Young, Healthy Subjects Can Reduce the Activity of Calf Muscles When Provided with EMG Biofeedback in Upright Stance

Recent evidence suggests the minimization of muscular effort rather than of the size of bodily sway may be the primary, nervous system goal when regulating the human, standing posture. Different programs have been proposed for balance training; none however has been focused on the activation of postural muscles during standing. In this study we investigated the possibility of minimizing the activation of the calf muscles during standing through biofeedback. By providing subjects with an audio signal that varied in amplitude and frequency with the amplitude of surface electromyograms (EMG) recorded from different regions of the gastrocnemius and soleus muscles, we expected them to be able to minimize the level of muscle activation during standing without increasing the excursion of the center of pressure (CoP). CoP data and surface EMG from gastrocnemii, soleus and tibialis anterior muscles were obtained from 10 healthy participants while standing at ease and while standing with EMG biofeedback. Four sensitivities were used to test subjects' responsiveness to the EMG biofeedback. Compared with standing at ease, the two most sensitive feedback conditions induced a decrease in plantar flexor activity (~15%; P < 0.05) and an increase in tibialis anterior EMG (~10%; P < 0.05). Furthermore, CoP mean position significantly shifted backward (~30 mm). In contrast, the use of less sensitive EMG biofeedback resulted in a significant decrease in EMG activity of ankle plantar flexors with a marginal increase in TA activity compared with standing at ease. These changes were not accompanied by greater CoP displacements or significant changes in mean CoP position. Key results revealed subjects were able to keep standing stability while reducing the activity of gastrocnemius and soleus without loading their tibialis anterior muscle when standing with EMG biofeedback. These results may therefore posit the basis for the development of training protocols aimed at assisting subjects in more efficiently controlling leg muscle activity during standing

Understanding motor control in humans to improve rehabilitation robots

Recent reviews highlighted the limited results of robotic rehabilitation and the low quality of evidences in this field. Despite the worldwide presence of several robotic infrastructures, there is still a lack of knowledge about the capabilities of robotic training effect on the neural control of movement. To fill this gap, a step back to motor neuroscience is needed: the understanding how the brain works in the generation of movements, how it adapts to changes and how it acquires new motor skills is fundamental. This is the rationale behind my PhD project and the contents of this thesis: all the studies included in fact examined changes in motor control due to different destabilizing conditions, ranging from external perturbations, to self-generated disturbances, to pathological conditions. Data on healthy and impaired adults have been collected and quantitative and objective information about kinematics, dynamics, performance and learning were obtained for the investigation of motor control and skill learning. Results on subjects with cervical dystonia show how important assessment is: possibly adequate treatments are missing because the physiological and pathological mechanisms underlying sensorimotor control are not routinely addressed in clinical practice. These results showed how sensory function is crucial for motor control. The relevance of proprioception in motor control and learning is evident also in a second study. This study, performed on healthy subjects, showed that stiffness control is associated with worse robustness to external perturbations and worse learning, which can be attributed to the lower sensitiveness while moving or co-activating. On the other hand, we found that the combination of higher reliance on proprioception with \u201cdisturbance training\u201d is able to lead to a better learning and better robustness. This is in line with recent findings showing that variability may facilitate learning and thus can be exploited for sensorimotor recovery. Based on these results, in a third study, we asked participants to use the more robust and efficient strategy in order to investigate the control policies used to reject disturbances. We found that control is non-linear and we associated this non-linearity with intermittent control. As the name says, intermittent control is characterized by open loop intervals, in which movements are not actively controlled. We exploited the intermittent control paradigm for other two modeling studies. In these studies we have shown how robust is this model, evaluating it in two complex situations, the coordination of two joints for postural balance and the coordination of two different balancing tasks. It is an intriguing issue, to be addressed in future studies, to consider how learning affects intermittency and how this can be exploited to enhance learning or recovery. The approach, that can exploit the results of this thesis, is the computational neurorehabilitation, which mathematically models the mechanisms underlying the rehabilitation process, with the aim of optimizing the individual treatment of patients. Integrating models of sensorimotor control during robotic neurorehabilitation, might lead to robots that are fully adaptable to the level of impairment of the patient and able to change their behavior accordingly to the patient\u2019s intention. This is one of the goals for the development of rehabilitation robotics and in particular of Wristbot, our robot for wrist rehabilitation: combining proper assessment and training protocols, based on motor control paradigms, will maximize robotic rehabilitation effects

The effects of peripheral nerve impairments on postural control and mobility among people with peripheral neuropathy

Approximately 20 million Americans are suffering Peripheral Neuropathy (PN). It is estimated that the prevalence of all-cause PN is about 2.4% in the entire adult population, whereas over 8-10% in the population segment over the age of 55 (Martyn & Hughes, 1997). Peripheral Neuropathy leads to a high risk of falling, resulting from the deficits of postural control caused by the impaired peripheral nerves, especially the degenerative somatosensory system. To date, there is no effective medical treatment for the disease but pain managements. The deficits of postural control decrease the life quality of this population. The degeneration of peripheral nerves reduces sensory inputs from the somatosensory system to central nervous system via spinal reflexive loop, which should provide valuable real-time information for balance correction. Therefore, it is necessary to investigate how PN affects the somatosensory system regarding postural control. Besides that, people with PN may develop a compensatory mechanism which could be reinforced by exercise training, ultimately to improve balance and mobility in their daily life. The neuroplasticity may occur within somatosensory system by relying on relative intact sensory resources. Hence, unveiling the compensatory mechanism in people with PN may help in understanding (a) essential sensations or function of peripheral nerves to postural control, (b) effective strategy of physical treatments for people with PN, and (c) task-dependent sensory information requirements. Therefore, this dissertation discussed the roles of foot sole sensation, ankle proprioception, and stretch reflex on balance as well as gait among people with PN. Furthermore, the discussion of the coupling between small and large afferent reflexive loops may spot the compensatory mechanism in people with PN

Mechanisms for human balancing of an inverted pendulum using the ankle strategy

Maintenance of upright, human balance is neurologically and biomechanically a complex process, though the ankle strategy predominates in quiet standing. This investigation seeks insight into the complex problem by studying a reduced, yet related problem of how the ankle mechanisms are used to balance a human proportioned inverted pendulum. A distinguishing feature of the task is that despite one's best efforts to control this unstable load some irreducible sway always remains. Contrary to published ideas, modulation of effective ankle stiffness was not the way that sway size was altered. Rather, position was controlled by an intermittent, neurally modulated, ballistic-like pattern of torque whose anticipatory accuracy was improved to reduce sway size. Using a model, and by direct measurement, I found the intrinsic mechanical ankle stiffness will only partially counter the "gravitational spring". Since this stiffness was substantially constant and cannot be neurally modulated, I attribute it to the foot, tendon and aponeurosis rather than the activated calf muscle fibres. Thus triceps-surae muscles maintain balance via a spring-like element which is itself generally too compliant to provide even minimal stability. I hypothesise that balance is maintained by anticipatory, ballistic-like, biasing of the series-elastic element resulting from intermittent modulation of the triceps-surae

Dynamic Determinants of the Uncontrolled Manifold during Human Quiet Stance

Human postural sway during stance arises from coordinated multi-joint movements. Thus, a sway trajectory represented by a time-varying postural vector in the multiple-joint-angle-space tends to be constrained to a low-dimensional subspace. It has been proposed that the subspace corresponds to a manifold defined by a kinematic constraint, such that the position of the center of mass (CoM) of the whole body is constant in time, referred to as the kinematic uncontrolled manifold (kinematic-UCM). A control strategy related to this hypothesis (CoM-control-strategy) claims that the central nervous system (CNS) aims to keep the posture close to the kinematic-UCM using a continuous feedback controller, leading to sway patterns that mostly occur within the kinematic-UCM, where no corrective control is exerted. An alternative strategy proposed by the authors (intermittent control-strategy) claims that the CNS stabilizes posture by intermittently suspending the active feedback controller, in such a way to allow the CNS to exploit a stable manifold of the saddle-type upright equilibrium in the state-space of the system, referred to as the dynamic-UCM, when the state point is on or near the manifold. Although the mathematical definitions of the kinematic- and dynamic-UCM are completely different, both UCMs play similar roles in the stabilization of multi-joint upright posture. The purpose of this study was to compare the dynamic performance of the two control strategies. In particular, we considered a double-inverted-pendulum-model of postural control, and analyzed the two UCMs defined above. We first showed that the geometric configurations of the two UCMs are almost identical. We then investigated whether the UCM-component of experimental sway could be considered as passive dynamics with no active control, and showed that such UCM-component mainly consists of high frequency oscillations above 1 Hz, corresponding to anti-phase coordination between the ankle and hip. We also showed that this result can be better characterized by an eigenfrequency associated with the dynamic-UCM. In summary, our analysis highlights the close relationship between the two control strategies, namely their ability to simultaneously establish small CoM variations and postural stability, but also make it clear that the intermittent control hypothesis better explains the spectral characteristics of sway

Revisiting the Body-Schema Concept in the Context of Whole-Body Postural-Focal Dynamics

The body-schema concept is revisited in the context of embodied cognition, further developing the theory formulated by Marc Jeannerod that the motor system is part of a simulation network related to action, whose function is not only to shape the motor system for preparing an action (either overt or covert) but also to provide the self with information on the feasibility and the meaning of potential actions. The proposed computational formulation is based on a dynamical system approach, which is linked to an extension of the equilibrium-point hypothesis, called Passive Motor Paradigm: this dynamical system generates goal-oriented, spatio-temporal, sensorimotor patterns, integrating a direct and inverse internal model in a multi-referential framework. The purpose of such computational model is to operate at the same time as a general synergy formation machinery for planning whole-body actions in humanoid robots and/or for predicting coordinated sensory–motor patterns in human movements. In order to illustrate the computational approach, the integration of simultaneous, even partially conflicting tasks will be analyzed in some detail with regard to postural-focal dynamics, which can be defined as the fusion of a focal task, namely reaching a target with the whole-body, and a postural task, namely maintaining overall stability

OBJECTIVE EVALUATION OF FUNCTIONAL ANKLE INSTABILITY AND BALANCE EXERCISE TREATMENT

Functional ankle instability (FAI) is a poorly defined entity but commonly used to describe patients who sustain multiple ankle injuries with slight or no external provocation and have a subjective feeling of ankle "giving way". There have been conflicting results reported in literature regarding the role of suggested etiological factors of FAI including deficit in joint proprioception, strength, and stiffness (laxity). Diagnosis of FAI has been mainly relied on a subjective reporting, so is the assessment of FAI treatments. In spite of controversies regarding FAI factors, balance training has been widely used in sports medicine clinics for patients with FAI. Most of past studies reported its effect for FAI, but strong evidence with definitive result is still missing. Furthermore, the mechanism that explains the effect of balance training on FAI is still unclear. Recently, it was suggested that altered threshold to the unloading reaction may be behind ankle giving way episodes in patients with ankle instability. Therefore, we wanted to duplicate this finding in individuals with FAI during sudden ankle inversion test and examine the effects of a four-week balance training program on unloading reactions in individuals with FAI. Twenty four recreationally active individuals with unilateral FAI were evaluated for unloading reactions on the involved and uninvolved limbs using a sudden ankle inversion test. In seven out of twenty-four subjects, we observed a drastic reaction (hyper-reactivity) in that they were unable to maintain upright standing position when a combination of dynamic ankle stretching and nociceptive stimuli was applied on their affected ankles. The subjects were then randomized to either a control or intervention group. Subjects in the intervention group were trained on the affected limb with static and dynamic components using a Biodex balance stability system for 4-weeks. The control group received no intervention. The results suggested that balance training may desensitize the hyper-reactivity to unloading reaction in FAI subjects, suggesting a possible mechanism for reducing the ankle "giving way" episodes. In addition, balance training was found to improve the subjective self-reported ankle instability and passive ankle joint position sense. No effect was observed on isometric and isokinetic peroneal muscle strength and ankle stiffness (laxity). In summary, this dissertation work provides evidence that balance training is effective in patients with FAI, however a further study with more sample size and additional outcome measures is required to better understand the mechanism of balance training in these individuals. The findings of this work have implications for research/rehabilitation of not only individuals with FAI but also in individuals with functional joint instability, such as functional knee instability which shares many common symptoms with FAI

Method to Measure Tone of Axial and Proximal Muscle

The control of tonic muscular activity remains poorly understood. While abnormal tone is commonly assessed clinically by measuring the passive resistance of relaxed limbs1, no systems are available to study tonic muscle control in a natural, active state of antigravity support. We have developed a device (Twister) to study tonic regulation of axial and proximal muscles during active postural maintenance (i.e. postural tone). Twister rotates axial body regions relative to each other about the vertical axis during stance, so as to twist the neck, trunk or hip regions. This twisting imposes length changes on axial muscles without changing the body's relationship to gravity. Because Twister does not provide postural support, tone must be regulated to counteract gravitational torques. We quantify this tonic regulation by the restive torque to twisting, which reflects the state of all muscles undergoing length changes, as well as by electromyography of relevant muscles. Because tone is characterized by long-lasting low-level muscle activity, tonic control is studied with slow movements that produce "tonic" changes in muscle length, without evoking fast "phasic" responses. Twister can be reconfigured to study various aspects of muscle tone, such as co-contraction, tonic modulation to postural changes, tonic interactions across body segments, as well as perceptual thresholds to slow axial rotation. Twister can also be used to provide a quantitative measurement of the effects of disease on axial and proximal postural tone and assess the efficacy of intervention

A study of the effects of sensory state on rhesus monkey postural control

Thesis (Ph. D. in Biomedical Engineering)--Harvard-MIT Program in Health Sciences and Technology, 2013.Cataloged from PDF version of thesis. "September 2013." Pages 215 and 216 blank.Includes bibliographical references (pages 208-214).Although many take the seemingly simple ability to balance in order to maintain posture for granted, approximately 8 million American adults have chronic balance impairment issues derived from vestibular dysfunction. For patients suffering from severe vestibular dysfunction, maintaining balance in daily activities, such as walking on an uneven surface at night, turning one's head, or attempting to stand on a moving surface, can prove extremely challenging. Unfortunately, many vestibular-loss sufferers are left with limited treatment options and can become permanently debilitated. In order to aid the vestibular-impaired population in partially restoring postural stability, it is important to develop rehabilitative solutions. For subjects suffering from severe bilateral vestibular loss, but with intact eighth nerve function, the invasive vestibular prosthesis is a potential rehabilitative solution. This must be developed and fully characterized in non-human primates in parallel with human implementation. In this research, we characterized the postural response of a severely vestibular-lesioned non-human primate instrumented with a prototype invasive vestibular prosthesis. We showed that the severely vestibular-impaired animal aided by the prosthesis was able to utilize the partially restored vestibular cues to increase its stability compared to the severely-impaired state. We also explored the impact on balance of (1) supplying an additional cue (light-touch) and (2) compensative strategies that the subject develops when suffering from mild or severe vestibular-impairment. We determined that the severely-impaired animal decreased its trunk sway when provided the light-touch cue, however a mildly-impaired animal did not. We also determined that an animal with mild vestibular impairment spontaneously compensated for its vestibular loss to stabilize itself both for stationary support surface conditions and for support surface perturbations. This thesis is the first time that animal posture measures for different levels of vestibular impairment have been used in conjunction with a feedback controller model to investigate the postural control mechanisms used. The results reported within this thesis begin to establish the baseline database of primate postural responses to a wide variety of test situations for different levels of vestibular impairment that will be needed for further investigation and evaluation of rehabilitative solutions, such as prototype vestibular implant systems.by Lara A. Thompson.Ph.D.in Biomedical Engineerin