The relationship between perception of effort and physiological responses to an acute fatiguing task of the elbow flexors. Evaluation of a new rating scale of perception of effort

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.While fatigue is a common daily phenomenon, the exact relationship between perception of effort and fatigue is still unknown. Existing tools for assessing perception of effort are effectively limited to whole body exercise, while current methods for assessing voluntary activation are painful and not feasible for clinical application. The main aims of this thesis were to evaluate existing methodologies for their appropriateness in assessing perception of effort and voluntary activation following isolated muscle function testing, and to examine the relationship between subjective perception of effort and objective changes in the healthy motor control system. The implementation of reliable and valid assessment tools in clinical practice may enable clarification of the pathogenesis of many neurological conditions that have chronic fatigue as a key feature. Four studies of within-subjects repeated measures design have been conducted. Sixtynine healthy volunteers were recruited among staff and students of Brunel University. Magnetic stimulation was tested as a valid alternative to electrical stimulation in the conventional single-pulse Twitch Interpolation Technique. The 0–10 Numeric Rating Scale (NRS) was also tested for its reliability and validity in assessing the perception of effort during isometric exercise of elbow flexors. The changes of perception of effort following a submaximal elbow flexion fatiguing task, as well as following transcranial direct current stimulation (tDCS) over the motor cortex were also tested. The main findings showed significant differences between peripheral and magnetic stimulation in conventional single-pulse Twitch Interpolation Technique. The 0–10 NRS demonstrated linear properties and reported excellent test-retest reliability and good concurrent criterion validity in recording perception of effort under repeated isometric contractions of elbow flexors. Ten minutes of a submaximal intermittent isometric fatiguing exercise produced a significant elevation in rating of perceived effort, which was associated with central and peripheral neurophysiological changes of the motor control system. In contrast, perception of effort did not change significantly following 10 minutes of tDCS. The major findings of this thesis suggest the 0–10 NRS is a valid and reliable scale for rating perception of effort in healthy individuals. Further testing of the scale on patients is needed to establish its validity in clinical settings. Additionally, the findings indicate a substantial role of perception of effort in the voluntary motor control system. However, further research towards revealing the underlying mechanisms of perceived effort regulation in both health and disease is required

Bioelectric control of prosthesis.

Based on a thesis in Electrical Engineering, 1965.Bibliography: p.79-86.Contract DA-36-039-AMC-03200(E)

The role of noise in sensorimotor control

Goal-directed arm movements show stereotypical trajectories, despite the infinite possible ways to reach a given end point. This thesis examines the hypothesis that this stereotypy arises because movements are optimised to reduce the consequences of signal-dependent noise on the motor command. Both experimental and modelling studies demonstrate that signal-dependent noise arises from the normal behaviour of the muscle and motor neuron pool, and has a particular distribution across muscles of different sizes. Specifically, noise decreases in a systematic fashion with increasing muscle strength and motor unit number. Simulations of obstacle avoidance performance in the presence of signal-dependent noise demonstrate that the optimal trajectory for reaching the target accurately and without collision matches the observed trajectories. Isometric force generation is also shown to have systematic changes in variability with posture, which can be explained by the presence of signal-dependent noise in the muscles of the arm. These results confirm the tested hypothesis and imply that consideration of the statistics of action is crucial to human movement planning. To investigate the importance of feedback in the motor system, the impact of static position on motor excitability was examined using transcranial magnetic stimulation and systematic changes in motor evoked potentials were observed. Force generated at the wrist following stimulation was analysed in terms of different possible movement representations, and the differences between force fields arising from stimulation over the cervical spinal cord and from stimulation over primary motor cortex are determined. These results demonstrate the structured influence of proprioceptive feedback on the human motor system. All the experiments are discussed in relation to current theories describing the control of human movements and the impact of noise in the motor system

Motor system plasticity induced by non-invasive stimuli

MD ThesisPrecisely timed paired stimulation protocols can change cortical and subcortical excitability. In the first study, induction of plastic changes in the long-latency stretch reflex (LLSR) by pairing non-invasive stimuli was attempted, at timings predicted to cause spiketiming dependent plasticity (STDP) in the brainstem. LLSR in human elbow muscles depends on multiple pathways; one possible contributor is the reticulospinal tract. The stimuli used are known to activate reticulospinal pathways. In healthy human subjects, reflex responses in flexor muscles were recorded following extension perturbations at the elbow. Subjects were then fitted with a portable device which delivered auditory click stimuli, and electrical stimuli to biceps muscle. The LLSR was significantly enhanced or suppressed in the biceps muscle depending on the intervention protocol. No changes were observed in the unstimulated brachioradialis muscle. Although contributions from the spinal or cortical pathways cannot be excluded, the results were consistent with STDP in reticulospinal circuits. In the second study, baseline TMS responses were recorded from two intrinsic hand muscles, flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC). In the first phase, paired associative stimulation (PAS) was delivered by pairing motor point stimulation of FDS or EDC with TMS. Responses were then remeasured. Increases were greatest in the hand muscles, smaller in FDS, and non-significant in EDC. In the second phase, intermittent theta-burst rapid-rate TMS was applied instead of PAS. In this case, all muscles showed similar increases in TMS responses. This study showed that potential plasticity in motor cortical output has a gradient: hand muscles > flexors > extensors. However, this was only seen in a protocol which requires integration of sensory input (PAS), and not when plasticity was induced purely by cortical stimulation (rapid rate TMS). In the third study, motor imagery was paired with TMS in healthy human subjects. They were asked to imagine wrist flexion or extension movement, while TMS was delivered to the motor cortex. Six different protocols were tested, but only flexor imagination with TMS and extensor imagination with TMS showed significant facilitation following the test. Flexor imagination with TMS increased motor evoked potential (MEP) in all four Abstract 2 muscles with maximum changes towards flexor, whereas extensor imagination with TMS increased MEP only in extensor. Above changes in the cortical or subcortical excitability evoked by non-invasive stimulation protocols were consistent with long term potentiation and long-term depression mediated plastic change

Biomechatronics: Harmonizing Mechatronic Systems with Human Beings

This eBook provides a comprehensive treatise on modern biomechatronic systems centred around human applications. A particular emphasis is given to exoskeleton designs for assistance and training with advanced interfaces in human-machine interaction. Some of these designs are validated with experimental results which the reader will find very informative as building-blocks for designing such systems. This eBook will be ideally suited to those researching in biomechatronic area with bio-feedback applications or those who are involved in high-end research on manmachine interfaces. This may also serve as a textbook for biomechatronic design at post-graduate level

Neuromechanical Tuning for Arm Motor Control

Movement is a fundamental behavior that allows us to interact with the external world. Its importance to human health is most evident when it becomes impaired due to disease or injury. Physical and occupational rehabilitation remains the most common treatment for these types of disorders. Although therapeutic interventions may improve motor function, residual deficits are common for many pathologies, such as stroke. The development of novel therapeutics is dependent upon a better understanding of the underlying mechanisms that govern movement. Movement of the human body adheres to the principles of classic Newtonian mechanics. However, due to the inherent complexity of the body and the highly variable repertoire of environmental contexts in which it operates, the musculoskeletal system presents a challenging control problem and the onus is on the central nervous system to reliably solve this problem. The neural motor system is comprised of numerous efferent and afferent pathways with a hierarchical organization which create a complex arrangement of feedforward and feedback circuits. However, the strategy that the neural motor system employs to reliably control these complex mechanics is still unknown. This dissertation will investigate the neural control of mechanics employing a “bottom-up” approach. It is organized into three research chapters with an additional introductory chapter and a chapter addressing final conclusions. Chapter 1 provides a brief description of the anatomical and physiological principles of the human motor system and the challenges and strategies that may be employed to control it. Chapter 2 describes a computational study where we developed a musculoskeletal model of the upper limb to investigate the complex mechanical interactions due to muscle geometry. Muscle lengths and moment arms contribute to force and torque generation, but the inherent redundancy of these actuators create a high-dimensional control problem. By characterizing these relationships, we found mechanical coupling of muscle lengths which the nervous system could exploit. Chapter 3 describes a study of muscle spindle contribution to muscle coactivation using a computational model of primary afferent activity. We investigated whether these afferents could contribute to motoneuron recruitment during voluntary reaching tasks in humans and found that afferent activity was orthogonal to that of muscle activity. Chapter 4 describes a study of the role of the descending corticospinal tract in the compensation of limb dynamics during arm reaching movements. We found evidence that corticospinal excitability is modulated in proportion to muscle activity and that the coefficients of proportionality vary in the course of these movements. Finally, further questions and future directions for this work are discussed in the Chapter 5

Neuromuscular adaptations to voluntary contraction following postactivation potentiation

Muscle contractile properties are history-dependent, and following a conditioning contraction, muscle tissue may be fatigued (slower, weaker) or potentiated (faster, stronger). Postactivation potentiation of evoked contractions, such as the electrically stimulated twitch, has been thoroughly studied. However, the effects of potentiation on voluntary contraction are not well understood, and prior study is largely equivocal. The following studies propose to determine the effects of potentiation during 1) submaximal contractions at different muscle lengths 2) ballistic contractions following tetanic and voluntary conditioning, and 3) motor evoked potentials following tetanic and voluntary conditioning contractions. Evoked twitch potentiation was assessed with all of the above voluntary measures to compare electrically evoked contractions to those involving the entire neuromuscular system. Study 1 illustrates that voluntary neuromuscular efficiency of the triceps brachii is greater in a shortened compared to lengthened muscle position. The results of Study 2 indicate that voluntary ballistic peak rate of torque development (RTD) is unchanged following a tetanic conditioning contraction, and is impaired following a voluntary conditioning contraction. This is observed concomitant to a 2-fold increase in twitch torque and peak RTD. Study 3 shows that despite failure of voluntary peak RTD to improve following potentiation, that RTD is enhanced at non-peak time points, implying that performance may adapt differentially throughout the time course of contraction. Study 4 used transcranial magnetic stimulation to provoke a cortical silent period to assess motor cortical inhibition. Following both voluntary and involuntary conditioning contractions, twitch potentiation was observed concurrent to cortical inhibition. This indicates that the conditioning contraction may simultaneously enhance muscular contractile properties and inhibit activity of the motor cortex. Together, these results indicate a limited opportunity for a conditioning contraction to enhance voluntary contractile properties, despite the substantial enhancement to twitch properties. In addition to the muscular fatigue to which the twitch is subject, the conditioning contraction has centrally inhibitory effects which constrain voluntary contractile performance. This thesis highlights the importance of considering the entire neuromuscular system when assessing contractile adaptations and performance in relation to contractile history

Aerospace Medicine and Biology: A continuing bibliography with indexes, supplement 145

This bibliography lists 301 reports, articles, and other documents introduced into the NASA scientific and technical information system in August 1975

Sensorimotor Control of 3D Arm Movement and Stability in Post-Stroke Hemiparesis

Deficits of the affected arm in people with post-stroke hemiparesis have been generally associated with decreased strength and increased spasticity. These deficits are varied in proximal (shoulder) and distal (elbow) joints which results in an overall impairment during movement or during stabilization of hand position in space. In this study, reaching of the hemiparetic arm in 3D workspace was characterized by a curved and non-smooth endpoint trajectory and a reduced functional range of motion, compared to the unimpaired arm. Smoother trajectories were observed in the acceleration phase more than the deceleration phase, which was common to both the stroke subjects and the neurologically intact controls. Decreased range of motion of the paretic arm in the proximal joint was associated with shoulder weakness, whereas limited range of motion in the elbow appeared to be due to increased antagonist muscle activation. In a task requiring subjects to stabilize their hand at different positions in space, arm weakness and movement synergy constraints may have contributed to stroke survivors generally decreasing the plane of elevation in order to maintain stable arm postures during movement and then stabilize the hand in space. The degree of decreased plane of elevation was negatively correlated with the Fugl-Meyer score. For a task when fine control movement was required simultaneously with a stable arm posture, stroke subjects demonstrated an inability to grade fine muscle control, resulting in larger range of the plane of elevation movements and larger endpoint error. These findings suggest that shoulder strength training might have important implications to the recovery of movement and ability to stabilize the hemiparetic arm during functional tasks

Novel Bidirectional Body - Machine Interface to Control Upper Limb Prosthesis

Objective. The journey of a bionic prosthetic user is characterized by the opportunities and limitations involved in adopting a device (the prosthesis) that should enable activities of daily living (ADL). Within this context, experiencing a bionic hand as a functional (and, possibly, embodied) limb constitutes the premise for mitigating the risk of its abandonment through the continuous use of the device. To achieve such a result, different aspects must be considered for making the artificial limb an effective support for carrying out ADLs. Among them, intuitive and robust control is fundamental to improving amputees’ quality of life using upper limb prostheses. Still, as artificial proprioception is essential to perceive the prosthesis movement without constant visual attention, a good control framework may not be enough to restore practical functionality to the limb. To overcome this, bidirectional communication between the user and the prosthesis has been recently introduced and is a requirement of utmost importance in developing prosthetic hands. Indeed, closing the control loop between the user and a prosthesis by providing artificial sensory feedback is a fundamental step towards the complete restoration of the lost sensory-motor functions. Within my PhD work, I proposed the development of a more controllable and sensitive human-like hand prosthesis, i.e., the Hannes prosthetic hand, to improve its usability and effectiveness. Approach. To achieve the objectives of this thesis work, I developed a modular and scalable software and firmware architecture to control the Hannes prosthetic multi-Degree of Freedom (DoF) system and to fit all users’ needs (hand aperture, wrist rotation, and wrist flexion in different combinations). On top of this, I developed several Pattern Recognition (PR) algorithms to translate electromyographic (EMG) activity into complex movements. However, stability and repeatability were still unmet requirements in multi-DoF upper limb systems; hence, I started by investigating different strategies to produce a more robust control. To do this, EMG signals were collected from trans-radial amputees using an array of up to six sensors placed over the skin. Secondly, I developed a vibrotactile system to implement haptic feedback to restore proprioception and create a bidirectional connection between the user and the prosthesis. Similarly, I implemented an object stiffness detection to restore tactile sensation able to connect the user with the external word. This closed-loop control between EMG and vibration feedback is essential to implementing a Bidirectional Body - Machine Interface to impact amputees’ daily life strongly. For each of these three activities: (i) implementation of robust pattern recognition control algorithms, (ii) restoration of proprioception, and (iii) restoration of the feeling of the grasped object's stiffness, I performed a study where data from healthy subjects and amputees was collected, in order to demonstrate the efficacy and usability of my implementations. In each study, I evaluated both the algorithms and the subjects’ ability to use the prosthesis by means of the F1Score parameter (offline) and the Target Achievement Control test-TAC (online). With this test, I analyzed the error rate, path efficiency, and time efficiency in completing different tasks. Main results. Among the several tested methods for Pattern Recognition, the Non-Linear Logistic Regression (NLR) resulted to be the best algorithm in terms of F1Score (99%, robustness), whereas the minimum number of electrodes needed for its functioning was determined to be 4 in the conducted offline analyses. Further, I demonstrated that its low computational burden allowed its implementation and integration on a microcontroller running at a sampling frequency of 300Hz (efficiency). Finally, the online implementation allowed the subject to simultaneously control the Hannes prosthesis DoFs, in a bioinspired and human-like way. In addition, I performed further tests with the same NLR-based control by endowing it with closed-loop proprioceptive feedback. In this scenario, the results achieved during the TAC test obtained an error rate of 15% and a path efficiency of 60% in experiments where no sources of information were available (no visual and no audio feedback). Such results demonstrated an improvement in the controllability of the system with an impact on user experience. Significance. The obtained results confirmed the hypothesis of improving robustness and efficiency of a prosthetic control thanks to of the implemented closed-loop approach. The bidirectional communication between the user and the prosthesis is capable to restore the loss of sensory functionality, with promising implications on direct translation in the clinical practice