Physical demand but not dexterity is associated with motor flexibility during rapid reaching in healthy young adults

Healthy humans are able to place light and heavy objects in small and large target locations with remarkable accuracy. Here we examine how dexterity demand and physical demand affect flexibility in joint coordination and end-effector kinematics when healthy young adults perform an upper extremity reaching task. We manipulated dexterity demand by changing target size and physical demand by increasing external resistance to reaching. Uncontrolled manifold analysis was used to decompose variability in joint coordination patterns into variability stabilizing the end-effector and variability de-stabilizing the end-effector during reaching. Our results demonstrate a proportional increase in stabilizing and de-stabilizing variability without a change in the ratio of the two variability components as physical demands increase. We interpret this finding in the context of previous studies showing that sensorimotor noise increases with increasing physical demands. We propose that the larger de-stabilizing variability as a function of physical demand originated from larger sensorimotor noise in the neuromuscular system. The larger stabilizing variability with larger physical demands is a strategy employed by the neuromuscular system to counter the de-stabilizing variability so that performance stability is maintained. Our findings have practical implications for improving the effectiveness of movement therapy in a wide range of patient groups, maintaining upper extremity function in old adults, and for maximizing athletic performance

Muscle synergy analysis of lower-limb movements

Dissertação de mestrado integrado em Biomedical Engineering (área de especialização em Medical Electronics)Neurological disorders and trauma often lead to impaired lower-limb motor coordination. Understanding how muscles combine to produce movement can directly benefit assistive solutions to those afflicted with these impairments. A theory in neuromusculoskeletal research, known as muscle synergies, has shown promising results in applications for this field. This hypothesis postulates that the Central Nervous System controls motor tasks through the time-variant combinations of modules (or synergies), each representing the co-activation of a group of muscles. There is, however, no unifying, evidence-based framework to ascertain muscle synergies, as synergy extraction methods vary greatly in the literature. Publications also focus on gait analysis, leaving a knowledge gap when concerning motor tasks important to daily life such as sitting and standing. The purpose of this dissertation is the development of a robust, evidence-based, task-generic synergy extraction framework unifying the divergent methodologies of this field of study, and to use this framework to study healthy muscle synergies on several activities of daily living: walking, sit-to-stand, stand-to-sit and knee flexion and extension. This was achieved by designing and implementing a cross-validated Non-Negative Matrix Factorization process and applying it to muscle electrical activity data. A preliminary study was undertaken to tune this configuration regarding cross-validating proportions, data structuring prior to factorization and evaluating criteria quantifying accuracy in modularity findings. Muscle synergies results were then investigated for different performing speeds to determine if their structure differed, and for consistency across subjects, to ascertain if a common set of muscle synergies underlay control on all subjects equally. Results revealed that the implemented framework was consistent in its ability to capture modularity (p < 0:05). The movements’ synergies also did not differ across the studied range of speeds (except one module in Knee Flexion) (p < 0:05). Additionally, a common set of muscle synergies was present across several subjects (p < 0:05), but shared commonality across every participant was only observed for the walking trials, for which much larger amounts of data were collected. Overall, the established framework is versatile and applicable for different lower-limb movements; muscle synergies findings for the examined movements may also be used as control references in assistive devices.As perturbações e traumas neurológicos afetam frequentemente a coordenação motora dos membros inferiores. Uma teoria recente em investigação neuromusculo-esquelética, denominada de sinergias musculares, tem demonstrado resultados promissores em soluções de assistência à população afetada por estes distúrbios. Esta teoria propõe que o Sistema Nervoso Central controla as tarefas motoras através de combinações variantes no tempo de módulos (ou sinergias), sendo que cada um representa a co-ativação de um grupo de músculos. No entanto, não existe nenhum processo uniformizante, empiricamente justificado para determinar sinergias musculares, porque os métodos de extração de sinergias variam muito na literatura. Para além disso, as publicações normalmente focam-se em análise da marcha, deixando uma lacuna de conhecimento em tarefas motoras do dia-a-dia, tais como sentar e levantar. O objetivo desta dissertação é o desenvolvimento de um processo robusto, genérico e empiricamente justificado de extração de sinergias em várias tarefas motoras, unindo as metodologias divergentes neste campo de estudo, e subsequentemente utilizar este processo para estudar sinergias musculares de sujeitos saudáveis em várias atividades do dia-a-dia: marcha, erguer-se de pé partir de uma posição sentada, sentar-se a partir de uma posição de pé e extensão e flexão do joelho. Isto foi alcançado através da implementação de um processo de cross-validated Non-Negative Matrix Factorization e subsequente aplicação em dados de atividade elétrica muscular. Um estudo preliminar foi realizado para configurar este processo relativamente às proporções de cross-validation, estruturação de dados antes da fatorização e seleção de critério que quantifique o sucesso da representação modular dos dados. Os resultados da extração de sinergias de diferentes velocidades de execução foram depois examinados no sentido de descobrir se este fator influenciava a estrutura dos módulos motores, assim como se semelhanças entre as sinergias de diferentes sujeitos apontavam para um conjunto comum de sinergias musculares subjacente ao controlo do movimento. Os resultados revelaram que o processo implementado foi consistente na sua capacidade de capturar a modularidade nos dados recolhidos (p < 0:05). As sinergias de todos os movimentos também não diferiram para toda a gama de velocidades estudada (exceto um módulo na flexão do joelho) (p < 0:05). Por fim, um conjunto comum de sinergias musculares esteve presente em vários sujeitos (p < 0:05), mas só esteve presente em todos os sujeitos de igual forma para a marcha, para a qual a quantidade de dados recolhida foi muito maior. Globalmente, o processo implementado é versátil e aplicável a diferentes movimentos dos membros inferiores; os resultados das sinergias musculares para os movimentos examinados podem também ser utilizado como referências de controlo para dispositivos de assistência

Afferent Convergence from Divergent Sources Appears to Enhance the Spastic Patient\u27s Ability to Inhibit Antagonist Motoneurons During an Agonist Contraction

Spasticity and excessive muscular cocontraction during movement are common impairments following upper motor neuron (UMN) lesions. For example, during voluntary ankle dorsiflexion, individuals with spastic type cerebral palsy (CP) do not inhibit the antagonist triceps surae motoneuron pool

Temporal and spatial muscle synergy features and its neural origins during sit-to-stand and stand-to-sit tasks

Sit-to-stand (STS) and stand-to-sit (StandTS) play a vital role in our daily lives. These two transitional motions are considered crucial for independent living. Many people with neurological disorders that lack neuromuscular control lose the ability to perform the transition tasks normally. Several muscles act together to achieve these motions and the inability to perform these daily life tasks, therefore, present the need to understand why they are important and what is the role of muscle synergy in the performance of such tasks. Reduced number of synergies have been found in populations with neurological disorders and the differences in the number of muscle synergies reflect descending neural pathway disruptions and present a correlation with motor deficits. Therefore, this review aims to understand the importance of these two transitional motions and muscle synergy extensively to help develop targeted interventions for healthy and clinical populations.Kinesiology and Health Educatio

Multi-Task Neuromuscular Generalization and Changes Through the Lifespan

Mobility in everyday life requires executing and shifting between a broad assortment of functional tasks and resisting disturbances that could cause falls. Though the importance of successfully performing a variety of functional tasks is recognized and incorporated in clinical assessments (e.g., the Timed-Up-and-Go Test, Berg Balance Scale), little is understood about the underlying neuromuscular control required, or how it changes with age. The neuromuscular control for functional tasks such as walking is typically studied in isolation, or with variations on the same task. Characterizing the coordination required to produce and shift between a wider variety of tasks and resist external disturbances is crucial to understanding mobility in daily life, not just within a controlled lab environment. In this work, we identify patterns of multi-muscle coordination (motor modules) across functional tasks in healthy young, middle-aged, and older adults. We demonstrate that healthy young adults recruit common motor modules across voluntary functional tasks (walking, turning, and chair transfers), and characterize changes associated with age. Additionally, we investigate whether motor modules are shared between reactive balance and these voluntary tasks, and whether there are age-related changes here. Identifying age-related changes in multi-muscle coordination can lead to a better understanding of the neuromuscular control underlying mobility changes due to normal aging. Further, fully characterizing changes in neuromuscular control that are due to normal aging can provide a basis for identifying the changes associated with impairments that commonly occur in older adults (e.g., stroke)

Effects of overground walking with a robotic exoskeleton on lower limb muscle synergies

Les exosquelettes robotisés de marche (ERM) représentent une intervention prometteuse dans le domaine de la réadaptation locomotrice. Sur le plan clinique, les ERM facilitent la mise en application de principes de neuroplasticité. Jusqu'à présent, la majorité des études analysant les effets de l’ERM a été menée avec des ERM fournissant une assistance robotique complète le long d’une trajectoire de mouvements prédéfinie des membres inférieurs (MI) de façon à reproduire la marche de façon quasi parfaite à très basse vitesse. La nouvelle génération d’ERM, maintenant disponible sur le marché, propose de nouveaux modes de contrôles qui permettent, entre autres, une liberté de mouvement accrue aux MIs (c.-à-d. trajectoire non imposée) et une possibilité d’offrir une assistance ou résistance aux mouvements de différentes intensités surtout pendant la phase d’oscillation du cycle de marche. Cependant, les effets de ces modes de contrôles sur la coordination musculaire des MI pendant la marche au sol avec l’ERM, caractérisé via l’extraction de synergies musculaires (SM), restent méconnus. Cette thèse mesure et compare les caractéristiques des SM (c.-à-d. nombre, profils d’activation, composition musculaire et contribution relative des muscles) pendant la la marche au sol sans ou avec un ERM paramétré avec six différents modes de contrôle chez des individus en bonne santé (articles #1 et #2) et d’autres ayant une lésion médullaire incomplète (LMI) (article #3). Les signaux électromyographiques (EMG) des différents muscles clés des MI, enregistrés lors de la marche, ont été utilisés afin d’extraire les SM avec un algorithme de factorisation matricielle non négative. La similarité des cosinus et les coefficients de corrélation ont caractérisé les similitudes entre les caractéristiques des SM. Les résultats montrent que: 1) les profils d'activation temporelle et le nombre de SM sont modifiés en fonction de la vitesse de marche avec, entre autres une augmentation de la vitesse de marche entrainant une fusion de SM, chez les individus en bonne santé marchant sans ERM ; 2) lorsque ces derniers marchent avec un ERM, les différents modes de contrôle testés ne dupliquent pas adéquatement les SM retrouvées lors de la marche sans ERM. En fait, uniquement le mode de contrôle libérant la contrainte de trajectoire de mouvements des MIs dans le plan sagittal lors de la phase d’oscillation reproduit les principales caractéristiques des SM retrouvées pendant la marche sans ERM ; 3) le nombre et la composition musculaire des SM sont modifiés pendant la marche sans ERM chez les personnes ayant une LMI. Cependant, parmi tous les modes de contrôle étudiés, seul le mode de contrôle libérant le contrôle de la trajectoire de mouvements des MI et assistant l’oscillation du MIs (c.-à-d. HASSIST) permets l’extraction de SM similaire à celles observées chez des individus en santé lors d'une marche sans ERM. Dans l’ensemble, cette thèse a mis en évidence le fait que différentes demandes biomécaniques liées à la marche (c.-à-d. vitesse de marche, modes de contrôle de l’ERM) modifient le nombre et les caractéristiques de SM chez les personnes en santé. Cette thèse a également confirmé que la coordination musculaire, mise en évidence via l’analyse de SM, est altérée chez les personnes ayant une LMI et a tendance à se normaliser lors de la marche avec l’ERM paramétré dans le mode de HASSIST. Les nouvelles preuves appuieront les professionnels de la réadaptation dans le processus de prise de décision concernant la sélection du mode de contrôle des MIs lors de l’entrainement locomoteur utilisant avec un ERM.Wearable robotic exoskeletons (WRE) represent a promising rehabilitation intervention for locomotor rehabilitation training that aligns with activity-based neuroplasticity principles in terms of optimal sensory input, massed repetition, and proper kinematics. Thus far, most studies that investigated the effects of WRE have used WRE that provide full robotic assistance and fixed trajectory guidance to the lower extremity (L/E) to generate close-to-normal walking kinematics, usually at very slow speeds. Based on clinicians’ feedback, current commercially-available WRE have additional control options to be able to integrate these devices into the recovery process of individuals who have maintained some ability to walk after an injury to the central nervous system. In this context, WRE now offer additional degrees of movements for the L/E to move freely and different strategies to assist or resist movement, particularly during the gait cycle’s swing phase. However, the extent that these additional WRE control options affect L/E neuromuscular control during walking, typically characterized using muscle synergies (MSs), remains unknown. This thesis measures and compares MSs characteristics (i.e., number, temporal activation profile, and muscles contributing to a specific synergy [weightings]) during typical overground walking, with and without a WRE, in six different control modes, in abled-bodied individuals (Articles #1 and #2) and individuals with incomplete spinal cord injury (iSCI; Article #3). Surface EMG of key L/E muscles were recorded while walking and used to extract MSs using a non-negative matrix factorization algorithm. Cosine similarity and correlation coefficients characterized, grouped, and indicated similarities between MS characteristics. Results demonstrated that: 1) the number of MSs and MS temporal activation profiles in able-bodied individuals walking without WRE are modified by walking speed and that, as speed increased, specific MSs were fused or merged compared to MSs at slow speeds; 2) In able-bodied individuals walking with WRE, few WRE control modes maintained the typical MSs characteristics that were found during overground walking without WRE. Moreover, freeing the L/E swing trajectory imposed by the WRE best reproduced those MSs characteristics during overground walking without the WRE; and 3) After an iSCI, alterations to the number and the composition of MSs were observed during walking without WRE. However, of all WRE control modes that were investigated, only HASSIST (i.e., freeing WRE control over L/E swing trajectory while assisting the user’s self-selected trajectory) reproduced the number and composition of MSs found in abled-bodied individuals during overground walking without WRE. Altogether, the results of this thesis demonstrated that different walking-related biomechanical demands (i.e., walking speed) and most of the WRE control modes can alter some MSs, and their characteristics, in able-bodied individuals. This research also confirmed that impaired muscle coordination, assessed via MSs, can adapt when walking with a WRE set with specific control options (e.g., HASSIST). These MS adaptations mimicked typical MS characteristics extracted during overground walking. The evidence generated by this thesis will support the decision-making process when selecting specific L/E control options during WRE walking, allowing rehabilitation professionals to refine WRE locomotor training protocols

A Study to Assess the Effectiveness of Rhythmic Auditory Stimulation along with Neurodevelopmental Therapy in improving the Gait Pattern of Post Stroke patients

INTRODUCTION: Gait restoration after stroke is a major concern of neurological rehabilitation. Stroke is the major cause of disability and raising mare number of handicaps in this industrialized world. In India thy rate of people affected by stroke is keep on increasing because of poor life style and other major factors. The need of rehabilitation after stroke places an important role to make the patient functionally independent in all aspect of basic life style. Physiotherapist is one of the team members who treat the patient in gross motor aspect. AIM OF THE STUDY: The aim of the study is to find the efficacy of combined treatment (Rhythmic auditory stimulation and Neuro Developmental Treatment approach) in improving the gait pattern of post stroke patient. MATERIALS AND METHODOLOGY: MATERIALS: Couch, Foot stool, Blocks\steps, Chalk, Inch tape, Ramp. METHODOLOGY: Study Design: Pre test – Post test experimental study design. Study setting: Health Care Institutes approved by college and Guide. Sampling Method: Simple random sampling method. Sample size: A total number of 10 subjects diagnosed as stroke were taken for the study. Study Duration: The study was conducted for a period of 3 months. Inclusion criteria: • Age 40 to 65 years. • Sex – both male and female. • Able to walk 10 meter independently. • Hemiplegia due to cerebrovascular accident of more than 3 months duration. Exclusion criteria: • Cerebellar ataxia. • Impaired cognitive function. • Aphasia. • Basal ganglion lesion. • Unconscious patient. • Condition that affect mobility like arthritis disease, spinal abnormalities (or) any amputations. • Communicative disorder. RESULT: The most common cause for stroke is due to occlusion of one of the major cerebral artery especially anterior cerebral artery. The stroke patient has reduced functional mobility and reduced leg function and spasticity. Deana and Richards (2000) suggested that rhythmic auditory stimulation along with NDT training had a greater contribution in improving the lower limb extensor muscles after the intervention. At thighs-off, the centre of the body mass has moved forward over the feet. This position ensures that the relative position of body segment at thighs-off enables lower limb extensor forces to accelerate the body vertically into the standing position. (Carr 2009). Stepping up and down in difference direction (forward and sideways) strengthen difference synergic relationship between hip, knee, ankle extensor and hip abductors or adductors to train in different pattern muscles activation and flexible walking performance. (Shepherd 2000). Repetitive stepping exercise using of various steps of various heights increase the strength in the lower extensor muscle. Reaching forward, sideways and in different direction help the individual regain strength and control of the lower limbs, which may enable them to take more weight through the affected leg. Therefore there is mounting evidence that progressive resistance training is effective in improving gait pattern following stroke. CONCLUSION: The study concluded that was the rhythmic auditory stimulation along with NDT effective treatment for improving gait pattern in stroke patients. And also step length and stride length test could be used as the assessment tool for stroke patients

Predictive Dynamic Simulation of Healthy Sit-to-Stand Movement

This thesis situates itself at the intersection of biomedical modelling and predictive simulation to synthesize healthy human sit-to-stand movement. While the importance of sit-to-stand to physical and social well-being is known, the reasons for why and how people come to perform sit-to-stand the way we do is largely unknown. This thesis establishes the determinants of sit-to-stand in healthy people so that future researchers may investigate the effects of compromised health on sit-to-stand and then explore means of intervening to preserve and restore this motion. Previous researchers have predicted how a person rises from seated. However aspects of their models, most commonly contact and muscle models, are biomechanically inconsistent and restrict their application. These researchers also have not validated their prediction results. To address these limitations and further the study of sit-to-stand prediction, the underlying themes of this thesis are in biomechanical modelling, predictive simulation, and validation. The goal of predicting sit-to-stand inspired the creation of three new models: a model of biomechanics, a model of motion, and performance criteria as a model of preference. First, the human is represented as three rigid links in the sagittal plane. As buttocks are kinetically important to sit-to-stand, a new constitutive model of buttocks is made from experimental force-deformation data. Ten muscles responsible for flexion and extension of the hips, knees, and ankles are defined in the model. Second, candidate sit-to-stand trajectories are described geometrically by a set of Bézier curves, for the first time. Third, with the assumption that healthy people naturally prioritize mechanical efficiency, disinclination to a motion is described as a cost function of joint torques, muscle stresses, and physical infeasibility including slipping and falling. This new dynamic optimization routine allows for motions of gradually increasing complexity, by adding control points to the Bézier curves, while the model's performance is improving. By comparing the predictive simulation results to normative sit-to-stand as described in the literature, for the first time, it is possible to say that the use of these models and optimal control strategy together has produced motions characteristic of healthy sit-to-stand. This work bridges the gap between predictive simulation results and experimental human results and in doing so establishes a benchmark in sit-to-stand prediction. In predicting healthy sit-to-stand, it makes a necessary step toward predicting pathological sit-to-stand, and then to predicting the results of intervention to inform medical design and planning