Regional recruitment and differential behavior of motor units during postural control in older adults.

Aging is associated with neuromuscular system changes that may have implications for the recruitment and firing behaviors of motor units (MUs). In previous studies, we observed that young adults recruit subpopulations of triceps surae MUs during tasks that involved leaning in five directions: common units that were active during different leaning directions and unique units that were active in only one leaning direction. Furthermore, the MU subpopulation firing behaviors [average firing rate (AFR), coefficient of variation (CoVISI), and intermittent firing] modulated with leaning direction. The purpose of this study was to examine whether older adults exhibited this regional recruitment of MUs and firing behaviors. Seventeen older adults (aged 74.8 ± 5.3 yr) stood on a force platform and maintained their center of pressure leaning in five directions. High-density surface electromyography recordings from the triceps surae were decomposed into single MU action potentials. A MU tracking analysis identified groups of MUs as being common or unique across the leaning directions. Although leaning in different directions did not affect the AFR and CoVISI of common units (P > 0.05), the unique units responded to the leaning directions by increasing AFR and CoVISI, albeit modestly (F = 18.51, P < 0.001). The unique units increased their intermittency with forward leaning (F = 9.22, P = 0.003). The mediolateral barycenter positions of MU activity in both subpopulations were found in similar locations for all leaning directions (P > 0.05). These neuromuscular changes may contribute to the reduced balance performance seen in older adults.NEW & NOTEWORTHY In this study, we observed differences in motor unit recruitment and firing behaviors of distinct subpopulations of motor units in the older adult triceps surae muscle from those observed in the young adult. Our results suggest that the older adult central nervous system may partially lose the ability to regionally recruit and differentially control motor units. This finding may be an underlying cause of balance difficulties in older adults during directionally challenging leaning tasks.

Cardiovascular response to anticipatory and reactionary postural perturbations in young adults.

NEW FINDINGS: What is the central question of this study? It has been suggested that the cardiovascular responses to a postural perturbation are centrally mediated and reflex mediated. We wanted to know the extent to which the cardiovascular responses to external perturbations could be executed in a feedforward manner, in anticipation of the perturbation. What is the main finding and its importance? We found no anticipatory component driving heart rate and systolic blood pressure responses, suggesting that reflexive mechanisms dominate cardiovascular regulation after a postural perturbation in young adults. ABSTRACT: Cardiovascular responses to postural perturbations have been reported, but whether the cardiovascular responses to external perturbations could be executed in anticipation of the perturbation is unknown. The purpose of this study was to determine the effect of anticipated and reactionary perturbations on heart rate (HR) and systolic blood pressure (SBP) responses in healthy young adults. A secondary aim was to determine whether perceived state anxiety scores were correlated with the change in HR response during postural perturbation. Twenty healthy young adults stood on a treadmill and experienced two perturbation conditions (anticipatory vs. reactionary), each with two intensity levels (Step vs. No Step). The HR and SBP were collected continuously. Two-way repeated-measures statistical non-parametric mapping tests were used to compare HR and SBP responses to the perturbations over time (from -3 to +8 s). The results indicated that HR was significantly elevated in the higher intensity perturbations [Step vs. No Step, at 0.56-1.32 s (P < 0.0001) and 1.92-3.44 s (P < 0.0001) post-perturbation], while there were no differences in HR between perturbation types (anticipatory vs. reactionary) or in SBP between perturbation types and intensity levels. The perceived state anxiety scores did not differ between perturbation types and intensity levels but were correlated with the change in HR post-perturbation (P = 0.013). We suggest that reflexive mechanisms dominate cardiovascular regulation after anticipatory and reactionary perturbations. The data highlight the cardiovascular mechanism(s) associated with perturbations that should be considered when assessing postural stability in populations with poor balance performance.

Differential behavior of distinct motoneuron pools that innervate the triceps surae.

It has been shown that when humans lean in various directions, the central nervous system (CNS) recruits different motoneuron pools for task completion; common units that are active during different leaning directions, and unique units that are active in only one leaning direction. We used high-density surface electromyography (HD-sEMG) to examine if motor unit (MU) firing behavior was dependent on leaning direction, muscle (medial and lateral gastrocnemius; soleus), limits of stability, or whether a MU is considered common or unique. Fourteen healthy participants stood on a force platform and maintained their center of pressure in five different leaning directions. HD-sEMG recordings were decomposed into MU action potentials and the average firing rate (AFR), coefficient of variation (CoVISI), and firing intermittency were calculated on the MU spike trains. During the 30°-90° leaning directions both unique units and common units had higher firing rates (F = 31.31, P < 0.0001). However, the unique units achieved higher firing rates compared with the common units (mean estimate difference = 3.48 Hz, P < 0.0001). The CoVISI increased across directions for the unique units but not for the common units (F = 23.65, P < 0.0001). Finally, intermittent activation of MUs was dependent on the leaning direction (F = 11.15, P < 0.0001), with less intermittent activity occurring during diagonal and forward-leaning directions. These results provide evidence that the CNS can preferentially control separate motoneuron pools within the ankle plantarflexors during voluntary leaning tasks for the maintenance of standing balance.NEW & NOTEWORTHY In this study, we demonstrate that the different subpopulations of motor units within the three muscles comprising the ankle plantarflexors behave differently during multidirectional leaning. Our results suggest that the central nervous system has the capability to control distinct subpopulations of motor units to meet the force requirements necessary for leaning. This may allow for a precise, efficient, and flexible control strategy for the maintenance of standing balance.

Cardiovascular response to postural perturbations of different intensities in healthy young adults.

The ability to regain control of balance is vital in limiting falls and injuries. Little is known regarding how the autonomic nervous system responds during recovery from balance perturbations of different intensities. The purpose of this study was to examine the cardiovascular response following a standing balance perturbation of varying intensities, quantify cardiac baroreflex sensitivity (cBRS) during standing perturbations, and to establish the stability of the cardiac baroreflex during quiet standing before and after balance disturbances. Twenty healthy participants experienced three different perturbation intensity conditions that each included 25 brief posteriorly-directed perturbations, 8-10 s apart. Three perturbation intensity conditions (low, medium, high) were given in random order. Physiological data were collected in quiet stance for 5 min before testing (Baseline) and again after the perturbation conditions (Recovery) to examine baroreflex stability. Beat-to-beat heart rate (HR) and systolic blood pressure (SBP) analysis post-perturbation indicated an immediate acceleration of the HR for 1-2 s, with elevated SBP 4-5 s post-perturbation. Heart rate changes were greatest in the medium (p = 0.035) and high (p = 0.012) intensities compared to low, while there were no intensity-dependent changes in SBP. The cBRS was not intensity-dependent (p = 0.402) but when perturbation conditions were combined, cBRS was elevated compared to Baseline (p = 0.046). The stability of baseline cBRS was excellent (ICC = 0.896) between quiet standing conditions. In summary, HR, but not SBP or cBRS were intensity-specific during postural perturbations. This was the first study to examine cardiovascular response and cBRS to postural perturbations.

Does the stimulus provoking a stepping reaction correlate with step characteristics and clinical measures of balance and mobility post-stroke?

BACKGROUND: Retraining stepping reactions in people post-stroke is vital. However, the relationship between the stimulus and resulting stepping performance in people post-stroke is unknown. We explored relationships between stepping stimulus and stepping reactions initiated by either paretic or non-paretic legs of people post-stroke and controls. Relationships were examined in the context of clinical measures of balance. METHODS: Centre of mass dynamics were measured during self-initiated destabilizing leaning stimuli that required stepping reactions by paretic and non-paretic legs of people post-stroke (n = 10) and controls (n = 10) to recover balance. Step characteristics of the first two steps of stepping reactions were measured. Correlations were calculated between clinical measures of balance and mobility and the centre of mass and step characteristics. FINDINGS: Steps were shorter and slower with decreased centre of mass fore-aft and downward displacement and velocity when initiated by paretic and non-paretic legs compared with controls. However, increase in centre of mass displacement and velocity in the fore-aft and downward direction tended to be associated with a greater increase in step length and speed when stepping reactions were initiated by the paretic and non-paretic legs compared with controls. Time to step initiation in response to onset of falling stimulus did not differ between groups. Strong positive correlations were found between clinical balance and mobility scores and centre of mass and step dynamics in fore-aft and vertical directions. INTERPRETATION: These results support objective measurement of centre of mass to quantify the stimulus influencing step dynamics and stepping performance during retraining interventions following stroke.

Maintenance of standing posture during multi-directional leaning demands the recruitment of task-specific motor units in the ankle plantarflexors.

The purpose of this study is to investigate whether regional modulation of the ankle plantarflexors during standing was related to the recruitment of motor units associated with force direction. Fourteen participants performed a multi-directional leaning task in standing. Participants stood on a force platform and maintained their center of pressure in five different target directions. Motor unit firings were extracted by decomposition of high-density surface electromyograms recorded from the ankle plantarflexor muscles. The motor unit barycentre, defined as the weighted mean of the maximal average rectified values across columns and rows, was used to evaluate the medio-lateral and proximo-distal changes in the surface representation of single motor units across different leaning target directions. Using a motor unit tracking analysis, groups of motor units were identified as being common or unique across the target directions. The leaning directions had an effect on the spatial representations of motor units in the medial gastrocnemius and soleus (p < 0.05), but not in the lateral gastrocnemius (p > 0.05). Motor unit action potentials were represented in the medial and proximal aspects of the muscles during forward vs. lateral leans. Further analysis determined that the common motor units were found in similar spatial locations across the target directions, whereas newly recruited unique motor units were found in different spatial locations according to target direction (p < 0.05). The central nervous system may possess the ability to activate different groups of motor units according to task demands to meet the force-direction requirements of the leaning task.

Non-uniform Effects of Nociceptive Stimulation to Motoneurones during Experimental Muscle Pain.

Nociceptive stimulation is predicted to uniformly inhibit motoneurone pools of painful muscles and those producing painful movements. Although reduced motoneurone discharge rate during pain provides some evidence, recent data show evidence of increased excitability of some motoneurones. These observations suggest non-uniform effects of nociception on motoneurone excitability. More direct measures are required, but this is difficult to assess as few measures enable in vivo evaluation of motoneurone excitability in humans. We investigated changes in motoneurone excitability during experimental pain using two methods in separate experiments: (i) estimation of the time-course of motoneurone afterhyperpolarization (AHP) from interval death rate analysis of interspike intervals of single motor unit discharge; and (ii) probability of early motoneurone discharge to a descending volley excited using transcranial magnetic stimulation (TMS). Tibialis anterior motor units were recorded with fine-wire electrodes before, during and after painful infusion of 5% hypertonic saline into the muscle. Activation of 17 units (16 participants) could be used for AHP analysis. Data show shortened (n = 11) and lengthened (n = 6) AHP time-course. Increased (n = 6) and decreased (n = 6) probability of early motoneurone discharge were observed in the TMS experiment. These convergent observations suggest non-uniform effects of nociceptive stimulation on motoneurone pools. This does not support the hypothesis that nociceptive input induces uniform inhibition of painful muscle. Instead, interpretation of results implies redistribution of activity between motor units, with possible benefit for unloading painful tissues. This finding supports an interpretation that differs from the generally accepted view in pain physiology regarding adaptation to motor function in pain.

Relationships Between Stepping-Reaction Movement Patterns and Clinical Measures of Balance, Motor Impairment, and Step Characteristics After Stroke.

OBJECTIVE: Successful stepping reactions, led by either the paretic or nonparetic leg, in response to a loss of balance are critical to safe mobility poststroke. The purpose of this study was to measure sagittal plane hip, knee, ankle, and trunk kinematics during 2-step stepping reactions initiated by paretic and nonparetic legs of people who had stroke and members of a control group. METHODS: Principal component analysis (PCA) was used to reduce the data into movement patterns explaining interlimb coordination of the stepping and stance legs. Correlations among principal components loading scores and clinical measures of balance ability (as measured on the Community Balance and Mobility scale), motor impairment (as measured on the foot and leg sections of the Chedoke-McMaster Stroke Assessment), and step characteristics (length and velocity) were used to examine the effect of stroke on stepping reaction movement patterns. RESULTS: The first 5 principal components explained 95.9% of the movement pattern of stepping reactions and differentiated between stepping reactions initiated by paretic legs, nonparetic legs, or the legs of controls. Moderate-strong associations (ρ/r > 0.50) between specific principal component loading scores and clinical measures and step characteristics were dependent on the initiating leg. Lower levels of motor impairment, higher levels of balance ability, and faster and longer steps were associated with stepping reactions initiated by the paretic leg that comprised paretic leg flexion and nonparetic leg extension. Step initiation with the nonparetic leg showed associations between higher scores on clinical measures and movement patterns of flexion in both paretic and nonparetic legs. CONCLUSIONS: Movement patterns of stepping reactions poststroke were influenced by the initiating leg. After stroke, specific movement patterns showed associations with clinical measures depending on the initiating leg, suggesting that these movement patterns are important to retraining of stepping reactions. Specifically, use of flexion patterning and assessment of between-leg pattern differentiation may be important aspects to consider during retraining of stepping reactions poststroke. IMPACT: Evidence-based interventions targeting balance reactions are still in their infancy. This investigation of stepping reactions poststroke addresses a major gap in research.

Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke: A Case Series.

BACKGROUND AND PURPOSE: Therapeutic exercise improves balance and walking ability in individuals after stroke. The extent to which motor planning improves with therapeutic exercise is unknown. This case series examined how outpatient physical therapy affects motor planning and motor performance for stepping. CASE DESCRIPTION: Individuals poststroke performed self-initiated stepping before (baseline), after (postintervention), and 1 month after (retention) intervention. Amplitude and duration of the movement-related cortical potential (MRCP) was measured using an electroencephalograph from the Cz electrode. Electromyography (EMG) of biceps femoris (BF) was collected. Additionally, clinical measures of motor impairment and function were evaluated at all 3 time points by a blinded assessor. INTERVENTION: Two types of outpatient physical therapy were performed for 6 weeks: CONVENTIONAL (n = 3) and FAST (n = 4, Fast muscle Activation and Stepping Training). OUTCOMES: All 7 participants reduced MRCP duration, irrespective of the type of physical therapy. The MRCP amplitude and BF EMG onset changes were more variable. Clinical outcomes improved or were maintained for all participants. The extent of motor impairment was associated with MRCP amplitude. DISCUSSION: Changes in MRCP duration suggest that outpatient physical therapy may promote neuroplasticity of motor planning of stepping movements after stroke; however, a larger sample is needed to determine whether this finding is valid.This case series suggests motor planning for initiating stepping may improve after 6 weeks of outpatient physical therapy for persons with stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A307).

Effect of repetitive transcranial magnetic stimulation combined with robot-assisted training on wrist muscle activation post-stroke.

OBJECTIVE: To compare the effects of active assisted wrist extension training, using a robotic exoskeleton (RW), with simultaneous 5 Hz (rTMS + RW) or Sham rTMS (Sham rTMS + RW) over the ipsilesional extensor carpi radialis motor cortical representation, on voluntary wrist muscle activation following stroke. METHODS: The two training conditions were completed at least one week apart in 13 participants >1-year post-stroke. Voluntary wrist extensor muscle activation (motor unit (MU) recruitment thresholds and firing rate modulation in a ramp-hold handgrip task), ipsilesional corticospinal excitability (motor evoked potential [MEP] amplitude) and transcallosal inhibition were measured Pre- and Post-training. RESULTS: For MUs active both Pre and Post training, greater reductions in recruitment thresholds were found Post rTMS + RW training (p = 0.0001) compared to Sham rTMS + RW (p = 0.16). MU firing rate modulation increased following both training conditions (p = 0.001). Ipsilesional MEPs were elicited Pre and Post in only 5/13 participants. No significant changes were seen in ipsilesional corticospinal excitability and transcallosal inhibition measures (p > 0.05). CONCLUSIONS: Following a single rTMS + RW session in people >1-year post-stroke, changes were found in voluntary muscle activation of wrist extensor muscles. Alterations in ipsilesional corticospinal or interhemispheric excitability were not detected. SIGNIFICANCE: The effects of rTMS + RW on muscle activation warrant further investigation as post-stroke rehabilitation strategy.

Challenging Standing Balance Reduces the Asymmetry of Motor Control of Postural Sway Poststroke.

Background: Ankle plantarflexor muscle impairment contributes to asymmetrical postural control poststroke. Objective: This study examines the relationship of plantarflexor electromyography (EMG) with anterior-posterior center of pressure (APCOP) in people poststroke during progressive challenges to standing balance. Methods: Ten people poststroke and 10 controls participated in this study. Anteriorly directed loads of 1% body mass (BM) were applied to the pelvis every 25-40 s until 5%BM was reached. Cross-correlation values between plantarflexor EMG and APCOP (EMG:APCOP) position and velocity were compared. Results: EMG:APCOP velocity correlations were stronger than EMG:APCOP position across all muscles (p < .01), and correlations were predominately stronger in the nonparetic compared with the paretic leg (p < .05). Increasing challenge to standing balance reduced asymmetry of EMG:APCOP relationships. Conclusions: These data suggest that sensory information reflected in APCOP velocity interacts more strongly with plantarflexor activity in people poststroke and controls than APCOP position. Furthermore, increasing challenge to standing balance reduces postural control asymmetry between legs poststroke.

Regional Vastus Medialis and Vastus Lateralis Activation in Females with Patellofemoral Pain.

INTRODUCTION: This study aimed to investigate whether regional activation patterns in the vasti muscles differ between females with and without patellofemoral pain (PFP), and whether muscle activation patterns correlate with knee extension strength. METHODS: Thirty-six females with PFP and 20 pain-free controls performed a standardized knee flexion-extension task. The activation of vastus medialis (VM) and vastus lateralis (VL) was collected using high-density surface EMG and analyzed using principal component (PC) analysis. Spatial locations and temporal coefficients of the PC, and the percent variance they explain, were compared between groups and between the concentric and the eccentric phases of the movement. Correlations were assessed between PC features and knee extension strength. RESULTS: The spatial weights of PC1 (general vasti activation) and PC2 (reflecting vastus-specific activation) were similar between groups (R > 0.95). Activation patterns in PFP were less complex than controls. Fewer PC features were necessary to reconstruct 90% of the signal for PFP participants in the concentric phase (P < 0.05), and the difference in bias of activation to VM (concentric phase) or VL (eccentric phase) was less between phases for PFP participants (P < 0.05). Smaller difference in vastus-specific activation in concentric and eccentric phases (less task specificity of VM/VL coordination) was related to greater maximal knee extension strength (P < 0.05, R < -0.43). CONCLUSION: These data suggest PFP involves a simpler control strategy of VM and VL. The inverse association between task specificity and maximal knee extension strength suggests different presentations of PFP: lower knee extension strength but VM/VL coordination task specificity comparable with controls, or knee extension strength comparable with controls but lower VM/VL coordination task specificity.

Cortical processing of irrelevant somatosensory information from the leg is altered by attention during early movement preparation.

The ability to actively suppress, or gate, irrelevant sensory information is needed for safe and efficient walking in sensory-rich environments. Both attention and the late phase of motor preparation alter somatosensory evoked potentials (SEPs) in healthy adults. The aim of this study was to examine the effect of attention on the processing of irrelevant somatosensory information during the early phase of preparation of plantarflexion movements. Young healthy individuals received tibial nerve stimulation while electroencephalography (EEG) recorded SEPs over the Cz electrode. Three conditions were tested in both legs: 1) Rest, 2) Attend To the stimulated limb, and 3) Attend Away from the stimulated limb. In conditions 2 and 3, vibration (80 Hz) was applied over the medial soleus muscle to cue voluntary plantarflexion movements of the stimulated (Attend To) or non-stimulated leg (Attend Away). Only SEPs delivered during early preparation were averaged for statistical analysis. Results demonstrated a main effect of condition for the N40 and N70 indicating that SEP amplitudes in the Attend To condition were smaller than rest (p ≤ 0.02). For the P50, no interaction effects or main effects were found (p ≥ 0.08). There was no main effect of leg for any component measured. The results indicate that gating of irrelevant sensory information during early preparation occurs in the leg when attention is directed within the same limb. If attention alters the somatosensory stimuli from a leg movement, then directing attention may affect safe community walking.

Suppression of somatosensory stimuli during motor planning may explain levels of balance and mobility after stroke.

The ability to actively suppress, or gate, irrelevant sensory information is required for safe and efficient walking in sensory-rich environments. Both motor attention and motor planning alter somatosensory evoked potentials (SEPs) in healthy adults. This study's aim was to examine the effect of motor attention on processing of irrelevant somatosensory information during plantar flexion motor planning after stroke. Thirteen healthy older adults and 11 individuals with stroke participated. Irrelevant tibial nerve stimulation was delivered while SEPs were recorded over Cz, overlaying the leg portion of the sensorimotor cortex at the vertex of the head. Three conditions were tested in both legs: (1) Rest, (2) Attend To, and (3) Attend Away from the stimulated limb. In conditions 2 and 3, relevant vibration cued voluntary plantar flexion movements of the stimulated (Attend To) or non-stimulated (Attend Away) leg. SEP amplitudes were averaged during motor planning per condition. Individuals with stroke did not show attention-mediated gating of the N40 component associated with irrelevant somatosensory information during motor planning. It may be that dysfunction in pathways connecting to area 3b explains the lack of attention-mediated gating of the N40. Also, attention-mediated gating during motor planning explained significant and unique variance in a measure of community balance and mobility combined with response time. Thus, the ability to gate irrelevant somatosensory information appears important for stepping in both older adults and after stroke. Our data suggest that therapies that direct motor attention could positively impact walking after stroke.

Location-specific responses to nociceptive input support the purposeful nature of motor adaptation to pain.

Movement is changed in pain, but the mechanisms remain unclear. Key questions are unresolved such as whether activation can be inhomogeneously distributed within a muscle in a manner that is specific to the location of noxious input. This study addressed this question using high-density electromyography (EMG) to study regional redistribution of muscle activation within the vasti muscles and changes in knee extension force direction in response to noxious stimulation applied to muscular and nonmuscular tissues around the knee. Fourteen participants performed a low-force knee extension contraction at baseline, during, and after pain induced in 4 locations (infrapatellar fat pad, vastus lateralis, distal vastus medialis, or proximal vastus medialis). The knee extension force direction was estimated from a 3-dimensional load cell positioned just above the ankle. Regional muscle activation was estimated from amplitude of high-density surface EMG signals from vastus medialis and lateralis. Pain-induced spatial variations of activation were identified as the position of the 5 channels that showed the largest decrease (or smallest increase) in amplitude from baseline to pain or after pain. Knee extension force was produced more medially during pain after infrapatellar pad injection only (P = 0.01). Preferential reduction of activation of the distal region of vastus medialis was observed when distal vastus medialis (P < 0.001) or vastus lateralis (P < 0.05) was injected. Both adaptations persisted after pain resolution. These results support the hypothesis that specific adaptation depends on the location of a noxious stimulus and imply that recovery of pain is not necessarily concomitant with return of the EMG to prepain patterns.

Identification of regional activation by factorization of high-density surface EMG signals: A comparison of Principal Component Analysis and Non-negative Matrix factorization.

In this study, we investigated whether principal component analysis (PCA) and non-negative matrix factorization (NMF) perform similarly for the identification of regional activation within the human vastus medialis. EMG signals from 64 locations over the VM were collected from twelve participants while performing a low-force isometric knee extension. The envelope of the EMG signal of each channel was calculated by low-pass filtering (8 Hz) the monopolar EMG signal after rectification. The data matrix was factorized using PCA and NMF, and up to 5 factors were considered for each algorithm. Association between explained variance, spatial weights and temporal scores between the two algorithms were compared using Pearson correlation. For both PCA and NMF, a single factor explained approximately 70% of the variance of the signal, while two and three factors explained just over 85% or 90%. The variance explained by PCA and NMF was highly comparable (R > 0.99). Spatial weights and temporal scores extracted with non-negative reconstruction of PCA and NMF were highly associated (all p < 0.001, mean R > 0.97). Regional VM activation can be identified using high-density surface EMG and factorization algorithms. Regional activation explains up to 30% of the variance of the signal, as identified through both PCA and NMF.

Symmetry of cortical planning for initiating stepping in sub-acute stroke.

OBJECTIVE: This study examined motor planning for stepping when the paretic leg was either stepping or standing (to step with the non-paretic leg), to understand whether difficulty with balance and walking post-stroke could be attributed to poor motor planning. METHODS: Individuals with stroke performed self-initiated stepping. Amplitude and duration of the movement-related cortical potential (MRCP) was measured from Cz. Electromyography (EMG) of biceps femoris (BF) and rectus femoris (RF) were collected. RESULTS: There were no differences between legs in stepping speed, MRCP or EMG parameters. The MRCPs when stepping with the paretic leg and the non-paretic leg were correlated. When the paretic leg was stepping, the MRCP amplitude correlated with MRCP duration, indicating a longer planning time was accompanied by higher cognitive effort. Slow steppers had larger MRCP amplitudes stepping with the paretic leg and longer MRCP durations stepping with the non-paretic leg. CONCLUSIONS: MRCP measures suggest that motor planning for initiating stepping are similar regardless of which limb is stepping. Individuals who stepped slowly had greater MRCP amplitudes and durations for planning. SIGNIFICANCE: Individuals who step slowly may require more time and effort to plan a movement, which may compromise their safety in the community.

Vastus Lateralis Motor Unit Firing Rate Is Higher in Women With Patellofemoral Pain.

OBJECTIVE: To compare neural drive, determined from motor unit firing rate, in the vastus medialis and lateralis in women with and without patellofemoral pain. DESIGN: Cross-sectional study. SETTING: University research laboratory. PARTICIPANTS: Women (N=56) 19 to 35 years of age, including 36 with patellofemoral pain and 20 controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants sustained an isometric knee extension contraction at 10% of their maximal voluntary effort for 70 seconds. Motor units (N=414) were identified using high-density surface electromyography. Average firing rate was calculated between 5 and 35 seconds after recruitment for each motor unit. Initial firing rate was the inverse of the first 3 motor unit interspike intervals. RESULTS: In control participants, vastus medialis motor units discharged at higher rates than vastus lateralis motor units (P=.001). This was not observed in women with patellofemoral pain (P=.78) because of a higher discharge rate of vastus lateralis compared with control participants (P=.002). No between-group differences were observed for vastus medialis (P=.93). Similar results were obtained for the initial motor unit firing rate. CONCLUSIONS: These findings suggest that women with patellofemoral pain have a higher neural drive to vastus lateralis but not vastus medialis, which may be a contributor of the altered patellar kinematics observed in some studies. The different neural drive may be an adaptation to patellofemoral pain, possibly to compensate for decreased quadriceps force production, or a precursor of patellofemoral pain.

Effectiveness of Client-Centered "Tune-Ups" on Community Reintegration, Mobility, and Quality of Life After Stroke: A Randomized Controlled Trial.

OBJECTIVE: To explore the effectiveness of a 2-week client-centered rehabilitation intervention (tune-up) delivered 6 months after inpatient discharge on community reintegration at 1 year in people with stroke. DESIGN: A multicenter randomized controlled trial with 2 groups: an intervention ("tune-up") group and a control group having the same exposure to assessment. SETTING: Three research laboratories. PARTICIPANTS: Participants (N=103) with hemiparetic stroke recruited from inpatient rehabilitation units at the time of discharge. INTERVENTIONS: Participants randomized to the tune-up group received 1-hour therapy sessions in their home 3times/wk for 2 weeks at 6 months postdischarge focusing on identified mobility-related goals. A second tune-up was provided at 12 months. MAIN OUTCOME MEASURES: Community reintegration measured by the Subjective Index of Physical and Social Outcome at 12 months and secondary outcomes included the Berg Balance Scale and measures of mobility and health-related quality of life up to 15 months. RESULTS: At 12 months, both groups showed significant improvement in community reintegration (P<.05), a trend evident at all time points, with no difference between groups (mean difference, -0.5; 95% confidence interval, -1.8 to 2.7; P=.68). Similarly, a main effect of time reflected improvement in mobility-related and quality of life outcomes for both groups (P≤.0.5), but no group differences (P≥.30). CONCLUSIONS: All participants in the tune-up group met or exceeded at least 1 mobility-related goal; however, the intervention did not differentially improve community reintegration. The improvements in mobility and quality of life over the 15-month postdischarge period may be secondary to high activity levels in both study groups and exposure to regular assessment.

Do Performance Measures of Strength, Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

OBJECTIVE: To investigate the extent to which physical performance measures of strength, balance, and mobility taken at discharge from inpatient stroke rehabilitation can predict health-related quality of life (HRQoL) and community reintegration after 6 months. DESIGN: Longitudinal study. SETTING: University laboratory. PARTICIPANTS: Adults (N=75) recruited within 1 month of discharge home from inpatient stroke rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 36-Item Short Form Health Survey (SF-36) for HRQoL and Subjective Index of Physical and Social Outcome (SIPSO) for community reintegration. Physical performance measures were the 6-minute walk test, timed Up and Go (TUG) test, Berg Balance Scale, Community Balance and Mobility Scale, and isokinetic torque and power of hip, knee, and ankle on the paretic and nonparetic sides. Other prognostic variables included age, sex, stroke type and location, comorbidities, and motor FIM score. RESULTS: Separate stepwise linear regressions were performed using the SF-36 and SIPSO as dependent variables. The total paretic lower limb torque and 6-minute walk test predicted the SF-36 Physical Component Summary (adjusted R2=.30). The total paretic lower limb torque and TUG test predicted the SIPSO physical component (adjusted R2=.47). The total paretic lower limb torque significantly predicted the SF-36 Mental Component Summary, but the adjusted R2 was low (.06). Similarly, the TUG test significantly predicted the SIPSO social component, but again the adjusted R2 was low (.09). CONCLUSIONS: Measures of physical performance including muscle strength and mobility at discharge can partially predict HRQoL and community reintegration 6 months later. Further research is necessary for more accurate predictions.