Behavioral outcomes following below-knee amputation in the coordination between balance and leg movement.

Lateral leg movement is accompanied by opposite movements of the supporting leg and trunk segments. This kinematic synergy shifts the center of mass (CM) towards the supporting foot and stabilizes its final position, while the leg movement is being performed. The aim of the present study was to provide insight in the behavioral substitution process responsible for the performance of this kinematic synergy. The kinematic synergy was assessed by the principal component analysis (PCA) applied to both hip joints and supporting ankle joint. Patients after unilateral below-knee amputation and control subjects were asked to perform a lateral leg raising. The first principal component (PC(1)) accounted for more than 99% of the total angular variance for all subjects (amputees and controls). PC(1) thus well represents the possibility to describe this complex multi-joint movement as a one degree of freedom movement with fixed ratios between joint angular time course. In control subjects, the time covariation between joints changes holds during all phases of the leg movement (postural phase, ascending and braking phases). In amputees, PC(1) score decreased during the ascending phase of the movement (i.e. when the body weight transfer is completed, while the movement is initiated). We conclude that a feedback mechanism is involved and discuss the hypothesis that this inter-joint coordination in amputees results from a failure in the pre-setting of the inter-joint coupling.

Equilibrium and movement control strategies in trans-tibial amputees.

This study was aimed at identifying changes in equilibrium and movement control strategies in trans-tibial amputees (TTA) related to both the biomechanical changes and the loss of afferent inflow. The coordinations between equilibrium and movement were studied in traumatical TTA and in controls during transition from bipedal to monopodal stance. TTA failed to perform the task in a high percentage of trials both when the sound and the prosthetic limb were supporting. Significant differences were also found between TTA and controls in the duration of the weight transfer phase, in the length of the initial centre of pressure (CP) displacement and in the electromyographic (EMG) patterns. Despite adaptive posturomotor control strategies, transition from bipedal to monopodal stance remains a difficult task to perform for TTA, both when the supporting limb is the affected one and when the sound one is. The results of this study are discussed with respect to the rehabilitation programme and the prosthesis design for transtibial amputees.

Arm raising in humans under loaded vs. unloaded and bipedal vs. unipedal conditions.

The aim of the present experiment was to study the central organization of equilibrium control during arm raising in the frontal plane. Nine adult subjects (five seniors and four young adults) were asked to raise their right arm to a horizontal position in the frontal plane in two support conditions (bipedal vs. unipedal) and two load conditions (unloaded vs. a 3.5-kg load added on the moving hand). No instructions were given concerning the movement speed. The movements were performed at about half the maximum speed achievable under reaction time conditions. The final lateral center of mass (CM) position 1 s after the movement offset, and the time course of the CM shift during the movement were studied in the four experimental conditions, using a CM compensation index. The electromyographic (EMG) pattern of the main muscles involved in the movement performance and in the postural control were studied in three out of nine subjects during movements performed at two velocities (at the preferred speed and as fast as possible). The results indicate that (1) the CM shift remains minimized in the frontal plane during the time course of the arm movement and during the final stabilization of the arm regardless of the stance and load conditions; (2) the time course of the CM compensation index remains stable during the first 400 ms after the movement onset, decreasing late in the movement and increasing again at the end of the stabilization stage. A modelisation suggests that the time course is the result of the interaction of two controls: a first one, putative feedforward, starting early and decreasing with time and a second one, putative feedback, starting late in the movement and increasing with time; (3) both early and late index values are influenced by the support and load conditions, the highest index values being observed during unipedal stance and load conditions; (4) activation of quadratus lomborum (QL) contralateral to the raising arm is time locked with the deltoidus activation of the raising arm in both fast and slow movements: this contralateral QL activation corresponds to an anticipatory postural adjustment (APA) aimed at minimizing the CM shift.

Postural reorganization of weight-shifting in below-knee amputees during leg raising.

The position of the center of gravity (CG) is a reference value that is controlled by the nervous system during the performance of movements. In order to maintain equilibrium, leg movement is preceded by a shift of the CG towards the supporting side. This CG shift is initiated by an early displacement of the center of pressure (CP) towards the moving leg. This characteristic CP thrust partly results from the activity of a distal muscle in the leg to be moved: the gastrocnemius medialis (GM). The aim of this study was to determine how this weight-shifting is initiated when the distal muscles are missing, as in amputees, and to identify any change in the central command. Experiments were performed on ten subjects: five below-knee amputees with no pathology and five control subjects. While standing, the subjects were instructed to raise one leg laterally as fast as possible to an angle of 45 degrees and to maintain the final position. The same weight-shifting strategy was used by both groups, whereas local adaptations associated with the behavior occurred. When the GM is lacking, an early tensor-fasciae-latae (TFL) burst is observed just prior to and associated with the onset of the lateral CP change. This moving-leg abductor may be responsible for initiating the thrust at a proximal level when that leg is still on the ground. In addition, upon analyzing the lateral displacement of the CP, two modes of CP shift were detected. The first CP-shift mode has been previously described and the second mode (which we term here the pre-pushing mode) was used by both amputees and controls. The prepushing mode consisted of two thrusts: an early thrust onto the ground was exerted by the leg about to become the supporting leg followed by the previously described thrust exerted by the leg about to be raised. The early thrust, which could be exerted by either the sound or prosthetic leg, may have increased the efficiency of the second, classical thrust by initiating a swing.

Normality and stationarity of EMG signals of elbow flexor muscles during ramp and step isometric contractions.

The purpose of this study was to test the stationarity and normality of electromyographic (EMG) signals obtained while exerting isometric contractions: (a) where a steady force level is maintained (step contractions); and (b) where the force level is increased linearly over time (ramp contractions). Ramp elbow flexions were performed from 0 to 100% of the maximum voluntary contraction (MVC) in a 5-s period. For the step contractions, four force levels (20, 40, 60 and 80% MVC) were maintained for a period of 3 s each. EMG signals of the biceps brachii (BB) and brachioradialis (BR) muscles of 16 subjects were recorded with surface electrodes and digitized at a sampling frequency of 2000 Hz. Tests of normality (Shapiro-Wilk test) and stationarity (reverse arrangement test) were performed locally on short finite time records (512-ms windows). Results show that, in general, EMG signals present a non-Gaussian amplitude distribution and are stationary. Furthermore, the amplitude distribution characteristics and the stationarity of the signal were not dependent on the muscle investigated, nor on the type of contraction or force level tested. The finding of local stationarity for both tasks is important, because it suggests that performing standard spectral analysis is applicable for both step and ramp contractions. It also allows a direct comparison between results obtained under both conditions.

Is the regulation of the center of mass maintained during leg movement under microgravity conditions?

1. Investigations on stance regulation have already suggested that the body's center of mass is the variable controlled by the CNS to maintain equilibrium. The aim of this study was to determine how the center of mass of the body is regulated when leg movements are made under different gravitoinertial force conditions. 2. Kinematic and electromyographic (EMG) recordings were made during both straight-and-level flight (earth-normal gravity condition, nG) and periods of weightlessness in parabolic flight (microgravity condition, microG). The standing subjects were restrained to the floor (kept from floating away in microG) and were instructed to raise one leg laterally to an angle of 45 degrees as fast as possible. 3. Two modes of center of mass (CM) control were identified during leg movement in nG: a "shift mode" and a "stabilization mode." The shift mode served to transfer the CM toward the supporting side before the leg raising, and it preceded the phase of single limb support. The stabilization mode took place after the CM shift was completed and was aimed at stabilizing the CM during raising of the leg. In this phase, the movement of the raising leg is counterbalanced by a lateral inclination of the trunk in the opposite direction. As a consequence, CM position did not change with respect to the position reached before the leg raising, and its projection on the ground remained within the support area delineated by the stance foot. 4. Under microG, the CM position did not change before the leg raising. Moreover, gastrocnemius medialis activity observed in the moving leg under nG, preceding the initiation of the body weight transfer toward the supporting leg, was greatly reduced. While the leg is raising, the simultaneous and opposite lateral trunk movement was still present in microG. 5. Results suggest that the body weight transfer corresponding to the shift mode, might depend on the gravity constraints, whereas the stabilization mode, which remains unchanged in microG, might be a motor stereotype that does not depend on the gravity conditions.

Balance control during lateral arm raising in humans.

The aim of the present study was to determine (i) whether the centre of gravity (CG) shift resulting from the mechanical effect of arm raising in the frontal plane is minimized in standing subjects and (ii) whether this putative minimization is affected by the support conditions (unipedal vs bipedal) and/or by adding a load (3.5 kg) to the moving hand. Our results indicate first that a CG control does exist during bipedal stance (compensating for 31% of the mechanical shift), which increases markedly in unipedal stance (73%) and secondly, that an additional load is compensated for solely in the case of unipedal stance (81%).

Changes in the electromyographic spectrum power distribution caused by a progressive increase in the force level.

The purpose of the present study was to determine the specific changes occurring in the power spectrum with an increasing force level during isometric contractions. Surface electromyographic signals of the triceps brachii (TB) and the anconeus (AN) of 29 normal subjects were recorded during isometric ramp contractions performed from 0 to 100% of the maximum voluntary contraction (MVC) in a 5-s period. Power spectra were obtained at 10, 20, 30, 40, 50, 60, 70, 80 and 90% MVC. Changes in the shape of these spectra were evaluated visually and with the calculation of several statistical parameters related to the distribution of power along the frequency axis, such as median frequency and mean power frequency, standard deviation, skewness, first and third quartiles and half-power range. For the AN, the behaviour of the spectrum was relatively similar across subjects, presenting a shift toward higher frequencies without any major change in the shape of the spectrum. For the TB, subjects with a thin skinfold thickness presented similar behaviours. In subjects with a thicker skinfold, however, a loss of power in the high frequency region paralleled the increase in the force level. Significant correlations were obtained between the extent of the change in the value of higher order statistical parameters across force and the thickness of the skin. This points out the importance of the skinfold layer when recording with surface electrodes. Furthermore, the use of a combination of several parameters appears to provide a better appreciation of the changes occurring in the spectrum than any single parameter taken alone.

[Sequential evaluation of lymphocytic blastogenesis in cancer patients after surgical treatment]. / Valutazione sequenziale della blastogenesi linfocitaria di pazienti neoplastici sottoposti ad intervento chirurgico.

Sequential evaluation of lymphocyte blastogenic response (LBR) to PHA was performed in 10 melanoma patients and in 10 gastric cancer patients undergoing radical operations. Preoperative determinations showed a significant depression of LBR in both patient groups as compared to healthy controls. In patients operated for melanoma the average duration of anesthesia was 101 minutes and in patients who underwent gastric resection it was 192 minutes. In both patient groups a further significant depression of LBR was observed in the early postoperative period; however the LBR returned to preoperative levels more promptly in patients who underwent melanoma excision than in those who underwent gastric resection.

[Controlled study of unspecific cellular immunity in cancer patients]. / Studio controllato dell'immunità cellulare aspecifica in pazienti neoplastici.

Cellular immunity has been studied in 92 patients with solid tumors undergoing surgery, in order to evaluate immunocompetence at the time of diagnosis and to assess the prognostic value of parameters of cellular immunity. The results show that total lymphocyte counts, T-lymphocyte counts and lymphocyte blastogenic responses are moderately depressed at diagnosis in the cancer patients as compared to age matched controls. These parameters of cell mediated immunity "in vitro" seem to be of limited prognostic value, since no correlation was found with the clinical course during the first 6 postoperative months. Depression of delayed hypersensitivity response to cutaneous antigens appeared to be an index of poor prognosis.