting from rest after viscoelastic laxity induced by 50 minutes of cyclic loading.

SUMMARY OF BACKGROUND DATA

Muscular forces from agonists and antagonists were repeatedly shown to be the most significant stabilizing structures of the lumbar spine. Reflexive muscular coactivation force from the multifidus muscle elicited by mechanoreceptors in the spinal viscoelastic structures were, however, shown to diminish drastically with the onset of laxity in the viscoelastic structures. Data describing the rate of recovery of reflexive muscular coactivation forces resulting from rest after cyclic loading were not found.

METHODS

Cyclic loading of the lumbar spine at 0.25 Hz was applied to L4-L5 for 50 minutes while electromyograms from the multifidus muscles of L1-L2 to L6-L7 were recorded. A rest period of up to 2 hours was given, during which electromyographic responses and load were measured every 10 minutes to sample recovery of laxity and reflexive muscular activity.

RESULTS

Load and electromyographic response demonstrated an exponential decrease during the 50 minutes of cyclic loading. The first 10 minutes of rest allowed a significant recovery in laxity and muscle activity, with additional slow recovery over the next 20 to 30 minutes. The electromyographic response and load were increasing at an extremely slow rate thereafter. Overall, 2 hours of rest yielded only a 20% to 30% recovery in electromyographic response. Full recovery was never observed. A biexponential model was developed to predict loss and recovery of reflexive muscular activity and viscoelastic tension with laxity.

CONCLUSIONS

Laxity in the viscoelastic structures of the lumbar spine desensitizes the mechanoreceptors within and causes loss of reflexive stabilizing forces from the multifidus muscles. The first 10 minutes of rest after cyclic loading results in fast partial recovery of muscular activity. However, full recovery is not possible even with rest periods twice as long as the loading period, placing the spine at an increased risk of instability, injury, and pain.

Damage to rabbit femoral articular cartilage following direct impacts of uniform stresses: an in vitro study

OBJECTIVE

To determine the acute gross and histologic damage resulting to femoral cartilage from an in vitro direct impact of uniform stress.

DESIGN

Gross and histologic evaluations were performed on rabbit femoral condyles impacted by a drop-tower device.

BACKGROUND

It is thought that impacts above a given threshold stress may initiate post-traumatic arthritis. The extent of damage following impacts of specific stress has not been previously studied.

METHODS

12 New Zealand White rabbit medial femoral condyles were divided into three groups by impact type and magnitude. A drop tower was used to strike the femoral condyle with a flat impactor, or with a custom contoured impactor. Gross and histological grades were given depending on the depth and number of fissures and cracks in the impacted condyle.

RESULTS

The degree of damage correlated best with the type of impactor used and with the impact force; correlation between damage and impact stress was less significant. Contoured impactors tended to produce superficial fibrillation, while flat impactors tended to produce deep cracks. Impact forces above 500 N tended to create more severe damage than impact forces below 500 N. Subchondral bone remained intact in all cases and deep cartilage damage did not occur without disruption of more superficial layers. Poor correlation was found between damage as graded by gross examination versus damage graded histologically.

CONCLUSIONS

Acute damage corresponds best with type of impactor and impact force, and not as well with impact stress. Micro structural injuries may be present in the absence of gross findings.

RELEVANCE

Post-traumatic arthritis is a disabling disease thought to occur when a blow of stress above a given threshold is delivered to articular cartilage. Current animal models of post-traumatic arthritis are unable to characterize the impact stress applied to an articular surface. This study examines grossly and histologically the structural damage occurring as a result of impacts of given stress and force.

Force and surface mechanomyogram relationship in cat gastrocnemius

The aim of this study was to compare the force (F) and the muscle transverse diameter changes during electrical stimulation of the motor nerve. In four cats the exposed motor nerves of the medial gastrocnemius were stimulated as follows: (a) eight separate trials at fixed firing rates (FR) from 5 to 50 Hz (9 s duration, supramaximal amplitude); (b) 5 to 50 Hz linear sweep in 2.5, 5, 7.5 and 10 s (supramaximal amplitude, separate trials); (c) four separate trials at 40 Hz, the motor units (MUs) being orderly recruited in 2.5, 5, 7.5 and 10 s. The muscle surface displacement was detected by a laser distance sensor pointed at the muscle surface. The resulting electrical signal was termed surface mechanomyogram (MMG). In stimulation patterns (a) and (b) the average F and MMG increased with FR. With respect to their values at 50 Hz the amplitude of the unfused signal oscillations at 5 Hz was much larger in MMG than in force. The signal rising phase was always earlier in MMG than in F. In (c) trials, F increased less in the first than in the second half of the recruiting time. MMG had an opposite behaviour. The results indicate that the force and the lateral displacement are not linearly related. The different behaviour of F and MMG, from low to high level of the MUs' pool activation, suggests that the force generation and the muscle dimensional change processes are influenced by different components of the muscle mechanical model.

The ligamento-muscular stabilizing system of the spine

STUDY DESIGN

Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4-L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles.

OBJECTIVES

To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento-muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc.

SUMMARY OF BACKGROUND DATA

The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co-contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found.

METHODS

The supraspinous ligament at L2-L3 and L3-L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4-L5. Electromyography was performed from the multifidus muscles at L2-L3 and L3-L4, bilaterally. In 12 cats, the supraspinous ligaments from L1-L2 to L6-L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion.

RESULTS

Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1-L2 to L6-L7 motion segments. In the free-spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligament resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below.

CONCLUSIONS

Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.

Methods to reduce the variability of EMG power spectrum estimates

Three methods that can significantly reduce the variability of the EMG power density spectrum (PDS) variable by eliminating artifactual components are described. Two methods, one that allows the subtraction of power line noise in the time domain and one which allows the subtraction of system noise in the frequency domain from the EMG, were shown to be effective in helping to accurately estimate the median frequency (MF) of the PDS, and especially during low level contractions (0-25% maximal voluntary contraction, MVC) when the signal-to-noise ratio is unfavorable. The techniques eliminate the artifactual effects of system and power line noises from the EMG recordings throughout the force range (0-100% MVC) while preserving the native EMG power at all frequencies. It was also shown that if a technique to train subjects to produce their true MVC is employed, the absolute force/torque produced could be as much as 30% higher than in untrained MVC. The effect of true MVC production was also shown to be significant when interpretation of PDS variables are correlated to the processes which produce contraction.

Ligamento-muscular protective reflex in the lumbar spine of the feline

A ligamento-muscular protective reflex in the lumbar spine was demonstrated in a feline model. Stimulating electrodes were applied to the supraspinous ligament between several lumbar vertebra (L1 to L6) while recording myoelectric discharge from the paraspinal muscles at the L3, L4 and L5, bilaterally. Electromyographic (EMG) activity was present in the paraspinal muscles bilaterally, upon stimulation of the supraspinous ligament, in six preparations. The EMG discharge was strongest in the muscles one level below that of the stimulated ligament, whereas weaker EMG signals were recorded from as far as two levels above and below. The mean time delay between the application of the stimulus to the ligament to the resulting EMG ranged from 2.52 to 2.77 ms at all levels. Stimulation of the supraspinous ligament in the L6 segment resulted in a weak reflex response, and stimulation in the L7 segment did not produce any EMG activity. It was concluded that mechanoreceptors in the supraspinous ligament at the L1/6 levels may initiate sensory signals upon strain of the ligament, during flexion. This, in turn, causes contraction of the paraspinal muscles, bilaterally, to extend the spine and prevent possible damage to the ligament while maintaining stability. The results may add to the understanding of low back pain, and to the formulation of surgical procedures which could spare the neural supply of the ligament, allowing advanced physiotherapeutic modalities to be implemented for post-surgical rehabilitation.

Force feedback control of motor unit recruitment in isometric muscle

The use of simple force feedback in an isometric muscle control system utilizing orderly recruitment of motor units is explored. Cat medial gastrocnemius motor units were stimulated with and without simple force feedback gain ranging from 0.7 to 0.9. Ramp, triangular, staircase, sinusoidal and bandwidth-limited pseudo-random input recruitment signals were used to study tracking accuracy through linear correlation in ramp and triangular signals, cross correlation in sinusoidal and random signals, and rise time and steady state error in staircase signals. Dramatic improvements were found in most tested tracking variables with the use of feedback; squared correlation coefficients increased from a mean of 0.93 to 0.99 for ramp signals and from 0.76 to 0.98 in triangular signals. Mean peak cross-correlations improved from 0.85 to 0.98 in random signals and from 0.93 to 0.98 for sinusoidal inputs, and mean time to peak cross-correlations decreased from 144 to 24 ms in random signals and from 156 to 25 ms in sine waves. Rise times in staircase signals decreased from a mean of 520 to 175 ms, and mean steady state error decreased from 12 to 3%. Significant effects of the triangle cycle time, sinusoidal frequency and staircase step were found on the performance of the muscle force control system. In addition, the possible effects of intrinsic feedback mechanisms on the control system were examined by repeating the closed loop part of the study but with the sciatic nerve cut proximally. The tracking results were essentially and statistically the same as in the closed loop condition. It was concluded that a simple feedback configuration provided superior tracking performance for a practical application in which orderly recruitment is used to control muscles; furthermore, it was concluded that this type of system would be virtually immune to external disturbances such as spasticity resulting from intact spinal neural feedback mechanisms found in paralyzed individuals.

Open-loop tracking performance of a limb joint controlled by random, periodic, and abrupt electrical stimulation inputs to the antagonist muscle pair

The ability of the cat's ankle joint to track various input signals when controlled by electrically elicited motor unit recruitment, firing rate and antagonist muscle coactivation was examined. Pseudo-random, sinusoidal and staircase signals were used to control the soleus and tibialis anterior muscles isometrically and with a 250-g pendulum. Tracking was evaluated through cross correlation for pseudo-random and sinusoidal signals, and by rise time and steady-state error in step signals. Better tracking was obtained in isometric conditions than in load-moving conditions. Pseudo-random signals resulted in 250-ms delay between input and isometric torque output. For load-moving conditions, 340-ms and 400-ms delay in torque and angle were obtained. For sinusoids, delays decreased from 240 ms at 0.5 Hz, to 140 ms at 2 Hz in isometric conditions. Time delays for angle were between 300 and 400 ms, decreasing as frequency increased. Poor cross correlation was found for torque in load-moving conditions, because of pendulum nonlinear dynamics. Step size was not uniform in staircase trials, with steady-state errors between 9% and 39%, and rise times between 200 and 1000 ms. It is concluded that open-loop joint control results in poor tracking, presumably because it is devoid of feedback mechanisms.

Frequency domain-based models of skeletal muscle

Models of skeletal muscle based on its response to sinusoidal stimulation have been in use since the late 1960s. In these methods, cyclic excitation at varying frequencies is used to determine force or muscle length amplitude and phase as functions of excitation frequency. These functions can then be approximated by models consisting of combinations of poles and zeros and pure time delays without the need to combine force-length or force-velocity relationships. The major findings of a series of frequency response studies undertaken in our laboratory revealed that: The frequency response models for isometric force including orderly recruitment of motor units were relatively invariant of the particular strategy or oscillation level employed. A critically damped second order model with corner frequency near 2 Hz and a pure time delay best described the relationship between input stimulation and output isometric force. The frequency response models for load-moving muscles consisted of an overall gain which is a function of mass, dependent mostly on the width of the length-force relation at a given load (force), and a frequency-dependent gain component independent of load mass. The phase lag between input and output was also independent of load. Muscle function and architecture are the primary determinants of its isometric force frequency response. Tendon viscoelasticity (excluding the aponeurosis) has no significant effect on isometric force dynamic response, but does have a minor effect on load-moving dynamic response. The effect of tendon in reducing or augmenting the load-moving muscle response bandwidth is muscle-dependent. The joint produces decreased high frequency gain and uniformly increased phase lags between input excitation and output force in isometric conditions. The joint acts as a lag network in load-moving conditions, increasing the phase lag without significant effect on the gain. Despite its inherent non-linear properties, the joint does not significantly deteriorate output signal quality in either isometric or load-moving conditions. Co-contraction strategy has a significant effect on the dynamic response of the joint. These frequency-based models have shown to be robust as long as the excitation type and mechanical conditions under which they are obtained are not varied. They are particularly useful for the design of neuroprostheses, where a dynamic description of muscle output as a function of stimulus input under given conditions is desirable.

The influence of antagonist muscle control strategies on the isometric frequency response of the cat's ankle joint

This study investigated the effect of various strategies to control the interaction between agonist and antagonist muscles on the frequency response of the isometric cat ankle joint actuated by the tibialis anterior (TA) and soleus (SOL) muscles. Some strategies were based on the physiologic need for increasing joint stability during forceful contractions; with these strategies, the proportional rate of physiologic antagonist activity was termed antagonist gain. Other strategies were based on the electrical stimulation literature, which advocates co-contraction at low force levels. The range of crossover of antagonist activity to the agonist's domain was termed overlap. Strategies consisting of 0%, 10%, and 20% antagonist gain were combined with 0%, 50%, and 100% overlap for a total of nine strategies. These were applied to the TA and SOL using sinusoidal input signals varying in frequency from 0.4 to 6 Hz. Gain and phase Bode plots were constructed through the use of the fast Fourier transforms (FFT's); and analysis of variance determined the significance of differences in gain and phase across frequencies. Best-fit models consisting of four poles and two zeroes were used to fit the experimental data and compared against an analytical model of muscles acting independently across the joint. Harmonic distortion was calculated to evaluate signal quality. It was found that changing the overlap and the antagonist gain produces significant changes in the dynamic response of the two-muscle joint system. The analytical approach to modeling such a system tends to consistently overestimate gain. It is suggested that signal quality is optimal when a moderate amount of antagonist gain (10%) is engaged, with overlap of 50% to smooth transitions between opposing movements. It is expected that this type of strategy will achieve optimum signal quality while preserving the long-term integrity of the joint.

Evaluation of antagonist coactivation strategies elicited from electrically stimulated muscles under load-moving conditions

Muscle coactivation strategies that produce ankle dorsiflexion and plantar flexion were elicited by electrical stimulation of the tibialis anterior (TA) and soleus (SOL) muscles of the cat, and examined under several loading conditions. Four different load types were used: free-limb motion (no load), fly-wheel, and two pendulums, each with a different lever arm. Three types of coactivation strategies were considered. The first coactivation strategy consisted of antagonist activity that decreased as the agonist activity increased. The second strategy consisted of increasing antagonist activity with increasing agonist activity. And, in the third strategy, antagonist coactivation decreased at low force levels, then increased at high force levels. The three strategies were evaluated based on the joint angle's peak-to-peak movement and its ability to track a linear input command given by the correlation coefficient of the output signal versus linear input. Results showed that increasing antagonist activity resulted in decreasing peak-to-peak angle and a decreased signal tracking capability for each load condition. The latter, however, was not as obvious in the flywheel load (as compared with free-moving and pendulum conditions). A decreasing peak-to-peak torque for pendulum loads was also observed with increasing antagonist activity. In all loading conditions, maximal peak-to-peak angle and torque were present when a moderate degree of antagonist activity was engaged, and signal tracking capability improved with earlier engagement of the antagonist muscles. It is suggested that strategies using a combination of low-level coactivation, as described in the physiological literature and previous functional electrical stimulation (FES) studies, could satisfactorily address the issues of controllability and efficiency while maintaining long-term joint integrity.

Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part II: Medical evaluation of 70 paraplegic patients

Medical evaluation was performed on a group of paraplegics who were trained to walk with the Reciprocating Gait Orthosis powered with electrical muscle stimulation (RGO II). The evaluation included changes in spasticity, cholesterol level, bone metabolism, cardiac output and stroke volume, vital capacity, knee extensors torque, and heart rate at the end of a 30-meter walk. After an average of 14 weeks of training during which patients walked for 3 hours per week, significant reductions in spasticity, total cholesterol and low-density lipids, hydroxyproline/creatinine ratio, and increased knee extensor torque were evident. The data also showed that improvements occurred in the calcium/creatinine ratio, serum calcium and alkaline phosphatase levels, cardiac output and stroke volume, and vital capacity, yet these improvements were not statistically significant. The final heart rate at the end of a 30-meter walk showed that the RGO II required only a moderate level of exertion, which was found to be the lowest among the other mechanical or muscle stimulation orthoses available to paraplegics. It was concluded that the limited but reasonable level of functional regain provided by the RGO II is associated with a general improvement in the paraplegic's physiological condition if used for a minimum of 3 to 4 hours per week.

Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part I: Performance evaluation of 70 paraplegic patients

Seventy paraplegics were fitted with an improved Reciprocating Gait Orthosis powered with or without (low-level injury) electrical stimulation of the thigh muscles (RGO II) as a secondary rehabilitation phase after the acute period. The patients comprised a broad cross-section of the paraplegic population applying for medical services and varied in age from 16 to 55 years, time since injury ranging from less than 1 to 15 years, injury levels ranging from C-6/7 to T-11/12, and varying levels of spasticity, contractures, scoliosis and other related medical and physiologic problems. The success/failure ratio was dependent on the injury level, which was 1:1 for paraplegics with injury level at C-6/7; 1.67:1 for those with injury of T-1/3; and about 4:1 for paraplegics with injury level from T-3 to T-12. Lack of motivation and medical problems unrelated to the RGO II treatment were the primary reasons for failure. The duration of treatment (outpatient service three times per week) ranged from 2 to 48 weeks (mean: 16). Forty-one patients who completed the RGO II rehabilitation and were sent home with the orthosis for independent use (for at least 6 months and up to 3 years) were surveyed by a staff member for analysis of the meaning and impact of the RGO II on the patient's life and health, and potential problems. It was shown that 80.5% of the 41 patients were regular users and 19.5% were non-users. Thirty-eight of the 41 patients declined an offer to return the RGO II equipment for a full refund, while three patients were willing to return the orthosis. It was concluded that the RGO II is viable orthosis for restoring standing and limited walking in paraplegics while providing sufficient function, safety, and reliability. The most appropriate patients for the use of such an orthosis consist primarily of those with T-3 to T-12 injury level and good motivation, although highly selected patients with higher injury levels also can benefit from its use. Regular use of the RGO II, even for exercise only, had a general positive impact on the patients' health and outlook.

Method to impact in vivo rabbit femoral cartilage with blows of quantifiable stress

The purpose of this study was to develop a technique by which a known stress could be applied uniformly across the femoral cartilage of a rabbit as a model for the development of post-traumatic arthritis. A system to impact the cartilage was designed that consisted of an apparatus to deliver a blow of quantifiable force, a method to apply the stress uniformly over the impact area, and a way to accurately measure the impact area. The knee joints of cadaveric New Zealand White rabbits were surgically exposed with the knee flexed so that the distal femoral articular surface was perpendicular to an impactor. With the knee fixed in position, a cup containing polymethylmethacrylate bone cement was applied to create an exact contour of the femoral surface, and the cement was allowed to cure. The form was then rested on the rabbit knee, and a drop tower released a weight of known mass from a known height onto an impactor (instrumented with strain gauges to measure the compressive force) that was attached to the cup. The area of the impacted surface was determined and, with the measured force, was used to calculate an accurate estimate of the impact stress. This method can be performed under sterile conditions, and therefore it is well suited for survival experiments in which the long-term effects of impact to cartilage will be studied.

Motor unit recruitment strategy of antagonist muscle pair during linearly increasing contraction

The motor unit recruitment control strategy of the antagonist thigh muscles was determined during linearly increasing isometric flexion and extension of the knees. The median frequency (MF) of the power density spectrum of surface electromyograms recorded from eighteen subjects was used as an indicator of motor units recruitment. The results showed that different recruitment strategies were used by the muscles that are antagonist to each other. When quadriceps and hamstrings acted as agonist most of the motor units were recruited in a linear manner up to 60% of maximal voluntary contraction (MVC). When the muscles acted as antagonist, quadriceps motor units were recruited up to 40% MVC during flexion while during extension the antagonist hamstrings recruited motor units up to 60% MVC. In both muscles, when acting as antagonist, the MF decreased after the recruitment phase, whereas when functioning as agonists, the MF remained relatively constant past the recruitment phase. The results suggested that a single muscle can employ different motor units recruitment strategies in accord with the type of contraction it performs and while acting as an agonist muscle as well as an antagonist.

Force, velocity and energy dynamics of nine load-moving muscles

Nine architecturally different muscles of the cat's hindlimb were investigated with respect to the kinetic energy, the potential energy, and the force variations associated with shortening contractions against gravitational loads. Insight about the energy dynamics of contractile muscle can provide a unifying concept for models of muscle performance capability. In this study, it was found that as contractions shortened from passive equilibrium against a constant mass load, acceleration and deceleration phases appeared. These phase were associated with muscular force variations of up to 25% of the mass weight in fast twitch muscles at low loads. In contrast, slow twitch muscles were associated with less than 10% force variations when shortening against a gravitational load. It also was found that optimal loads exist which maximize each muscle's ability to impart kinetic and potential energy, these optimal loads tend to be in the mid-force range for highly pennate muscle and in the low-force range for justform muscles. It was concluded that the kinetic energy provided by each muscle is a small percentage of that calculated from its length-force relationship, especially at low loads. This study confirms that the efficiency of kinetic energy conversion is very low at low loads (gradually improving as the loads increase) and thereby substantiates early experiments with heat and metabolic energy.

Load, length, and velocity of load-moving tibialis anterior muscle of the cat

Three-dimensional relationships of load, length, and velocity of shortening of the tibialis anterior muscle in the cat were derived experimentally and fitted with an analytic model. Gravitational loads were applied to the isolated muscle, which arrived at an equilibrium with the passive forces before supramaximal tetanic stimulation was delivered to its nerve. Recordings of initial passive muscle length at equilibrium and length changes throughout the shortening phase up to the final length at active equilibrium were taken and numerically differentiated to obtain each load's instantaneous velocity. A three-dimensional surface was constructed by using instantaneous length and the corresponding velocity for each of several loads. Maximal velocity of shortening was shown to gradually decrease, occurring earlier in the shortening phase (at larger muscle lengths) as loads increased. Whereas load-velocity curves were hyperbolic for middle and short muscle lengths, they were nonmonotonic during shortening above the optimal length. The model was found to correlate well with the experimental data (R = 0.98) and allowed for prediction of both muscle performance boundaries and instantaneous shortening velocity for a given length across the physiological load spectrum, thus offering a realistic estimation of the contractile properties exhibited by the tibialis anterior muscle in functions similar to naturally occurring movements against gravitational loads, which are accelerated and decelerated during the movement.

Mechanoreceptors and reflex arc in the feline shoulder

A reflex arc from the glenohumeral capsule to the biceps, infraspinatus, supraspinatus, and subscapular muscles was shown in a feline preparation. Branches of the suprascapular and subscapular nerves terminating in the capsule were identified and then stimulated with a 100 microseconds supramaximal pulse at 10 pulses per second. Stimulation of the suprascapular articular nerve elicited electromyographic discharge in the biceps and infraspinatus muscles, whereas stimulation of the subscapular articular nerve elicited electromyographic discharge in the biceps, subscapularis, infraspinatus, and supraspinatus muscles. When the articular nerves were transected between their emergence from the main nerve trunk and the stimulation electrodes, the electromyographic discharge was abolished confirming the afferent nature of the nerves. The mean time delay ( +/- SD) from application of the stimulus to the peak of the recorded electromyographic activity was 3.2 +/- 0.27 msec. Anatomic dissection and staining of the capsule segments where the articular nerves terminated revealed mechanoreceptors consisting primarily of free nerve endings and Golgi tendon organs, Ruffini's endings, and pacinian corpuscles. The existence of a ligamento-muscular reflex arc in the glenohumeral joint extends the concept of passive and active restraints of a joint by virtue of the synergy between ligaments and muscles. That such a reflex exists may advocate modification of surgical repairs of the capsule, leading to preservation of as many neurologic structures as possible; it may also form the foundation for new postsurgical therapeutic modalities.

Evaluation of isometric antagonist coactivation strategies of electrically stimulated muscles

The performance of various coactivation strategies to control agonist-antagonist muscles in functional electrical stimulation (FES) applications was examined in a cat model using the tibialis anterior and soleus muscles to produce ankle isometric dorsiflexion and plantarflexion torques, respectively. Three types of coactivation strategies were implemented and tested. The first strategy was based on coactivation maps described in the literature as consisting of decreasing antagonistic activity as the input command to the agonist was increased. The second type of strategy was based on the physiologic coactivation data collected from normal subjects exhibiting joint stabilization during the full range of contractions. These strategies included scaled increasing antagonist activity and therefore joint stiffness with increasing agonist input command. A third strategy was devised which at low force levels mimicked the strategies described in the literature and at high force levels resembled strategies exhibited by normal subjects. The three strategies were evaluated based on their ability to track a linear or sinusoidal input command and their efficiency of torque transmission across the joint. Coactivation strategies using increasing antagonist activity resulted in decreased maximal joint torque and efficiency, decreased signal tracking capability for linear inputs, and increased harmonic distortion for sinusoidal inputs. Peak efficiency and tracking ability appeared when a moderate degree of antagonist activity was engaged near the neutral joint position. Signal tracking quality improved with earlier engagement of the antagonist muscles. Our results suggest that strategies combining low-level coactivation as described in the physiological literature and previous FES studies could satisfactorily address the issues of controllability, efficiency, and long-term joint integrity.

Electromyography and biomechanics of a dynamic knee brace for anterior cruciate ligament deficiency

Twelve anterior cruciate ligament (ACL)-deficient subjects performed concentric isokinetic knee extensions at maximum effort both with and without the Bledsoe Pro Shifter knee brace. Electromyogram signals from the quadriceps, hamstrings, knee angle, and the extension force were recorded and evaluated to determine the effects of such dynamic bracing on muscle activity and joint stability. High activity, or asymptomatic, subjects (n = 5) experienced no change in muscle activity, but displayed a decrease in extension force throughout the active range of the brace. Low activity, or symptomatic, subjects (n = 7) exhibited increased quadriceps activity and decreased hamstrings activity, and displayed a minor increase in force in the mid-range (80 degrees to 40 degrees flexion). These results indicate that dynamic bracing prevents quadriceps inhibition in symptomatic subjects by exerting a posteriorly directed force to the superior tibia; thus, the brace compensates externally for the absence of the ACL.

Force-velocity relations of nine load-moving skeletal muscles

The relationship between maximal velocity and load was studied in nine muscles of the cat's hind limb using a technique in which the initial and final muscle lengths are determined by equilibrium of a suspended mass and the muscle's passive and active forces elicited by tetanic stimulation. The maximal velocities of shortening during contraction under each of various loads was used to fit a Hill model using the least-squares method. It was shown that different muscles varied significantly in their ability to generate maximal velocity over a range of loads. The tibialis anterior muscle generate the highest velocity (28.4 cms-1), whereas the tibialis posterior generated the lowest maximal velocity (4.2 cms-1). In general, muscles with predominantly fast twitch fibres and with the largest elongation/shortening range displaced the load at the highest velocities, as compared with muscles with predominantly slow twitch and short excursion range which respond with low velocities. The a/P0 ratio of Hill's equation, which defines the curvature of the force velocity, also varied widely, being most monotonic (0.927) for the soleus and the steepest (0.067) for the extensor digitorum longus, further suggesting that fibre composition is also highly influential on the force-velocity relations of the muscle.

Architecture-based force-velocity models of load-moving skeletal muscles

A predictive model of muscle force-velocity relationships is presented based on functional architectural variables. The parameters of Hill's equation describing muscle force-velocity relationship of nine muscles were estimated by their relationships with variables extracted from the whole-muscle length-force relationship and the percentage of slow-twitch fibres. Specifically, the maximal unloaded velocity (Vo) was estimated through multiple linear regression, from each muscle's fibre composition and the shortening range through which each muscle could produce active force. The maximal isometric force (Po) was also extracted from each muscle's length-force relationship. The ratio of Hill's dynamic constanta to Po and b to Vo, which determines the degree of curvature of the relation, was determined solely by the percent of slow-twitch fibres. This model was verified by fitting it to experimental force-velocity curves of nine different muscles in the cat's hindlimb. It was found that reasonable fits of force-velocity curves would be obtained with correlation coefficient in the range of 0.61 to 0.92, with an average of 0.82. The model predicted that muscles with relatively long shortening ranges would achieve higher maximal velocity, and that muscles with higher percentage of slow-twitch fibres had less pronounced curvature and lower maximal velocity in their force-velocity relationships. RELEVANCE: The results have direct implications in the design of neuroprosthetic limb control systems, which use electrical stimulation to restore function to muscles paralysed from spinal cord injury. The designer is enabled to optimally calibrate the controller according to the predicted individual force-velocity curves of different muscles by using the length-tension curves and fibre composition data available in the literature.

The dynamic response of the cat ankle joint during load-moving contractions

The dynamic response of the cat's ankle joint during load-moving activation of the medial gastrocnemius was determined. Sinusoidal-input oscillations of ankle plantar flexion were performed by the muscle at frequencies ranging from 0.4 to 5 Hz against a 10-N load acting via a cable through a pulley with a 2 cm radius. This was followed by sinusoidal muscle length changes against the same load while excluding the joint. The frequency responses of the two conditions were compared and decomposed in terms of their relative phase and gain, and best-fit pole-zero models to yield the dynamic model of the joint isolated from the muscle properties. The muscle displacement transfer function M(j omega) was characterized as two sets of double poles at 2.1 and 3.2 Hz, with a pair of zeros at 0.92 and 20 Hz, and pure time delay of 8 mS. The joint model J(j omega) was obtained by adding a pole at 5 Hz and a zero at 13 Hz. It was concluded that the ankle joint acts as a lag system, introducing significant increase in the phase lag between stimulus input and mechanical output without affecting the frequency-dependent attenuation of gain. Average harmonic distortion was less than 5% in all cases. This particular finding reveals that, despite its inherently nonlinear mechanical characteristics, the joint introduces no degradation in the simplified linear behavior of the muscle-joint system. This model is useful in the design of systems employing electrical stimulation to restore movement to limbs paralyzed by spinal cord injury or stroke.(ABSTRACT TRUNCATED AT 250 WORDS)

Motor unit recruitment strategy of knee antagonist muscles in a step-wise, increasing isometric contraction

The purpose of this study was to determine if differences exist between the control strategies of two antagonist thigh muscles during knee flexion and extension muscular coactivation. Surface myoelectric signal (MES) of the quadriceps (rectus femoris) and the hamstrings (semitendinosus) were obtained from both muscles while performing step-wise increasing contractions during flexion and extension with the knee at 1.57 rad of flexion (90 degrees). The median frequency of the power density spectrum, which is related to the average muscle fiber action potential conduction velocity and therefore to motor unit recruitment, was calculated from each MES. The results suggest that, in all the subjects tested, when the muscle acts as antagonist most motor units are recruited up to 50% of the maximal voluntary force, whereas when the muscle acts as antagonist motor units are recruited up to 40% of the maximal voluntary force. The force range past 40-50% of the maximal force is also characterized by differences between the agonist/antagonist.

Role of the tendon in the dynamic performance of three different load-moving muscles

The effect of the tendon's viscoelastic properties on the dynamic performance of three different load-moving muscles was determined. The frequency response models of the cat's medial gastrocnemius (MG), extensor digitorum longus (EDL), and tibialis anterior (TA) with and without their tendons were derived under sinusoidal shortening-lengthening, manipulated by orderly recruitment and derecruitment of motor units together with firing rate increase and decrease. The passive load sizes applied to the muscles were approximately 30%-40% of each muscle's maximal isometric force. It was shown that the tendon has a moderate effect on the dynamic response of muscles while moving loads of fixed mass. The MG and EDL without their tendons show a decrease in high frequency gain (2-5 dB) and increasing phase lag angles (7 degrees-9 degrees). In contrast, the TA without its tendon shows an increase in high frequency gain (2 dB) and decreasing phase lag angles (20 degrees) compared with the same muscle with the tendon. It was concluded that tendon's viscoelastic properties have a moderate effect during load-moving contractions, influencing the dynamic performance of different muscles in a different manner.

Isotonic length/force models of nine different skeletal muscles

The isotonic length/force relationships of nine skeletal muscles in the cat's hindlimb were determined using electrical stimulation of the sciatic nerve branches. Large variability in the active, passive, total force patterns and elongation ranges was found. The lateral gastrocnemius (LG), medial gastrocnemius (MG), peroneus longus (PL), flexor digitorum longus (FDL), tibialis posterior (TP) and soleus (Sol) showed symmetric active force curves, whereas those of the extensor digitorum longus (EDL), tibialis anterior (TA) and peroneus brevis (PB) were asymmetric. The total force curves of the EDL, LG, MG, FDL, TP and Sol increased quasilinearly through the elongation range, whereas the PL and PB increased in a nonlinear fashion. The TA had an intermediate plateau. The ranges were generally asymmetric, with a longer shortening range than lengthening past the optimum length. A simple model of the active force was fitted to all except the MG, EDL and TA, which are complex, with at least two compartments. These were successfully fitted with a two-compartment model. The variabilities encountered in the various isotonic length/force curves confirm the need to represent muscles according to their architecture to account for the variety of properties exhibited, which reflect their adaptations to their functions.

Impact tolerances of the rigidly fixated maxillofacial skeleton

A study was designed to determine how soon an athlete who undergoes rigid fixation of a facial fracture can return to full competition. The impact resistance of a rigidly fixated malar complex fracture was studied and compared with that of an intact malar complex. Twelve fresh human cadaver heads were used. A custom-designed impact device was used to deliver a blow of a specific energy to each intact malar complex. The subsequent fractures were rigidly fixated at three points using titanium miniplates and screws. A second impact of identical energy was delivered. The forces generated and the subsequent displacement of hard and soft tissues were recorded after each impact. It was concluded from this study that an impact to a rigidly fixated malar complex fracture produced less force and greater displacement of hard and soft tissues than an impact of identical energy to an intact malar complex. The potential for sustaining more severe maxillofacial injuries after an initial facial fracture should be seriously considered. The results suggest that sufficient time should be allowed for the bony healing of a facial fracture to occur, even after rigid fixation, before an athlete can resume full contact activities.

Role of tendon properties on the dynamic performance of different isometric muscles

The effect of the tendon's viscoelastic stiffness on the dynamic performance of muscles with different architecture was determined using the cat's medial gastrocnemius and extensor digitorum longus. Dynamic response models were derived under sinusoidal contraction-relaxation in the range of 0.4-6.0 Hz and between 20 and 80% of the muscles' maximal isometric tension, manipulated by orderly recruitment-derecruitment of motor units together with firing rate increase-decrease. It was shown that, for isometric contractions at the muscle's optimum length, the dynamic response of the muscles was not significantly different before and after dissection of the tendon. Therefore the conclusion that under these conditions the tendon acts like a stiff force transmitter without significantly modifying the muscle's performance was confirmed and extended to muscles with different architecture.

Integrating computers into orthopedic research

The role of computers in orthopedic research and education is expanding rapidly. Its potential to manipulate large amounts of data and execute multiple complex assignments with great speed and accuracy indeed make the computer an awe-inspiring device. An important instrument in research is the computerized database, a collection of related data arranged so that useful information may be retrieved. Computer models derived from classical physics and fluid mechanics have been used to study motion of both extremities and spinal articulations. Computers also have found usefulness in clinical orthopedic research. The orthopedist of the future will use the computer directly in clinics and private practice for patient evaluation, computer-assisted preoperative planning, and financial recordkeeping.

Energy consumption in paraplegic ambulation using the reciprocating gait orthosis and electric stimulation of the thigh muscles

The energy consumption of six thoracic paraplegic persons ambulating in the reciprocating gait orthosis (RGO) with and without functional electric stimulation (FES) of their thigh muscles was determined as a function of walking speed. Plots of Kcal/kg-min and Kcal/kg-m vs walking speed in the RGO and RGO & FES were experimentally determined in this study and compared with the energy cost of walking in the long leg brace (LLB), the hip guidance orthosis (HGO), and an FES walking aid from data available in the literature. The RGO powered with electric stimulation of the thigh muscles required the lowest energy expenditure in Kcal/kg-m across the full range of walking speeds. The RGO, HGO, LLB, and FES walking orthoses ranked second, third, fourth, and fifth respectively. The lowest energy costs in Kcal/kg-min were associated with the RGO & FES, followed by the RGO, HGO, LLB, and FES for walking speeds below .28m/sec. At walking speeds higher than .28m/sec the HGO demonstrates lower energy cost followed by the RGO & FES, RGO, FES, and LLB. At the end of a 30-m walk, patients using the RGO & FES had a mean heart rate (HR) which was 12 beats/min less than the mean HR when using the RGO without FES, 31 beats/min less than the HR when using the LLB, and 42 beats/min less than the HR when using FES only. It was concluded that the FES-powered RGO combines the advantages of a passive mechanical orthosis with those of FES to provide substantial improvements in energy cost which may provide paraplegic persons with a mode of independent ambulation superior to the wheelchair.