Transcranial Direct Current Stimulation of the Leg Motor Cortex Enhances Coordinated Motor Output During Walking With a Large Inter-Individual Variability

Background Transcranial direct current stimulation (tDCS) can augment force generation and control in single leg joints in healthy subjects and stroke survivors. However, it is unknown whether these effects also result in improved force production and coordination during walking and whether electrode configuration influences these effects. Objective We investigated the effect of tDCS using different electrode configurations on coordinated force production during walking in a group of healthy subjects and chronic stroke survivors. Methods Ten healthy subjects and ten chronic stroke survivors participated in a randomized double-blinded crossover study. Subjects walked on an instrumented treadmill before and after 10 minutes of uni-hemispheric (UNI), dual-hemispheric (DUAL) or sham tDCS applied to the primary motor cortex. Results tDCS responses showed large inter-individual variability in both subject populations. In healthy subjects tDCS enhanced the coordinated output during walking as reflected in an increased positive work generation during propulsion. The effects of DUAL tDCS were clearer but still small (4.4% increase) compared to UNI tDCS (2.8% increase). In the chronic stroke survivors no significant effects of tDCS in the targeted paretic leg were observed. Conclusions tDCS has potential to augment multi-joint coordinated force production during walking. The relative small contribution of the motor cortex in controlling walking might explain why the observed effects are rather small. Furthermore, a better understanding of the inter-individual variability is needed to optimize the effects of tDCS in healthy but especially stroke survivors. The latter is a prerequisite for clinical applicability

Center of mass movement estimation using an ambulatory measurement system

Human body movement analysis is done in so-called 'gait-laboratories' where several gait variables are estimated by measurement systems such as optical position measurement systems, EMG or force plates. The accuracy of the ambulatory system is verified by comparing it to an optical reference system based on the semental kinematics method

Center of mass velocity-based predictions in balance recovery following pelvis perturbations during human walking

In many simple walking models foot placement dictates the center of pressure location and ground reaction force components, whereas humans can modulate these aspects after foot contact. Because of the differences, it is unclear to what extend predictions made by models are valid for human walking. Yet, both model simulations and human experimental data have previously indicated that the center of mass (COM) velocity plays an important role in regulating stable walking.\ud \ud Here, perturbed human walking was studied for the relation of the horizontal COM velocity at heel strike and toe-off with the foot placement location relative to the COM, the forthcoming center of pressure location relative to the COM, and the ground reaction forces. Ten healthy subjects received various magnitude mediolateral and anteroposterior pelvis perturbations at toe-off, during 0.63 and 1.25 m s−1 treadmill walking.\ud \ud At heel strike after the perturbation, recovery from mediolateral perturbations involved mediolateral foot placement adjustments proportional to the mediolateral COM velocity. In contrast, for anteroposterior perturbations no significant anteroposterior foot placement adjustment occurred at this heel strike. However, in both directions the COM velocity at heel strike related linearly to the center of pressure location at the subsequent toe-off. This relation was affected by the walking speed and was, for the slow speed, in line with a COM velocity based control strategy previously applied by others in a linear inverted pendulum model. Finally, changes in gait phase durations suggest that the timing of actions could play an important role during the perturbation recovery

Reliability and agreement of intramuscular coherence in tibialis anterior muscle

Background: Neuroplasticity drives recovery of walking after a lesion of the descending tract. Intramuscular coherence analysis provides a way to quantify corticomotor drive during a functional task, like walking and changes in coherence serve as a marker for neuroplasticity. Although intramuscular coherence analysis is already applied and rapidly growing in interest, the reproducibility of variables derived from coherence is largely unknown. The purpose of this study was to determine the test-retest reliability and agreement of intramuscular coherence variables obtained during walking in healthy subjects. Methodology/Principal Findings: Ten healthy participants walked on a treadmill at a slow and normal speed in three sessions. Area of coherence and peak coherence were derived from the intramuscular coherence spectra calculated using rectified and non-rectified M. tibialis anterior Electromyography (EMG). Reliability, defined as the ability of a measurement to differentiate between subjects and established by the intra-class correlation coefficient, was on the limit of good for area of coherence and peak coherence when derived from rectified EMG during slow walking. Yet, the agreement, defined as the degree to which repeated measures are identical, was low as the measurement error was relatively large. The smallest change to exceed the measurement error between two repeated measures was 66% of the average value. For normal walking and/or other EMG-processing settings, not rectifying the EMG and/or high-pass filtering with a high cutoff frequency (100 Hz) the reliability was only moderate to poor and the agreement was considerably lower. Conclusions/significance: Only for specific conditions and EMG-processing settings, the derived coherence variables can be considered to be reliable measures. However, large changes (>66%) are needed to indicate a real difference. So, although intramuscular coherence is an easy to use and a sufficiently reliable tool to quantify intervention-induced neuroplasticity, the large effects needed to reveal a real change limit its practical use

Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude